Facilitator Journal | Issue #0253, April 25 2006 ....
Last Friday, I had the honor of being by the bedside of my partner's
mother as she passed away. Fortunately, it all happened rather quickly.
I say fortunately because she suffered from severe respiratory illness
that could have made her passing quite uncomfortable. She only spent
24 hours in her bed before leaving us. We attribute this "easy"
exit largely to her being complete with her family, her readiness
to go, and to the loving support of our local Hospice caregivers.
This week's article, "Facilitating the Final Act," shares
this story with you and some tips for dealing with this process
when you encounter it yourself. We look forward to your comments.
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Facilitating the Final Act
Last Friday, I had the honor of being by the bedside of my partner's mother,
Ann as she passed away. Fortunately, it all happened rather quickly. I
say fortunately because she suffered from severe respiratory illness that
could have made her passing quite uncomfortable. She spent only 24 hours
in bed before leaving us. We attribute this "easy" exit largely
to her being complete with her family, her readiness to go, her family's
readiness to let her go, and to the loving support of our local Hospice
I know that many baby boomers like us are now dealing with the long-term
care or passing of our elder parents. During the two week's prior to her
transition, we had an unsettling view into the ways our "health"
care system feeds on the dying at the expense of the living.
Ann had been in and out of the emergency room many times over that past
few months with severe respiratory issues, and with her lung capacity
nearly exhausted, our hospice request was honored and we took her home
after her last 10-day stay in the hospital. However, during her final
week in the hospital, doctors discovered breast cancer and wanted to extract
it. We questioned their reasoning behind an operation she probably wouldn't
survive, not to mention the financial and emotional costs involved. We
never got a coherent answer. So as a family, we politely declined.
Still, in the hospital, when her family was absent ( merely a coincidence?),
doctors flocked to her. Not one, not two, but sometimes three or four
in rapid succession. We only speculate of course when we infer the motives
of this fleet of surgeons hovering around this ripe and dying Medicare
candidate like hungry vultures. On one occassion, two came to her "aid"
to convince her of surgery, while she lie vulnerable and semi-cogent.
The first time she consented to surgery under their pressure, not thinking
about the repercussions. After our discussions with her about the risk
versus value of such a procedure at this time, she agreed it wasn't a
good idea and canceled it. They came once more on the day of her discharge
to try to convince her again. Early, we coached her to "Just Say
No" to surgery, which she did in no uncertain terms.
Our complaints to the head nurse (the doctors never seemed to be around
when we were, nor would they schedule appointments with us) received replies
couched in "privacy act" language--being of sound mind, she
is qualified to make her own decisions. It all felt very manipulative
and, well, kind of "sick," in our opinion. After my recent experience
of my own father's passing last October, this experience felt hauntingly
familiar in a hospital in an entirely different town 250 miles away.
Our goal was to get her home and arrange for full-time care. If by some
chance she did recover to the point of being independent, we would revisit
the cancer issue. When we took her out of the hospital and got hospice
involved, everything shifted. Ann was able to spend a couple of quality
days at home with her family, her beloved cat Lilly, and her wonderful
caregiver. This angel of a hospice worker helped us through the process
and actually helped create a spiritual space that invited Ann to move
onward and upward. She was a true Facilitator in every sense of the word.
A Facilitator of the Final Act.
Reflecting on this
experience, our concerns with the health care industry, and on our wonderful
experience with hospice, one thing became very clear to Ginger, my partner,
and I--hospice may be the only hope for our current health care system
With that thought, I did some research on medical costs around terminal
illness. I discovered that 83% of people who die each year are eligible
for Medicare and 27-30% of the total Medicare budget is spent in last
year of life. The article containing this data also stated that: several
studies suggest cost savings associated with the use of hospice care.
In 1995, every dollar paid by Medicare for hospice patients saved the
program $1.52 in Part A and Part B expenditures. (Lewin-VHI study, commissioned
by the National Hospice Organization April 1995).
The full text of this article can be found here.
Tips for Facilitating the Final Act
with an Elderly Friend or Loved One.
- Beware of 'life extension" measures for an elderly person
with a chronic illness who is ready to go. Solutions pedaled by the medical
profession don't usually consider the quality of life whatsoever. Their
only goal is to "prevent" death.
- Get complete with your loved one. Often times, they'd like to move
on but they only hang around because of incompletions. If you can't speak
to them to get complete, write them a letter. This will help you get clear
and make sure your thoughts and feelings are heard by them. Click
here to view an earlier issue of this journal that contains more on
- See death as a natural process. When my father was dying last
year, I repeatedly heard the local pastor, of all people, advise him to
keep "fighting" to live and to pray for health. At nearly 91
and ready to die, that seemed ironic to me. That is, that a person who
on one hands speaks of a glorious afterlife urging another, who is ready
for it, to avoid it at all costs! Facilitating the final act calls on
those of us in the support role to embrace all of the stages of the dying
process without false hope or denial of the obvious. This can help prepare
a dying person and their family for the inevitable.
- If there's any question that your parent or loved one will live more
than six months, urge them to get hospice involved. Hospice is a Godsend.
They tailor their support based on your family's needs, and can be prescribed,
cancelled, and represcribed as the patient's needs change. They not only
provide unique medical attention, but they also provide counseling, and
many other services. Hospice helps create a comfortable environment at
home for the family and the patient to cope with the dying process. Pay
them a visit in your community to find out more.
- Don't give doctors too much power. View doctors simply as one
of many consultants on a team to assist the patient and their family with
their healthcare decision making. Some doctors don't believe that any
patient of theirs can possibly be terminally ill and hence by definition,
not eligible for hospice. If the patient's instincts say that it's time
to let the dying process proceed, support the patient in trusting their
own instincts and wishes.
- Weigh life quality with life span. Our culture has created a
medical system that keeps people alive at all cost...often at incredibly
unreasonable costs. Conventional allopathic medicine's mechanistic view
doesn't include the emotional and spiritual consequences of medical solutions.
"Living" in the hospital on machines and drugs may allow one
to live longer, but at what financial, emotional, and spiritual costs?
Help your loved assess how the quality of life they desire will be impacted
by proposed life extension measures.
- Support a "rituals withdrawal." Doctor William G. Bartholome,
in his article, "Lessons
of the Angel of Death," talks about how we need to recover and
respect rituals of withdrawal for the dying. When one is ready to die,
simply withdrawing from life and all interventions, will facilitate the
process. In the eighteenth and nineteenth centuries, this was commonly
referred to as "taking to bed." One would simply go lie in bed
until dead. People at that time knew to respect this withdrawal as natural
when someone's time has come. So if you're around a dying person, know
that there may come a time when they want to be left alone, to process
their life, withdraw from it, and go within. Honor this as a natural desire.
"Final" Note: After being at her mother's bedside for
nearly 24 hours straight, Ginger slipped away for a much needed chiropractic
adjustment. It seems Ann took her last breath while Ginger was in a meditative
state on the chiropractor's table. In that moment, Ann's spirit visited
her to say good bye, to let her know that dinner at "Steamers"
tonight was on her, and that she was on her way to take care of other
business while the office phone was ringing. Her sister was calling to
let Ginger know that her mother had just passed away. To this she replied,
"Yes, I know. She just told me."
Are you effectively facilitating your health and wellness? What are your
views on your own death? On hospice? Explore the answers to each of these
questions. I look forward to your comments, insights or feedback about this
article - just click reply and type them directly into this email.
Ira Byock (M.D.)
I'm the kind of person whose eyes start to glaze over if I try to absorb
more than a few pages of social science/self help type writing. I was
steered to this book when I was helping my mother as she died. I had so
little experience with death that I worried about doing the wrong thing.
As I read the stories I was drawn in, absorbing each small "message"
with each story. One, about a man whose final gift to his family was to
allow them to help him as he died, touched me so deeply I read it to my
mother in her last days. I wish I'd read this book earlier but I don't
think it could ever be too late.
--James Dietsch, Albuquerque,
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