Tag: Grief

Lessons From The Dying

IP

“You can look death right in the eye, tough as it is, and life lights up.” -Frank Ostaseki

My mom cautioned me not to write too much about death and dying in this blog. So, I felt I should clarify that I am not depressed, nor am I overly consumed by death. I remember the point in my residency when I really started to take note of the ways in which people approach death. It was at a point when I really needed something good to come from everything I witnessed that a preceptor encouraged me to write down three things I learned each day. I am sure this person meant what I learned about disease processes. However, I often wrote down what I learned about life. Luckily, nobody reviewed this notebook as part of my residency requirements! Within the pages of my “What I Learned Today” notebook, I started writing about what the dying said, how they acted, whether or not they accepted what was about to come. Through these observations, I have come to realize that death is a beautiful part of life, which is why a great number of my stories are about these patients and my interactions with them or members of their family.

I have been a part of more deaths than I can recount, so I realize that my comfort level might be higher than average. Often, how the patient spends their final moments can be a source of comfort. Take for example, my patient, who was telling jokes as he was dying. Steering the conversation in humor, as he had always done, was a great relief to his family. “He was ornery until the end,” they told me. There is also the patient who watched Maury until she could not any more. She watched and LOVED Maury for nearly 15 years and did not intend to stop before she needed to. The mundane eased her worry, a reminder that life would go on and as long as she was breathing she still had some control.

On the other hand, sometimes a patient spends their final moments in distress. We can try to mitigate the distress from disease processes. However, the emotional distress some patients feel often cannot be helped. One patient, through no fault of his own, had not seen his son in a number of years, and despite every attempt on our part to establish contact on behalf of the patient, we were not successful. The patient was distraught as he was passing because he was never able to reconnect with one whom he loved so much.

Most often, the way someone dies teaches me something. For example, from the patients above I learned that a sense of humor is key, one should do what they love until the end, and always maintain contact with cherished family and friends. These are life lessons I have usually heard along the way. Whatever the moral, these lessons imparted through observation certainly stick!

While some may believe these stories are not necessarily profound or breathtakingly beautiful in any way, I feel differently. I have realized that finding the goodness, and considering what is learned from the dying is probably the healthiest coping mechanism health care professionals can develop. I seek to honor my patients by speaking of them and gaining a better understanding myself. I desire to find beauty in and learn from my patient’s lives. I want to practice pharmacy in a way that integrates what is meaningful to me.

Strive for a beautiful life, that your dying might also be beautiful.

©2019 Inspired Pharmacist

Living Deliberately

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“Do not be afraid of death; be afraid of an unlived life.  You don’t have to live forever; you just have to live.” –Natalie Babitt

At least once a day, I am reminded of my own mortality, and it awakens me.  It has been almost three years since I met Ms. M*.  She came to us because she was becoming progressively short of breath.  She was nearly my age, newly married, and had just moved back to the area.  When I arrived that day, the physician alerted me to her presence.  She was very rapidly and mysteriously deteriorating, and would need to be placed on a ventilator very soon.  

When asked if a ventilator is what she would want, she was understandably scared.  I recall her telling the nurse she knew she was dying, but that she could not because she had too many things left to accomplish.  Almost immediately, and right after her husband stepped out of the room, her heart stopped beating.  Despite our best and most valiant resuscitation attempts, she did not survive.  She had an endearing personality, that all of us could see shining through despite her severity of illness.  

In the aftermath of ‘time of death,’ as I sat at my desk taking a mental break, I was once again confronted with the need to live deliberately instead of just passively filling my days.  In this case, the patient’s life so similarly resembled my life, and in my moment of pause, I could feel a ton of bricks set squarely on my shoulders.  It could have been me! The weight of it was profound and heartbreaking.  

It is uncomfortable to think about death in general, especially my own.  However, I have found that allowing myself to linger within the unpleasantness, if only for a moment, can be truly liberating.  For me, considering my last days also helps to reshape the present.

I often ask myself the following set of questions.  A spiritual mentor originally gave these questions to me; I have adapted them along my journey.  

If you were no longer here tomorrow, who would notice?  Further, what would they notice? Would they notice the absence of your kindness? Would they notice the somewhat mundane tasks you performed; daily acts of love now profoundly absent?  Do you have any regrets when you think about the answers to these questions?  If so, what can you do TODAY to change course.

If one is truly living, I believe the above questions can be answered with no misgivings.  To live, simply requires a search within for something more.  Bigger dreams, more passion for the things that occupy our time, the desire to continually learn and do better and the creation of memories with loved ones that will last long after death are required.   I certainly do not want my life to end until I have reached a wonderful old age, but witnessing death serves as a reminder that I am not the one who chooses. While I may not have a vote in how things turn out, everyday I wake up and plant my feet on the floor, I receive the opportunity to live deliberately and take control of the options available.

Moreover, one does not have to witness death to have a wake-up call that serves to increase motivation to take control and create change.  Use my lesson as your alarm.  Do what can be done today, no matter what else is happening, to create a life course that will not be viewed with retrospective regret.  Do it today before the choices run out.

“Tell me, what is it you plan to do with your one wild and precious life?”

The Summer Day by Mary Oliver

*Name changed for patient privacy.

©2019 Inspired Pharmacist

Seasons of Love

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The leaves are about to show us how lovely it is to let things go. – Unknown

Recently, we cared for an elderly woman who presented with a massive stroke. When it was clear she would not make it, I heard her husband say to the chaplain “we have been married 70 and ½ years, and I say the ½, because like a kid I was really looking forward to 71.”

The vivid yellows, oranges and reds of autumn foliage were just beginning to appear.  I noticed them on the way to work that day. For me, fall always brings about an acute awareness of the passage of time.  It also reminds me that not all things are for all seasons.

I grew up gazing in awe at the wooded hillside bluffs of Pike County, IL painted with warm fire-like fall colors.  I used to stand outside in the cool crisp air astounded and humbled by the sight. I would watch the trees day to day and notice how the leaves would dramatically change and eventually drop. As a younger person, I would wish for beautiful leaves year round.  Now, I understand this universal principal: in order to grow, we must release something.  Hanging on to what can no longer be possible hinders our development.

While the leaves teach us the beauty of letting go, they also remind us to celebrate the loveliness of how we have grown in the previous seasons of life.  Like the leaves, we have a limited time here on earth. We MUST continually evaluate our purpose and reignite our passions.

As I looked at the patient’s husband, so near to losing a woman who was obviously the love of his life, I was overcome with joy as he lovingly said to her, “I wouldn’t have traded a single day with you.” To them I would like to say, thank you for sharing the beauty of your marriage vocation.  Thank you for briefly showing us the legacy your children will inherit and paving the way for a new generation. We should cherish and enjoy our relationships while we still have time. Like leaves on the trees, you reminded those of us lucky enough to be in the room that letting go can be beautiful. How blessed I am to witness and acknowledge the seasons of change.

Leave a comment: What are some beautiful things in your life that you’ve let go of, and how have they helped you to change and grow?

© 2019 Inspired Pharmacist

*Name and some details changed to protect the privacy of others.

Hail Mary

IP

You can’t outwit fate by trying to stand on the sidelines and place little side bets about the outcome.  Either you wade in and risk everything to play the game, or you don’t play at all.  And if you don’t play, you can’t win. -Judith McNaught

Football season is in full swing around the Midwest.  I have spent many weekends recently on the sidelines watching the team my husband volunteers to coach.  Because I did not grow up watching football, and my high school did not have its own team, this has all been a learning experience.  I am slowly growing to appreciate the game. Notably, I am now critically evaluating how I believe the game could be better played and what penalties I would like to see enforced.  (I am frequently annoyed by the time outs at the end of the game! Illegal time out, anyone?) The play I now love to see incorporated in a game is better known as the “Hail Mary.”  Football is not really my thing, so I never gathered the true meaning of the term until a physician used it to describe the treatment plan for Mrs. C.*

 I had just received a call about her minutes before – “need you in the ER for a code.” When I walked into the room, the physician said, “she’s only 45, so I’m not going to call it, yet. What else can we do?”  I quickly went through my arsenal of ideas, slowly eliminating each one from my mental checklist of options, except for one.  “We could try this treatment,” I said.  “I’m thinking it will have a low probability of a good outcome, but based on what you are telling me, it makes sense to use it in this case.” The physician said, “it sounds like a Hail Mary, but we have to try.”  

 The physician was correct.  It was a Hail Mary play in the truest sense. A desperate measure to resolve a serious problem at the very last minute.  It was unlikely to be successful.  Truly, divine intervention would be needed for the treatment to succeed.  Therefore, I prepared the drug and hoped that against all odds it would work.  We had no other choice.  The treatment did not seem so risky when all other options were exhausted.

 When the nurse gave the medication, I prayed.  With every pulse check and every blip on the cardiac monitor, I prayed harder.  I kept my hand diligently on the femoral artery, anticipating that at any moment I would feel something other than my own pounding heartbeat. I prayed harder.

 As we left the room that day, the physician said, “Well, we did everything we could.”  He was right; we did it all, and then some.  It is at that exact moment when I realized that many times in our lives we are all faced with a decision of whether or not to take a risk. Not all of these risks are matters of life and death. Sometimes it is taking a new job, moving positions within the same organization, starting a new business, or just doing something outside your comfort zone.   Greatness requires risk.  Whether or not you are successful, the risk will stretch you and give you confidence in yourself and the faith to try again the next time.  

 I now understand why the “Hail Mary” pass is so important.  Whether or not the risk was worth it in the end does not matter.  What matters is leaving it all on the field.  You cannot expect to win if you give up.  Never leave the room thinking you could have given more.  

 

How will you identify the daily “Hail Mary” opportunities in your life?

 

 © 2019 Inspired Pharmacist

*Name and some details changed to protect the privacy of others.

 

Piecing Shattered Dreams Into A Beautiful Story

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“If your heart is broken, make art with the pieces.” – Shane Koyczan

The low-pitched, gut-wrenching, tortured wail of grief sounds the same in every language. A sound that gives you chills to your core.  The sound of unbridled pain.  Sometimes, after especially brutal shifts, I can still hear those horrifying screams ringing in my ears.

The first time I heard it, I was a student; the patient was eight.  He had been admitted the entire time I was on my pediatric rotation with complications from leukemia, but was slowly improving. In fact, the medical team was talking about transferring him out of the ICU.  He unexpectedly coded one day while we were rounding; his mom was in the shower.  She heard the alarms and came running, arriving to the room barely dressed and soaking wet.  Because I was a student, I smashed myself against the wall to observe.  He did not make it.

As they called time of death, and the alarms that initially alerted us to his deteriorated condition were silenced, I remember looking around the room trying to find something familiar, because everything in that moment seemed so foreign.  It was not right; he was too young to die.  Hanging around the room were hundreds of letters and cards from his classmates, wishing he would be well again.  All of them telling the story of his vibrant life, a stark contrast to what I now saw.  His mother was crumpled laying on the floor in a heap near my feet, understandably weeping.  The faces of the seasoned medical professionals appeared so emotionless, mechanical, and cold.  I wondered how they could be so unfeeling.  I wanted to lay on the floor with his mother, but I pulled myself together, fearing I would appear weak.  I did not cry until I got into my car that night.  In my grief over his life cut short, I made a vow to myself that I would never be so detached.

Walking in the room that day, I thought I would learn about the role of a pharmacist in a pediatric code, and I did, but it also deeply and completely changed me.  The idea that I could grow through this experience still seems objectionable.  However, death and loss teach us something about ourselves and challenge our assumptions.  We have no choice about death.  We have no choice but to grieve.  What we can choose is how we will respond…will we grow better, or will we grow bitter?

It was in that moment that I chose to grow better.  I reassessed my life and how I functioned within it.  My priorities changed. Now, every day, I make a choice to be optimistic and kind to those I encounter.  I am determined to truly listen to those around me.  I dive deep into my spirituality, because what good is all this without the love of God beside me.  I have realized that I am stronger than I ever thought or knew I was.  Most of all, I am grateful for my life.  His death taught me about living; it also changed a job into my vocation.  I wish I could tell his mom how much he touched my life and changed my attitude.

When I made the promise that I would never grow jaded, I also vowed that if there ever came a day when I, too, was emotionless, mechanical, and cold, I would hang it up. Yet, how do I remain optimistic despite the heartbreaking things I regularly see?  The truth: there is no simple answer.  Thus, Inspired Pharmacist was created to document this journey, my journey.  A journey of gratitude, hope, love, and resilience – the good drugs of life.

*Names and some details changed to protect the privacy of others
Copr 2019 Inspired Pharmacist