Over the past couple of weeks I have been reflecting on palliative care and what it is to experience a Good Death. I have had the honour of being a nurse to several patients in their final days and moments, and to my glee they have all experienced what I would call a Good Death. This also triggered thoughts surrounding my family losses in recent years, and the ones that are to come. More broadly this raised the discussion around assisted suicide and the moral, legal, and ethical issues surrounding the idea.
Some people will find it unusual or even confronting to read the fact that I had glee in my heart when dealing with someones death. Please realise that it warms my heart to see friends and family surrounding someone, who is comfortable, in no pain, well presented and cared for, all in their final moments on the planet. For me I define a good death by several factors. Firstly, comfort; the patient should be as comfortable as physically, emotionally, and spiritually possible. If this means Morphine infusions so be it, if it’s aromatherapy so be it, 12 pillows, a heater, their favourite blanket, if it can be arranged and not be a danger to them that’s what I will do. Secondly is pain; unfortunately most of us won’t meet the end of life without pain. My job as a nurse is to liaise with Doctors and ensure that the pain is either eliminated all together, or kept to an absolute minimum. Thirdly, well presented and cared for; the patient should have their hygiene needs met, new clothes as appropriate, hair attended, mouth cares attended, clean pad if appropriate, and generally look like someone has actually cared for them. Finally, family, and this can be a tricky one. Nobody can force family to be in attendance. Nobody can force family to be civil. We can facilitate an environment whereby the family don’t feel the need to clash, bicker, or argue with one another. The family of the patient should be able to say their goodbyes in a fashion that suits both them and the patient. Nothing will fill a person with regret quicker than not seeing a family member in their final moments, and having to apologise at the funeral.
A couple of years ago I lost my Nan and my Aunty within the same week. My Grandfather lost a Wife and his Only daughter. It was a rough week, and an emotional roller coaster. My Aunty suffered a massive brain haemorrhage and spent over a week in ICU before being declared brain dead. Within 24 hours of her passing she saved 6 lives as an organ donor. Please register to donate your organs here. My Nan was moved to palliate care after 4 days on a medical ward deteriorating. She spent 3 days on the ward before being called back to God. In those three days she was surrounded by family, memories, stories, and a whole gambit of emotion. She was prayed for, prayed over, and had the last rights read to her by the local chaplain. She was kept comfortable by some of the most attentive nurses I have ever met – one of the driving forces behind my choice to become a nurse. She was part of a going away party the night before she passed whereby her husband, sons and their family at pizza, drank beer, and reminisced over stories old, and not so old. There was laughter, there was tears, there was acceptance. We left Nan that evening and returned in the morning. That morning the Cheyne Stokes pattern kicked into high gear, we all knew it was close. We gathered around, and there was an absolute silence, and she slipped away. I led a prayer for her as she was taken back to be with God, and then the inevitable emotional release hit all of us like a ton of bricks. There was tears, and hugs, and silent nods of acceptance. My Nan passed without pain, well presented and cared for, surrounded by her family. She experienced a Good Death.
In the effort to ensure that everyone has the opportunity for their Good Death, the conversation around Assisted Suicide or Euthanasia was bound to come to the front. My viewpoint is simple, everyone has the right to choose the way they want to die, how it looks, who is there, and what is involved. I am happy to facilitate all of that, just don’t ask me to push you over the edge. I can appreciate the fact that some people are in immense amounts of pain, and that their final days could be potentially agonising, though I am not convinced that a medical and pharmaceutical care plan could not deal with the pain. I also appreciate that some people won’t have a quality of life that they are accustomed to in their final days. I am not convinced that a well structured and considered Nursing care plan could make their final moments as dignified and for-filling as possible. I know that this subject is both currently controversial and emotionally charged, however it is something that needs to be discussed. It is also something that is unlikely to simply go away.
With all of this said, the best way to ensure that the patient, a family member, or even yourself experiences a Good Death is to talk to your friends and family. If you want to be an organ donor, register and tell people so they know. Have an Advance Health Directive drafted so your wishes, should the terrible befall you, can be executed. Talk with your friends and family about your wishes and how you would like to be treated. Be informed of what is available in your region for palliation. Can you be palliated in your own home? Do you need to go to hospital? Would you need to travel to be palliated? These seemingly macabre things are considered as irrelevant or too distant to warrant discussion, but accidents can happen to anyone, or a sudden and fatal medical episode could befall you. Set yourself up properly for a Good Death.
Maintain The Rage