“Signs” of Respect, by Dr. Monica Williams-Murphy

“Signs” of Respect, by Dr. Monica Williams-Murphy


A “Sign” is defined as an object, quality or event whose presence indicates the probable presence of something else.

One day after having read, “Attending the Dying” by my friend Megory Anderson, I found myself at work in the ER. There was a half-naked psychotic lady screaming in the hall, the sound of a beeping ventilator alarm escaped from the curtained room of a man in respiratory failure, and a large crowd was gathering outside of Bed 2 because a matriarch was dying. Although I am accustomed to such visual and auditory chaos, it struck me that my dying patient and her family were not. Further, as I stood in this hall with the family whom I was attempting to shepherd along in creating a good death for their well-loved matriarch, I became acutely aware that I was not following the wise counsel set out by my friend, Megory.

In her brief and powerful tome, “Attending the Dying- A Handbook of Practical Guidelines”- Megory sagely advises those of us who accompany others on their journey towards last breaths. Standing in the bustle and roar of the ER, I could clearly recall her words regarding creating a sacred space for the dying and their loved ones:

“You have the calling and ability to set the stage for a good and holy death.”

“Creating sacred space is one of the first steps in setting the environment apart from day-to-day issues, which in turn helps everyone present remember the sacredness of the event unfolding.”

“Contain or mark the space.”

“Try to make this an intimate experience for the family, within the boundaries of the medical unit.”

“A sign on the door is always appropriate.”

Hmm…I thought, “What I really need is a sign. But what would it say?”

I mused that my favorite sign would go something like this:

“Shut up! Can’t you see that someone is dying in here?”

Being known for my public decorum, however, I decided against this one. But, what?

I could not imagine the family wanting a sign on the door that overtly stated that someone was dying. This would rob them of some of the privacy that I was hoping to create.

I could not come up with anything decent and reasonable on my own so I turned to the experts. In my ER, we have these fabulous humans called “Patient/Family Representatives” whose job is to socially, emotionally and spiritually help support and gain resources for people who are critically ill or dying. If ever there was a font of wisdom, these people are it! So, I presented the idea to them and of course they had the solution and here it is:

quiet please

Ah, now there we go.

This sign promotes respect and privacy without announcing the condition of the patient.

Brilliant!

So, I shared this on twitter and got this interesting response.

Love it! But this has to be “branded” or a commonly understood symbol for uninformed people to understand the message, or this funny response might be the product:

Ha!

So the point is that indeed a sign is often a necessary, simple and powerful tool in defining a sacred space for the dying, particularly in a medical facility. But remember, when creating YOUR OWN signs for this purpose: A “Sign” is defined as an object, quality or event whose presence indicates the probable presence of something else. You have to understand the sign to obey it!

Make sure your sign is recognizable, respectful, and gets the job done.

Thank you, Megory, for teaching us how to better attend the dying and to groom the environment practically and with dignity, even within the chaos of the ER.

*****

To learn more about Megory Anderson’s work visit the Sacred Dying Facebook page

Dr. Megory Anderson was called to a vigil at the bedside of a friend who was dying one night. That experience was so powerful that she began working with others who needed help attending to those who were dying. Today, Anderson is the executive director of the Sacred Dying Foundation in San Francisco, and trains others in the art of “vigiling,” a way of attending to the needs of the dying. She may be reached at: Megory@sacreddying.org



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The ? of “Suffering” by Monica Williams-Murphy, MD

The ? of “Suffering” by Monica Williams-Murphy, MD


deathnotification

“Oh God!” she groaned, looking upward with tears flooding her cheeks, which were stretched into the shape of agony. Her chest heaved uncontrollably with grief.

“I am so very sorry,” I whispered again while leaning in and stroking her hand.

This is what death notification often looks like and feels like. We doctors should be masters of delivering some of the worst news that could ever be uttered, the worst news that could ever be heard.

Suddenly, she sat bolt upright! Clearing her throat, and staring me squarely and directly in the eyes, she asked me the most common and most important question that could ever be answered during death notification: “Doctor, did he suffer?”

I heard the question echo in the air: “Doctor, did he suffer?” “Doctor, did he suffer?” “Doctor, did he suffer?”

The air was thick, silent, and still as I deliberated the answer. I never removed my eyes from hers, because I knew that no matter what, I needed to deliver the answer with complete honesty and integrity.

Very slowly, I answered: “No, I do not believe he suffered.”

Thankfully, it was the honest truth.

Some of the greatest human fears surrounding dying are not death itself. Instead, one of the most prominent concerns is whether suffering will or will not occur, whether someone did or did not suffer. In fact, themes of the presence or absence of suffering should be a human fear that we in healthcare seek to actively manage and address. We cannot divorce emotions from medical events and medical decision making, so it becomes our role to manage them instead.

Specifically, we must learn to manage fears of suffering in two distinct end of life scenarios:

1- As the end of life approaches.

2- During death notification.

Let’s discuss each briefly:

1- As the end of life approaches, we must be able to describe whether a choice may increase or produce unnecessary suffering. This sounds awfully heavy doesn’t it? Because, in healthcare we like to talk about beneficial outcomes of medical choices (even when giving our spiel about Risks, Benefits and Alternatives to treatment options). But, for the patient and the family, the potential for suffering may be at least as important, if not more important than the benefit potential.

In fact, on more than one occasion, the minute that I explained to a patient or surrogate that the broken ribs often produced by effective CPR could cause the 90 year old grandmother to suffer should she be resuscitated… the minute I used the word “suffering”… the whole plan changed.

At other times, I spend a great deal of time using words that explain how a plan of care will reduce or mitigate suffering: “We will not allow her to suffer. I will do my best to keep her comfortable.”

2- During death notification, some of the most important words which could ever be spoken are; “He did not suffer” or “I do not believe he suffered.” The catcher here is that these words must ONLY be spoken when they are the honest truth. These words are very powerful purveyors of peace for surviving loved ones and will become part of the oral history of the deceased. These honest words are a priceless gift.

So, if you are a healthcare provider, please start actively addressing “suffering” in your care of the dying or the dead.

If you are a patient or family member, ask your healthcare provider about how a medical intervention could increase or reduce “suffering.”

We will ALL benefit from more open conversations about the topic.

 

 



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