Allow Natural Death

Allowing Natural Death...

…is a plan for life’s end which seeks to provide comfort and dignity above all else
…acknowledges that death is the inevitable result of the aging process
…supports a kinder and gentler way to die
…relies less on medicine, technology and hospitalizations and more on the relief of pain and discomfort
…is helpful language to use in shared decision making for elders as they speak about their desired death
…is not the same as Do Not Resuscitate (DNR) orders
…must be negotiated with families and providers who agree to honor the wishes of the elder person for a good death
…chooses to maintain the loved one’s quality of life even when it means that death will come sooner
…is not euthanasia
…does not rule out the use of substances that bring comfort

More than anything else Allowing Natural Death requires courage and love that can take us to the places that scare us most – so that we are able to enjoy each precious day that we are given in this life.

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I hate cancer as much as the next guy BUT

When I first began to work at Dartmouth Hitchcock I was hired to float between the Oncology/Hematology and General Medicine floors. It was the only way to have a set schedule – to agree to float. I loved the set schedule and I also enjoyed floating – more to learn and less involvement with any lurking politics or drama. The two units mirrored each other and were built at the same time. Separated by a large entryway to the whole inpt tower. Go right upon entrance and you are in (One West) Cancer World. Go left and you are in (One East) the unit called The Beast by insiders.
It was pretty clear that there were differences as soon as you walked through the doors. 1W was brighter and more open – less equipment stashed around the hallways. It had a small nicely decorated room with videos to watch, a library, and a massage therapist had an office too where she massaged PTs, but also went to rooms to deliver massage – the only massage in the building for about 10 years at the time. Each pt room had a DVR- and the library had a huge selection of dvd’s to choose from. There always seemed to be fewer humans around 1W – maybe because there were fewer specialties stopping by to do a consult – cancer being a more self contained disease than say diabetes that affects all systems of the body.(and the diabetics are on 1E) The fewer number of staff milling about on 1W contributed to the lower level of activity and more perceived calm on 1W.
1E /The Beast – what can I say? I later became a Nurse Manager here and I loved the Beast. We all did…sort of. It was love hate with a camaraderie born in the trenches. 1E was a unit always overflowing with needs attempting to be fulfilled because this was where elders were hospitalized …and GI PTs – meaning there was a lot of excrement – at times contained. No DVR’s in the rooms though, and no library, no endowments from wealthy benefactors for diagnoses like heart disease or end stage COPD or renal failure. No massage therapist would walk across the hall separating the two units either – apparently chronic diseases bear no benefit from massage. And in general – it just seemed more run down and dark and crowded …and sad.
Maybe the most telling difference though was the activity room. Can’t recall the actual name but it was a room that was staffed by an OT who specialized in geriatrics. It was like going into someone’s Living room with newspapers and reading materials and craft activities – no windows but ACTIVITY!!!!!!!!! How life enhancing is that! The Activity room and the programming that took place there, was closed down after two years – no more funding was available and the OT was let go from the facility. Now elderly folks could sit in their beds/rooms doing  - nothing. Nothing leads to trouble – worsening dementia, behavioral problems requiring restraints, increased experience of pain while distraction is lacking, boredom, loneliness….
What was different about 1W that required  more niceties for PT’s? Well they had CANCER so that meant they would die. So that meant they deserved more life enhancing stuff while hospitalized. Right?
So I have a hard time getting excited about Cancer. Cancer doesn’t need more services. It is already happening. LOTS. But I don’t see the Make A Wish program that fulfills the bucket lists of elders. I don’t see benefits being held to raise money  for elders who need assistance for ….well…anything. I get that folks with Cancer are young and vital and raising families but what does that make our elders – chopped liver?!
The only good thing I see is that Cancer makes people think about death. Most folks really believe that it is a death sentence but it is now a group of illnesses, like so many others with periodic treatment required as it carries the PT along that chronic disease trajectory. But we don’t identify the chronic illnesses as causes of death – we should. WE REALLY SHOULD. Because they are. More than Cancer even. It is as if when we get old, if we have dodged the cancer bullet, then we will never die. Whew. What a relief. Have you noticed the commercials for inhalers? They have little words running under the ads and one says “COPD worsens over time”. Holy shit! What does that mean? Hopefully no one notices that,  cause it could be upsetting if you think about it too much. Good thing it doesn’t say “cancer”.
So yea…speak sooner…about approaching frailty and death.