Unprepared to Talk About Dying

In our reality, millions of people die everyday worldwide from sudden, expected, prolonged or even accidental death. Death for the vast majority is considered to be an overwhelming and emotional topic however death is inevitable. Due to the painful nature of death in almost every culture namely the western culture it is taboo to discuss which is why in most cases there is no preparation, end of life decisions, funeral wishes and costs and even financial debt and responsibilities go undone.

One way to become more comfortable talking about death and responsibilities of family members once death occurs is to start talking more openly about death with our children. For children it is said that death is fully understood by the age of four. In one typical study, researchers found that 10 percent of 3-year-olds understand irreversibility, compared with 58 percent of 4-year-olds.(Hughes, 2013). When talking to children we need to be honest and simple. It is important to give children the opportunity to Express their emotions and put them into words as well as to grieve and comfort them through the process.

It is even more important to allow children to see adults process their grief so they can begin to comprehend the natural and real emotions that comes along with death. This will allow them to grow up knowing positive ways to handle grief.

We may not want to think about it but children can lose their parents, family members and even their friends at a very young age. The earlier we discuss this topic, the easier it is for children to cope and eventually heal.

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Children should be allowed to take part when appropriate and be told of funeral rituals specific to their cultural beliefs and others if known. It is important to note that while it is important for children to know and discuss death, we as adults have to be more open and honest about death ourselves. Another way to become more open about death is to become more familiar with the important legal documents pertaining to healthcare options and death that are available to people.

One important issue to discuss with loved ones want to include a DNR order in their medical records. Do Not Resuscitate (DNR) is a no code and allowance of a natural death that can be apart of ones advance directive. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient’s breathing stops or if the patient’s heart stops beating(“Do-not-resuscitate order,” n.d.). DNR is not to be confused with DNI which is considered a partial code. This means the patient wants chest compressions but does not want to be intubated. If one is in the hospital and elects this decision the doctor will talk briefly with them, place the order in the chart and all of the staff apart of the treatment team will be made aware of the order and the patient will be given a purple arm bracelet marked DNR. This decision can be reversed at any time. Most terminal and hospice patients choose this order because this order helps to promote death with dignity and prevent any further suffering when treatment outcomes are bleak.

Another legal decision is to have an executor who you name to take care of your affairs after you die. An executor is different from the power of attorney. The Power of attorney handles matters while you are still alive their power ceases when you die. At this point you can have an estate representative named.

In whichever manner we eventually die, there are some decisions we should think about and put into play. Some require us to get lawyers and notaries but it is and should be really simple.

For those of us with drivers license we have the opportunity to elect whether we want to be an organ donor. This is important as it will play a role in how our bodies are handled after death and the decision on whether our bodies are able to be donated or not based on the circumstances of our death. Depending on how we die donating your organs may not be possible and for those who are able to donate organs there is a critical window between being able to donate your organs and your death. You and or your family are electing to help save the lives of one to several lives in a single donation. Many hospitals now have the honor walk in which availablhospital staff line the halls along the path of your hospital room, many times you are in the intensive care unit, to the operating room. Your family is allowed to walk the path as well.

When a patient is unable to breathe on their own, the only option is to place the patient on life support. When life support comes to mind the first thing visualized is usually a mechanical ventilator. A ventilator is a machine that partly aids a patient in breathing or completely aid in breathing for the patient entirely. The ventilator mentioned in the case study breathes entirely for the patient since the patient was unable to breath on their own after slipping into the coma. The ventilator brings oxygen into the lungs while also removing carbon dioxide from the body. While ventilators are very important medical devices that extend life expectancy times for patients, they can come with some dangerous risks. With ongoing ventilator care, doctors and nurses have to carefully wath patients.

One of the more serious risks of being on a ventilator is ventilator associated pneumonia (VAP). VAP is defined as as pneumonia that occurs 48-72 hours or thereafter following endotracheal intubation characterized by the presence of a new or progressive infiltrate, signs of systems infection, changes in sputum, characteristics and detection of a causative agent (“Guidelines for the Management,” 2005). VAP occurs only about eight to twenty-eight percent of the time in patients and is treated with antibiotic when VAP occurs earlier in treatment.

However, if VAP occurs after the initial infection window, it tends to be a much more serious infection which can be fatal. Other risks associated with ventilators are lung damage, oxygen toxicity, and pneumothorax. Pneumothorax is a condition in which air leaks out of the lungs and into the space between the lungs and the chest wall (“Ventilator/Ventilator Support,” n.d.). This causes pain, shortness of breath and even lung collapse. Mechanical ventilation also imposes a risk of blood clots and skin infections. This is especially true for patients who are comatose and confined to a hospital bed. Mechanical ventilation treatment can save lives by extending life expectancy from months to even years. However, ventilators bring rise to the question of whether families are extending life or postponing death, This is especially true in cases of patients that are comatose or brain dead.

Once a patient’s prognosis takes a turn for the worse difficult life and death decisions usually have to be made. Our groups case study revolves around a 90 year old patient Mr. B, who after being admitted to the hospital became unresponsive and fell into a coma. Unable to breathe for himself, Mr. B was placed on a ventilator. His doctors made it clear that Mr. B was dying and that his family had to make some difficult choices due to the fact he never discussed end of life choices with his family.

Our group decided to use our subjugated judgement. When using substituted judgment, doctors and family members try to make the decision that the patient would have made if he or she were able to make decisions (Torke, Alexander, Lantos, 2008, p. 1514). Due to Mr. B’s grave diagnosis our group has decided to only keep Mr. B on the ventilator for two to four weeks. This reasoning is based on not only the complications associated with ventilators but also due to Mr. B’s daughter not wanting to prolong his suffering any further. Even though comas are still poorly understood, the longer a patient remains in a coma the worse the outcomes tend to be. Though this is one of the toughest decisions most people have to make, by removing Mr. B from the ventilator it allows him to not only pass peacefully but also allows him to pass with dignity.

Despite the difficulties of coming to a solution for this study case, what makes it even harder is that fact that Mr. B and his family has never talked about situations like this. No one has any preferences or suggestions on how to handle affairs if one of the family members lose the ability to communicate. This brings up the importance of more in-depth and assertive conversation. Family members should be comfortable showing their stands on death. They should express how they feel about dying and what would make them feel more at ease with it. It is never too early to be prepared for unexpecting cases.

Conclusion

Although there are numerous conversations that are difficult to discuss, talking about death is one of the most difficult topics to discuss. There are countless reasons why people avoid this discussion. Perhaps, death is inevitable and unpredictable in life, but it will affect everyone at some point. Therefore, the topic of death can not be avoided. Haruki Murakami, an inspirational writer said, “Death is not the opposite of life, but a part of it.” death is an already set part of everyone’s journey and some journeys end earlier than others.

It all depends on one’s life choices. Healthy choices could lead to a healthy lifestyle and poor decisions could draw up a bad conclusion. However, as people live their lives, they often forget about the consequences. So, by opening up and talking about death, one could potentially foresee the results and act accordingly. In addition, discussing the topic death could create empathy and encourage people to treat their loved ones right. People do not feel comfortable talking about death because they fear family dispute, they do not feel prepared for death within the family. Avoiding death does not make potential issues go away, it just simply delays it and often exacerbates them.

Death is not frightening, it is just unfamiliar to us. Come back to the reality, death is just a part of life and we need to stop fearing death and just should embrace it. Discussing it and familiarizing ourselves with it will help to ease our minds. Finally, it allows us to live life gratefully and appreciate everything life has given us.