An Understanding of Death and its Implications - Essay Example

Deathography Introduction A 78 year old Catholic priest was one of the patients that I had the opportunity to care for during my experience in palliative care. He was diagnosed with The patient was transferred to palliative care with the diagnosis of advanced stage IV aggressive Non-Hodgkin Lymphoma (NHL) with severe bone marrow depletion that had not responded to chemotherapy. Chemotherapy was the only treatment considered (Anderson-Reitz, 2006). Due the age of the patient and the advanced stage of the disease in the patient, the more aggressive interventions like bone marrow transplant were considered unsuitable by the clinical haemo-oncologist (Saha, 2001). The patient remained in palliative care for approximately four weeks before he passed away. It is his passing away that left a deep impression on me during my stint in palliative care and the reason fro my choice on reflecting on death and my experiences with death as a part of experiential learning that will be very useful to me in my career as nursing professional (Fowler, 2008). The significance of handling death and its implications to a nursing professional lies in the understanding that among all the health care professionals it is the professionals that are most immediate to the patients in end of life situations and can provide the care, comfort and counsel to such patients and their families (Dickinson, 2007). Death Experiences I had met the Catholic priest for the first time, when he was admitted into palliative care. Thoughts run through my mind, as to why this brief period of knowing and caring for the priest was to affect me so much. The most probable answer that I can find lies in the understanding of this provided by Tan et al, 200g. According to Tan et al 2006, p.17 “Nurses are at the forefront of caring for dying patients in hospices, nursing homes, acute-care hospitals, and patients’ homes” and “felt it reminded them of their own mortality, made them treasure life more and made them ask questions about life and death”. However, the passing away of the Catholic priest was not the first time that I was deeply affected by death. This occurred in my late teens, when my cousin, who was also my best friend and companion, passed away. This was not my first experience of death and my first brush with death did not leave me with grief and a sense of loss, as the death of my cousin did. My first experience of death in my family was the passing away of my grandmother, when I was five years old. I have hardly any memories of interaction with my grandmother, as she was quite sickly. Her passing away created no sadness in me. I cried when my mother cried, because my mother was crying and not from any sadness. To be frank, I enjoyed the few days after my grandmothers death, as I had a number of my cousins of the same age in my house and we played as we liked, without interference from my mother and elders, who were deeply affected by the sadness of my mother and engrossed with religious and mourning ceremonies that were part of the passing away of an individual and the burial. My understanding of death was minimal, for it was not spoken about, when I was around and nor was I taken to see any burials. I knew my grandmother would be put underground during the burial and she was probably not coming back. Looking back at this first brush with death and the lack of any grief and sadness, I have come to realize that for death to bring about grief and a sense of loss there must be strong closeness in the relationship, a feeling of void in the absence of that relationship and an understanding of death and its finality. This was exactly what I felt when my cousin died and left a void in my life that still remains unfilled. The passage of time from being a kid into my late teens had brought with it clarity that death was inevitable and a final parting, which was a frightening thought. Death thus is inevitable and a final parting that brings grief, sense of loss and insecurity. It could occur at any time and to anyone bringing into play these emotions and anxieties, which is the reason that a nursing professional needs to have a proper understanding of death and its implications in the various forms it could occur and its impact on the bereaving families, so that the nursing professional can provide solace and support to the dying individual and to the bereaved families (Tan et al, 2006). The final parting on this world through death has put in place a wide range of rituals based on religion and culture. For example Christians bury their dead after performing religious rituals, while Hindus cremate the dead after the religious rituals. Variations in these death rituals can be based on the culture of the society. In essence the purpose of these rituals is to assist the concerned individuals to come to terms with the final parting, with the assistance of the society that they live in and the faith in their religion (Lobar, Youngblut & Brooten, 2006). Personal fears in these death rituals are possible. This can be seen from the case of the fear that is present in some Christians of being buried even before death has really occurred. The strength of these fears can be seen in the several measures that were made to provide reassurance that in the case of being buried alive, there would be means to communicate this and thus get out of the predicament (Pollizotto, 2006). According to Ritchie 2004, p.8, ontological security for an individual depends on the individual finding a meaning for existence or living, but that this meaningfulness always carries the shadow of threat of chaos and confusion that can be brought about by death. Nothing exemplifies this better than when death and devastation result from acts of terrorism, wherein a number of innocent people are killed for no real reason at all (Berko & Erez, 2005). An Understanding of Death and its Implications Starting with a perspective of death and its meaning to children Charles 2007, p.32, suggests that even infants as young as six months are capable of grief expression in death experiences, in a similar manner to death. This suggestion implies that even at tender ages, children do experience grief from death, though there is no proper understanding death. Families tend to prevent their children from exposure to death, by not discussing it in front of them or making them part of any of the after death religious rituals. The finality of death is not grasped by very young children, as they are encouraged to believe that the dead individual is in deep slumber and thus the understanding of the finality and inevitability of death comes late in childhood or as an adolescent (Charles 2007). Children are dear to their parents and the loss of life of their children at any stage particularly at a tender age is devastating to parents. Yet, parents can lose children even before they are born through miscarriage, ectopic pregnancy, stillbirth, neonatal death and other losses, which Callister 2006 terms “perinatal loss”. Perinatal loss brings on a unique kind of bereavement, for the expectations and happiness of the emerging new life is all of sudden turned to devastation and grief. Perinatal grief is a unique part of parental bereavement, for only the parents have experienced the new life and there are no societal expectations in the mourning for the loss of the child. It is a loss really borne by the parents, with a minimal of societal support. However, nursing support and intervention is useful in the promotion of health and healing, when perinatal loss is experienced (Callister, 2006). Callister, 2006, p. 227 recommends employing “helping to create meaning through the sharing of the story of parental loss, the facilitation of sociocultural rituals associated with loss, the provision of tangible mementos, sensitive presence, and the validation of the loss” as nursing interventions to promote health and healing in perinatal loss. Loss of a child is a devastating experience for the parents. There is evidence from studies that show that the effect of the loss of a child is felt with greater intensity and for a longer duration than any other from of loss and is it quite challenging for support interventions, which has also to take in to consideration the high potential for suicide by the parents. This is more so when death occurs as a result of suicide, homicide, violence or accidental death (Raphael, 2006). There is a general feeling that among these of sudden or violent death of a child, death from suicide causes the worst outcomes for the parents. Shirley et al, 2003, based on the study puts this myth at rest and conclude that any violent or sudden death is equally devastating to the parents. The challenges in the case of death from a prolonged illness are different from the case of the loss of a child from violent or sudden death. Quite often it is the mother that directs her efforts and life in trying to postpone the inevitable in the belief that such activity could bring this about. There is also the attempt to isolate the child from any talk of death. The child however, is alive to the situation and makes it difficult for the child. The child will find it difficult in such a situation to give up the struggle for life, in the belief that the parents would not be able to cope with it. This situation makes it difficult to prepare the child and provide palliative care to bring about a good death for the child. These issues need to be on the mind of the intervening nursing professional to ensure an honest interaction with the parents of the child, to allow the child to depart peacefully and with the required palliative care (Raphael, 2006). Ageing and death are natural processes, which is still difficult to reconcile to and there still exists grief and loss, even when the person who dies is aged. Every death spreads its grief and loss. In these modern times’ advances in medical sciences and technology have increased life spans, which mean individuals live longer than earlier, even when they are victims of illness and diseases. Yet this does put health stress on the carers of the elderly particularly those disabled or in morbid conditions (Son et al, 2007). It is not just the health support intervention that the carer requires during providing care, but also at the time of death, for according to Doka 2006, p.4, “it is unsurprising that individuals caring for persons who are dying would experience grief”, because a strong relationship develops between the patient and the carer and the snapping of the bond through the final parting leads causes grief and a sense of loss in the carer (Doka, 2006). A terminal illness can intrude on the life of an individual at any age and the lives of the family of the terminally ill individual. Individuals with illness continue to look forward to the support from their familiar worlds of family and friends, as they move forward to the unfamiliar reality of death in the near future. The family on the other hand are devastated with reality of losing a loved one and the need to cope with that loss. In addition there is the issue of the fear that science and technology would unnecessarily prolong life and thereby cause unneeded suffering. Support interventions for the individual with terminal illness and the family, thus become a requirement (Spichiger, 2006). Palliative Care Over the last four decades there has been growing and enhanced understanding that the needs of the terminally ill patients and their families are essential to the quality of the healthcare provided to such patients. The consequence has been the development and growth of hospice and palliative care for the terminally ill, supported by self-help networks and counselling services for the family that come into play at the time of bereavement (Doka 2006). Palliative care thus is provided to the patients, whose disease is no longer responsive to any form of curative treatment and so require active and complete care with the objective of providing the best quality of life to the patients and their families. Hospices are the organizations designed to give the end-of-life palliative care, with this care provided at the home of the terminally ill patient, nursing home, hospital or special care facility (Kirby, Keeffe & Nicols, 2007). It was in such palliative care that I cared for the Catholic priest. Why did I develop such a bonding with this patient and experience loss and grief at his passing away? The answer lies in the strength with which he bore the pain and discomforts of his illness, as well as the oncoming spectre of death. I did not have to prepare and support him in the journey to death. His strong religious faith made him not to fear death and also gave me lessons in the strength of spirituality and religious faith providing the means to face the challenge of death and loss of a loved one. There was more to learn from him, but death took him away before my learning was complete. The loss is mine. Conclusion Death is inevitable and a final parting, but can occur suddenly as in the case of an accident or with warning as in the case of terminally ill patients. In the case of terminally ill patients the patients and the family require nursing interventions in support of during the journey to death of the terminally ill patient and in the bereavement that this loss causes to the family. In this journey it is quite possible that the nursing professional picks up added knowledge and skills to provide more care and support, when such a situation arises again. Literary References Anderson-Reitz, L. (2006). Dose-dense Chemotherapy for Aggressive Non-Hodgkin Lymphoma. Cancer Nursing, 29(3), 198-206. Berko, A. & Erez, E. (2005). “Ordinary People and “Death Work”: Palestinian Suicide Bombers as Victimizers and Victims. Violence and Victims, 20(6), 603-623. Callister, L. C. (2006). Perinatal Loss: A Family Perspective. Journal of Perinatal & Neonatal Nursing, 20(3), 227-234. Charles, C. (2007). Kids Grieve Too: Supporting Bereaved Children in a Group Setting. Grief Matters, 10(2), 32-35 Dickinson, G. E. (2007). End-of-Life and Palliative Care Issues in Medical and Nursing Schools in the United States. Death Studies 31(8), 713-726. Doka, K. J. (2006). Caring for the carer: The lessons of research. Grief Matters, 9(1), 4-7 Fowler, J. 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