Death, Dying and Bereavement - Essay Example

Deathography BY YOU YOUR SCHOOL INFO HERE HERE DEATHOGRAPHY Background My most prevalent experience with death involved a family friend who was diagnosed with terminal cancer. Before the diagnosis, there had been no outward, physical signs that she was ill and the cancer was discovered through routine physical examination. After physicians identified the cancer, our long-time friend (Aunt Linda, we called her) went from a stable, confident woman to a frail, dependent person needing constant emotional and medical support. In the six months duration from diagnosis to death, Linda’s reaction to her disease forever changed my view of dying and coping with end of life issues. Combined with unprofessional clinicians that provided support, I found a new lease on dying and the processes involved that have far-reaching consequences on family and the victim. Introduction: Most children do not think of death and dying nor contemplate its somewhat grotesque cultural symbolism, instead they are too busy considering peer relationships or the receipt of their next reward for good behaviour. Perceptions of death at the childhood level are usually ambiguous sensations that occur when exposed to different death scenarios, such as the loss of a distanced great-grandmother. It is not until adulthood arrives that the individual begins to think about death, reinforced by different retirement packages offered by companies or other cultural symbols, and wonders about the realities of death as an unstoppable outcome to living. I have always had a form of thanaphobia, which is fear of dying or death, and of the dead (Aiken, 2000). It is likely a product of different media images, such as Michael Jackson’s “Thriller” which depicts the gruesome, mangled aspects of death that come from decomposition. Perhaps it was built as a combination of different stimuli related to death, such as news reports that highlight the crushed automobile that reinforce our absolute frailty as human beings. Until Aunt Linda was diagnosed with cancer, I had been able to calm my mild thanaphobia and just accept that it would be an eventual part of my life cycle that should be accepted, but rarely reflected upon. It was her response to having terminal cancer and the emotional phases that this once-vibrant woman went through that forever changed my view of dying and transformed mild thanaphobia into a full-blown case of it. When an individual is told they have a terminal illness, they often reach a stage in coping referred to as anger, where the individual looks for someone to fault for their problem, such as the doctor, God, or anyone they perceive should have helped them prevent its onset (Heegaard, 1990). Out of this anger can come different, individualized behavioural responses such as explosive verbal onslaughts or a level of withdrawal that only serves to isolate the dying person from their support network. Those that cope with their anger by choosing not to articulate their feelings find comfort in a low-key approach to managing the stress of dying, however they receive social pressure to express themselves more openly (Zaslow, 2005). There is a phenomenon in the cultural norm which suggests that dying should have more demonstrative behaviours in terms of discussing their emotions or illustrating more dependency on caretakers to support their needs. It is this social pressure that likely causes more symptoms of depression or other emotional problems when they are told to behave differently than what might be their preferred low-key style. Everyone in society faces death and dying differently, having their own mechanisms to help drive their coping or grief processes. There are less resilient types that might hover in the anger stage indefinitely without ever finding acceptance of their impending death, blaming their caretakers or society until the end. There are those who dwell on their condition so often that they develop physical health symptoms brought on by anxiety or ongoing tension (Stroebe, Schut & Stroebe, 2007). It seems that the more intense the grief, and more dependent the personality, the more possibility of developing outward physical symptoms beyond the original disease. There are those who enter a stage of denial about their condition or loss of a loved one, which is a symbolic impression as they try to cope with the reality that their loved one (or themselves) will not be returning or able to make a simple social telephone call (Bolden, 2007). It does not provide opportunities for healing or coming to grips with their condition when denial is present or continues throughout the duration of an illness. This only makes the problem harder on caretakers or trusted friendship circles if the person continues to show false resiliency through denial or simply refuses to accept their condition. It is common as an individual waits for death for them to develop periods where they remain silent, looking to be disengaged from others attempting to communicate (cancercare.org, 2009). This is a reasonable and expected behavioural outcome and should be met with support and understanding. Methods for caretakers to assist involve the creation of a peaceful environment, such as using soft music or ambiance to try to make them feel more relaxed and appreciated. Generally, the silent victim of the disease will come looking for social reinforcement eventually once they have managed and dealt with the cause of their silence. Death and dying and thoughts about end of life should be managed by the victim of the disease until they are ready to move through further stages until they reach a self-induced acceptance of their condition. When the disease requires an individual to make frequent visits to the hospital, there is an ethical tenet from nurses and physicians that describes their role in creating a more rewarding end-of-life care routine and programme. Under one specific ethical tenet, “Nurses individually and collectively have an obligation to provide comprehensive and compassionate end of life care” (aspmn.org, 2003, p.1). Nurses, more than regular citizens in society, are trained in dealing with diverse patient reactions that stem from end-of-life care issues and should display considerable emotional support for the patient. Nurses provide the information needed for the patient to make informed decisions about what steps to take to manage their emotions and condition and require end-of-life care to be independent of organisational politics or other factors that negate the person’s basic humanistic needs. However, cultures have their own sets of values about death and how these issues are discussed (in any environment) will have their own rituals or attitudes (Inman, Yeh, Madan-Bahel & Nath, 2007). A professional, ethical nurse or physician will recognise these cultural differences and attempt to use compassionate care with a cultural background in order to better relate and make the patient feel comforted and secure. “Denying death makes us tense; accepting it brings peace. It helps us become aware of what is really important in life” (Khadro, 2003, p.4). This seems to be a phenomenon that occurs where an individual does not consider their own place in society until they are told they will soon be exiting it. For example, recognising that more time should have been spent with family over the years or considering their treatment of others might be on the forefront of the sick person’s consciousness. They might find personal anxiety over failed relationships or failed religious devotion (each unique to cultural values) and begin trying to make amends for these perceived social or lifestyle failures. This can bridge family gaps and bring people closer if the dying person attempts to make amends for their failings. There is also the responsibility of the workplace to recognize needs of people in a bereavement situation, relying on managers to help create a supportive environment during this process. Smith (1997) offers that managers need to create an understanding environment by keeping a delicate balance between employee needs and company needs while bereavement is occurring. In the face of death or the loss of a loved one, work obligations remain part of their responsibilities and it is natural to assume that performance will not be superior during this time as they reflect on the loss or their emotional reactions to it. People need a supporting environment that does not apply too many pressures for performance or productivity and advise employees to handle the situation with tact and social support. When men have lost their spouses, they often report not having someone to talk to when feeling depressed. A recent study identified that 77 percent of men in this category were concerned about minimal social support, especially from other men (Balaswamy, Richardson & Price, 2004). This is likely because of the gender role expectations often applied to men as being aggressive, resilient dominators versus that of the feminine persona which is more active to suggest a personal need for social support or emotional discussion. However, the impact on a spouse that has lost his wife can have broader impacts on family and friends and they should be provided similar support as that of their female counterparts; the emotions are just as real whether they reach out for assistance or not. Discussion Aunt Linda had a form of cervical cancer that was inoperable and diagnosed as terminal. The first reaction was intense grief about her condition that pervaded all social interactions for the first month as she sought alternative treatments or any other life-prolonging effort. “Grief can cause you to act in ways that you would not usually act” (seattlechildrens.org, 2009, p.1). This was noticeable with Linda who had always been the strong role model, independent, and with a good job that was higher-paying than most women her age. As she tried to come to terms with her grief, and make plans to support her husband and grown daughter, her behaviours were intense and she was often lashing out at others, having moved into the anger stage very quickly. She would be having discussions with my family in the kitchen, drying dishes or some other activity, and then she would suddenly crash the dish to the floor and begin a crying period that would endure for hours. The slightest phrase would send her into this spiral and it took considerable toll on the family who tried to adjust to these spontaneous outbursts. It was clear that she was looking for a shoulder to cry on, but had too much pride in her own resiliency to ask for in-depth counselling. When it was proposed, she would flatly refuse. Offers the Seattle Children’s Hospital, “Grief shared can be grief diminished” (seattlechildrens.org, 2009, p.1). Linda did not see it this way and preferred the emotional outbursts over rational social discussion, which was something that was completely uncharacteristic for the strong Aunt Linda. Henslin (2003) provides that people trying to offer support for the dying should realize that the victim is facing a sharply different reality than those who perceive they will be alive many years from now. In reflection, though I was a bit younger during Aunt Linda’s illness and death, I began to understand that my family and her friends were somewhat insensitive to this and would often discuss her outbursts after she had left the kitchen or went home to her husband. Culturally, there seems to be a predisposition toward the belief that death should be handled just one way and to exhibit behaviours outside of this norm leads people to believe that the dying person is unable to cope or needs counselling. However, I have come to realize that all of Linda’s outbursts were just a manifestation of her anger towards nobody in particular and likely sensed that my family was not equipped to offer support for Linda’s true reality. There is also the situation that occurs when a person is in the hospital waiting for death. It is known as emotional limbo where survivors or other caretakers begin questioning their own roles in life and have a sense of helplessness for the victim and themselves. A recent article described the challenges that a husband felt in this limbo stage as his wife was being kept on life-support equipment. Said the spouse, “I visited almost every day, but it was more out of a sense of duty than love” (Zaslow, 2007, p.D1). I witnessed this occurring with Linda almost every day, with people coming in and out with flowers or candy, but only staying a moment to offer their support or condolences. In retrospect, I think Linda was deducing that people tend to visit or offer social discussion about their illness out of this sense of duty with few genuine emotions attached to the activity. Linda never seemed to want to see the visitors or accept their gifts, though she had always been a very social person before the illness. I recognized an aspect of society that made me somewhat more fearful toward my own death, wondering whether sincerity would help to flatter my condition or whether I would be visited out of duty. This was another cultural symbol that I found entirely disgraceful and it strongly impacted my own anxiety levels about death. On a few occasions where I brought Linda something to eat, especially on her bad days, I would often find her crying as she took a sipful of soup or a bite of the crackers. She would often refuse the food or curl into her blanket and sob for hours on end. Though Linda never denied her condition, at least not openly, she maintained a depressive state almost right until the end. On several occasions, friends or family offered to take her on a recreational drive to the zoo or something that would give her more flexibility than crying on the sofa or in her bed. Even Jim, her husband, could not coax her to experience more in life as she waited for death. It was clear that Jim wanted her to be much more active so they could experience things together, however it was all about Linda and she seemed to not care much about the feelings of others. I did not then nor do I today think this was selfish, only that when faced with their own reality, the reality of others does not seem to matter much. The experience with Aunt Linda ended rather quickly, as she went to sleep one evening and was pronounced dead in the morning. She actually did not suffer much nor experience a great deal of pain, though she became physically gaunt and did not even look like the same person by the end of the disease’s duration. Her physical state further added fuel to my long-standing thanaphobia as all of my personal experiences with death dealt with emaciated figures that I once cared about. My deepest concern about my own death, which has been completely redesigned in the wake of Aunt Linda, is the social network and ability of people to provide help during a very difficult life event. I worry that might be surrounded by people who try to help out of personal duty, rather than out of comforting compassion. I consider issues of medical support staff competency and whether I might become a confident, independent person who seems unable to control their outbursts that stem from anger. Though I learned much about death through this experience, and the stages of dying, I learned more about cultural symbolism and how the realities of the healthy conflict with the realities of the terminally ill. Aunt Linda’s situation was a genuine eye-opener to surround oneself with real friends with the will to provide excellence in support and counselling to avoid a similar situation. References Aiken, L.R. (2000). Death, Dying and Bereavement, Mahwah: NJ Lawrence Erlbaum Associates, Inc. Aspmn.org. (2003). ASPMN position statement on pain management at the end of life, American Society for Pain Management Nursing. Retrieved April 9, 2010 from http://www.aspmn.org/Organization/documents/EndofLifeCare.pdf Balaswamy, S., Richardson, V. & Price, C. (2004). Investigating patterns of social support use by widowers during bereavement, Journal of Men’s Studies, 13(1), p.67. Bolden, L.A. (2007). A review of on grief and grieving: Finding the meaning of grief through the five stages of loss, Counseling & Values, 51(3), p.235. Cancercare.org. (2009). Caregiving at the end of life. Retrieved April 10, 2010 from http://www.cancercare.org/pdf/fact_sheets/fs_bereavement_end-of-life.pdf Heegaard, M.E. (1990). Coping with Death & Grief: Lerner Publications. Henslin, J.M. (2003). Sociology: A Down to Earth Approach (6th ed.). A&B Publishers. Inman, A., Yeh, C., Madan-Bahel, A. & Nath, S. (2007). Bereavement and coping of South Asian Families post 9/11, Journal of Multicultural Counseling and Development, 35(2), pp.101-116. Khadro, S. (2003). Preparing for death and helping the dying: A Buddhist perspective. Retrieved April 8, 2010 from http://www.buddhanet.net/pdf_file/death_dying.pdf Seattlechildrens.org. (2009). Reactions to Grief, Seattle Children’s Hospital Journey Program. Retrieved April 8, 2010 from http://www.seattlechildrens.org/pdf/PE861.pdf Seattlechildrens.org. (2009). Grief: taking care of yourself. Seattle Children’s Hospital Journey Program. Retrieved April 8, 2010 from http://www.seattlechildrens.org/pdf/PE481.pdf Smith, A.L. (1997). Coping with death and grief at work, Ivey Business Quarterly, London. 62(1), pp.20-22. Stroebe, M., Schut, H. & Stroebe, W. (2007). Health outcomes of bereavement, The Lancet, London. 370(9603), p.1960. Zaslow, J. (2005). Moving on: saying no to the grief industry: The case for not facing death head on, Wall Street Journal, Jun 2, p.D1. Zaslow, J. (2007). Moving on: waiting for the end, when loved ones are lost in limbo, Wall Street Journal, August 16, p.D1. Read More