Compassionate, informed advice about healthcare decision making

Posts Tagged ‘peace’

The Patient Wanted “Peace” — His Wife Wanted “Cure” — What Is a Good Death?

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“I pray for peace,” said the man with advanced cancer. He was a new in-home hospice patient I was visiting for the first time. Turns out, I knew his wife as a coworker at the nursing home from years before — she was a nurse, and I was the chaplain.

We were sitting in the upstairs bedroom of their suburban home. He was in a wheelchair, and I was sitting in front of him. His wife was in a chair on the other side of the room. I often ask patients, “Do you pray?” And like most everyone else, this man replied, “Yes.”

“What do you pray for?” was, of course, my next question. “I pray for peace,” he immediately responded. Across the room, out of sight of my patient, his wife was shaking her head, as if to say, “That’s not what I pray for.”

As we walked down the stairs on my way out, she confided, “I pray for a cure.” That was totally understandable.

This scene came to mind as I listened to a recent GeriPal Podcast titled, “What Makes a Good Death?” I have also explored this topic in a previous blog, “Can a POW Have a Good Death Hundreds of Miles from Home.”

Peace is more important to patients than doctors imagine

Photo by Raphael Nogueira on Unsplash

The “GeriPal” podcast focuses on geriatrics and palliative care. Each week, they feature the latest research on a variety of topics. Last week, they were revisiting the idea of a good death from the perspectives of patients, families, doctors, and other healthcare professionals. They also discussed a new paper comparing and contrasting the idea of a good death as found in Brazil versus the United Kingdom.

One of the surprises in the research is that although patients felt being at peace was important, physicians did not believe that it was that important for a “good death.” Another curious finding was that doctors rated being pain-free higher than patients did. Perhaps that was related to the finding that patients rated being mentally aware as more important and doctors not so much.

Control in Brazil v. the UK

Photo by Marcin Nowak on Unsplash

Another interesting finding was the idea of being in control of the dying process. Folks in the United Kingdom ranked being in control as very important. Responses from Brazil were essentially, “What do you mean by ‘control?’ God is in control.” This, of course, reflects the more religious leanings in Brazil compared to the more secular UK.

The bottom line — listen to patients

Researchers concluded by warning all of us not to make assumptions about a particular patient or their family. Yes, there are often common ideas about what constitutes a “good death.” But this particular patient might not agree. So, we need to stay curious — and ask.

The whole podcast episode is worth a listen or, at least, read the transcript.

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Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books Hard Choices for Loving People and Light in the Shadows (also available on Amazon).

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Me: “I’m the chaplain.” Patient: “Oh God NO!”

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I started our first meeting as I have hundreds of times before and since, “I’m Hank. I’m the chaplain.”

The response from our new hospice patient took me aback, “Oh God, NO!”

One of the great things about being a chaplain is that, generally, people are glad to see you.

…Let me restate that: People are not glad that they are in hospice and need to see a chaplain. People who are seriously ill and dying are usually pleased to see the chaplain. My standard greeting on a first meeting is, “I am glad to meet you but sorry for what has brought us together.”

An invitation to revisit my experience as chaplain

 A recent “GeriPal Podcast” has caused me to reflect on my years as a healthcare chaplain. That’s “GeriPal,” as in geriatrics and palliative care. “Spiritual Care in Palliative Care” is discussed by three chaplain educators and trainers and the two physician hosts.

Years ago, by chance, I became part of an experiment to find out how people actually felt about the prospect of seeing a hospice chaplain. I was the only chaplain working out of the Loudoun/Western Fairfax office of the Hospice of Northern Virginia.

When a new patient came into our service, the admitting nurse would ask the patient or family, “Would you like to see the chaplain?” About 30% said, “Yes.” Even at that low rate, my caseload was getting too much for me to cover adequately.

Then, something very fortuitous happened. We merged with another hospice, and suddenly, we had another chaplain to cover the whole eastern half of the region.

Now, we were looking to find a way to increase the caseload to fill this new abundance of chaplain hours. We changed from a question (“Would you like to see the chaplain?”) to a simple statement from the admitting nurse — “The chaplain will be calling to set up an appointment in a few days.” Bingo! We went from seeing 30% of the patients to seeing more than 75% overnight.

Why would so many people go from saying “No” to a question to so willingly accepting a call from a chaplain?

There are all kinds of reasons people said “No” to the question. Perhaps saying “Yes” implied, “I am not spiritual enough and need help.” Or people think of chaplains as “religious” and “I am not religious.” Or maybe accepting a visit from the hospice chaplain means, “I don’t think my pastor is good enough.”

Or, maybe it’s the reason the man who said, “Oh God NO!” had when I introduced myself. I asked him, “Why did you respond like that?” He immediately said, “I don’t want to die.”

Oh my goodness. He was equating meeting the chaplain as meaning he is going to die. In his mind, you only see the chaplain when you are dying. In truth, to be admitted to hospice, he had to acknowledge that his physician was estimating that he had only six months to live. Perhaps, he had seen too many movies with a chaplain escorting a prisoner to the gas chamber or a chaplain comforting a dying soldier.

I used that first visit to assure the man he didn’t have to die just yet. I told him people flunk out of hospice all the time by their condition improving. In my mind, I could explore his fear of death in a future visit. But it was not to be.

He had another stroke and never spoke another word. His pastor and I could provide general words of comfort and encouragement in the face of the fear of death, but we had no idea what he was thinking.

So, people refuse to see the chaplain because seeing the chaplain means, “I am dying.” The ill-founded logic goes, “Asking to see the chaplain means I am dying. I don’t want to die. Therefore, I will refuse the chaplain visits and will not die.”

I wish it were that simple.

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Chaplain Hank Dunn is the author of Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness and Light in the Shadows. Together they have sold over 4 million copies. You can purchase his books at hankdunn.com or on Amazon.

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