Something to Think About: a blog on end of life

Barbara's blog

For the last 30 years all of my patients have died. I will be sharing observations and ideas that I have gathered from working with people in their final months of life.

You may not agree with what I am saying. I don't pretend that what I've figured out about living and dying is "capital 'T' truth" or that it is absolutely how everyone dies. This blog is just an expression of my experiences and ideas.

A question about vomitting
by Barbara Karnes, R.N. | September 17, 2012

QUESTION: Why didn’t you write about the vomitting that occurred18 hours before my husband died?
I am sorry your husband had what appears to be an unusual yet not abnormal experience of vomitting in the hours before he died. I’m sure it was difficult for all of you.
Gone From My Sight is a booklet outlining the most common signs of approaching death. Some people will do everything I write about, some people will have none of the things I write about. Most people experience at least some of the signs of approaching death months before they die. Because each person dies in their own time and own special way I will not have addressed everything each person does before they die. I have detailed the most common signs. Vomitting can occur; it is not abnormal if it does. It can happen for a variety of reasons that correspond to the actual disease process of an individual person.
Reply · Like · Follow Post · September 4 at 1:36pm

TAGS Family
Palliative Sedation
by Barbara Karnes, R.N. | September 4, 2012

The question, "Will you discuss palliative sedation?" has come up several times so I am putting my response in this section rather than the Comments.
Palliative Sedation is a term used by hospice, palliative care and medical professionals. The National Hospice and Palliative Care Organization states it’s position on palliative sedation as follows:
“PALLIATIVE SEDATION - Terminal illnesses can cause distressing symptoms, such as severe pain, mental confusion, muscle spasms, feelings of suffocation, and agitation. Despite skilled palliative care, in some cases these symptoms may not respond to standard interventions. After all other means to provide comfort and relief to a dying patient have been tried and are unsuccessful, doctors and patients can consider palliative sedation. Palliative sedation is the use of sedative medications to relieve extreme suffering by making the patient unaware and unconscious (as in a deep sleep) while the disease takes its course, eventually leading to death. The sedative medication is gradually increased until the patient is comfortable and able to relax. Palliative sedation is not intended to cause death or shorten life.” (Vol. 39 No. 5 May 2010 NHPCO Position Statement on the Use of Palliative Sedation 915)
Over the years my personal experience has been  that most people who are dying do not need palliative sedation. If pain was not a part of the disease process then the likelihood of pain as death approaches is slim. The actual dying process does not cause pain. It is the particular disease leading a person to death that causes pain.  With today’s medical advancements there is no reason for a person to die in uncontrolled pain. If the disease process has been a pain filled experience and all comfort management options have been unsuccessful then sleep is our friend. Sleep, created by regulated, supervised medications (palliative sedation), is a compassionate alternative to needless end of life suffering. The key to a gentle death is to relax. If we are in extreme pain and suffering we cannot relax and peacefully leave our bodies.f

The Gift of Time
by Barbara Karnes, R.N. | June 26, 2012

I, Barbara, am not afraid of being dead. I have a belief system that says “When you are dead you are in a better place.” I also think being dead is easy and being alive is hard work. So I am not afraid of being dead but I am really nervous about the time in my life from right now to when I am dead. I am actually more afraid of dying than I am of being dead.

Recognizing this part of myself I thought if God, which is what I call my Higher Power, were to say to me, “You’re going to die like this (on a particular day, at a particular time and this is how you are going to die)” I would relax. I would put my fears of what kind of scary, unexpected death life has in store for me aside and live a freer life. When a physician says, “I can’t fix you. Go home. Put you affairs in order. You are going to die sometime soon” that message is the same as my fantasy. You are being told when you are going to die. Yet most often people stop really living and concentrate on their life ending. Since we are all going to die someday, being told you can’t be fixed could be considered a gift. A gift of time to say and an opportunity to do those things that are important. 

TAGS Fear, Gift, Time


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