RP101 – Dying & Death (Jan 2018)



Session Readings

 

**PLEASE SEE PRE-SESSION ASSIGNMENT BELOW. IT IS IMPERATIVE THAT YOU REVIEW THESE SOURCES AHEAD OF OUR PANELISTS’ STORIES**

BACKGROUND

Coping with death and dying can be challenging.  Although death has been noted to be the one great certainty of life, the dying process is replete with uncertainty, and this dichotomy can be stressful – for the individual facing death, their family members, and those who care for them.  As a topic which most people do not discuss frequently, the impending death of someone with whom we have a connection both forces us to examine our own views about death and dying and to navigate the discordance that may exist between our views and those of others. Doing this in our role as healthcare providers requires thoughtfulness, self-awareness,  and skill in order to ensure that our patients’ needs, and those of their families remain our focus during these times.

It its important that we recognize that although military healthcare providers likely encounter death and dying more frequently than most, the impact of these experiences on our lives is no less profound.  Indeed, these experiences, and our reactions to them, have significant implications for how we treat our patients.  It is also important to recognize that among learners in this curriculum, there is a wide range of experience with death and dying.  In past years, some students struggled to identify their personal context as it relates to Dying and Death, noting that they had no personal experience with the death and/or dying of someone with whom they had a relationship. For those of you who fall into this category, I think you will find, as have students in the past, that thinking about your perceptions of the way your family of origin and the community/ies of which you have been a member (geographical, religious, organizational, or otherwise) dealt with dying and death, including avoiding its discussion, will help you to quite readily identify the sources of your reactions.

At its core, the experience of Dying and Death, for those who remain alive, includes a sense of loss. How we cope with the dying process, the death of others, and our sense of loss has significant implications for our care of patients and their families.  There are many facets to this topic, and we explore just some of them in this session.  With this in mind, I welcome you to join us in our exploration of this important topic.


PANELISTS

  • CPT Daniel Fedderson is a current member of the GSN Clinical Nurse Specialist (CNS)/Doctorate of Nursing Practice (DNP) program, class of 2019.
  • LtCol Chris Jonas is an Assistant Professor in the Department of Family Medicine. He has deployed in support of OIF and worked at the White House Medicine Unit.
  • CAPT Jeffrey Quinlan is the Chair of the USU Department of Family Medicine. His career has spanned over 26 years, and includes being stationed overseas and 3 deployment-related tours at Guantanamo Bay, Cuba.

OBJECTIVES

By the end of the RP101 session on Dying and Death, through written and verbal expression, students will demonstrate the ability to:

  1. Identify their conception of death, their “gut reaction” to the thought of their patient’s death, and their concerns about their patient’s death to include:
    1. The personal loss entailed in the death
    2. Thoughts about their own mortality
    3. Their faith and spiritual beliefs, if applicable
    4. Concerns about their own competence
    5. Concerns about how they might appear to their patients’ family, colleagues, others with whom they work, family and friends, and perhaps most importantly, themselves.
  2. Explore the source(s) of those reactions, including:
    1. Their experiences with death at different points in your life
    2. How they perceive death to be viewed by: the family/community in which they were raised, their current family/community, the medical community, the military community, etc.
    3. Their thoughts and feelings about death depending on: the age of a patient, whether it is anticipated or unexpected, the location where or the manner in which a patient dies (Home vs. hospital, stateside vs. deployed)
  3. Analyze how their reactions to death and dying may influence, both positively and negatively their care of a patient and their family prior to their death (when death is anticipated) and after their death
  4. Develop a plan (not a goal) to mitigate the negative and enhance the positive implications identified.

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ASSIGNMENT

Preparation for the panel
Prior to the panel, reflect on your conception of death and your past experiences with loss – including those involving the death of friends and family as well as patients, if you have had such experiences. In addition, reflect on your perspective on death of people at various ages, including children; concerns about your own competence when caring for a patient who dies; thoughts about your own mortality and fears about death; and your views on end of life care.

–Please watch the video, created by CPT Fedderson, which is a tribute to his child and provides background for his narrative on the panel. The link is on Sakai.

Reflective Essay (R.S.I.P. format)


Reaction: As stimulated by the panel and supplemental resources, identify your thoughts and reactions, including each of the following:

  1. At least two reactions to the panelists’ narratives or supplemental resources that struck you as particularly poignant.

Sources/Your Story: Through the medium of your personal narrative, explore the sources of these thoughts, feelings, and reactions. Your narrative must include specifics and be written in the first person. Your sources will likely include one or more of the following:

  • your perceptions of how loss in general and death in particular were/are viewed in your family of origin, faith group, community, and among your peers (both growing up and now)
  • your perceptions of how loss and death are addressed by your faith group
  • your experiences to date with loss in general and death in particular
  • your perceptions of how loss and death are viewed in the military and medical communities

Implications: Keeping in mind what your reactions and the sources of those reactions reveal about your perspective on loss and the death of your patient, analyze both the positive and negative implications of this perspective for how you might care for patients in the future.

Plan: Develop a realistic and specific plan (NOT A GOAL) to mitigate the negative and enhance the positive implications described in your Implications section.

TEDxLet’s Talk About Dying by Peter Saul A discussion of the success of intensive care and how that has impacted how we die, and how we react to others’ death in the 21st Century.
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Journal of General Internal MedicineDying for the First Time by Jesse Kane, MS III Sackler SOM A medical student’s reflection on the first patient he watched die - a story of observing a Code run in the hospital. Brief and poignant.
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New York TimesHow Doctors Die a look at how - and why - doctors often choose differently from their patients when making decisions about their own deaths.
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TEDxShould We Be Afraid of Death? by Stephen Cave Why are humans afraid to die? Four stories we tell ourselves about death in reaction to our fear.
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NYTAt U.S. Hospital, Reflections on 11 Hours and 91 Casualties Dec 21 - a date these soldiers will never forget - where the casualty level greatly surpassed what everyone was prepared for - logistically and emotionally.
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RadiolabSight Unseen (must download to hear) Listen to a family's reaction after learning that their son's death had been documented by a photographer embedded with a medevac team in Afghanistan.
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Death Over DinnerDeath Over Dinner How we want to die represents the most important and costly conversation America isn’t having. In response, The Conversation Project has gathered dozens of healthcare and wellness leaders to cast an unflinching eye at end of life, and has created an uplifting interactive adventure that transforms this seemingly difficult conversation into one of deep engagement, insight and empowerment.
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TEDxBrain Surgery with Words Dr. Ray Barfield is a pediatric oncologist at Duke University and director of pediatric palliative care for Duke. He co-leads The Healing Arts Institute that brings together students from the schools of medicine, nursing and divinity around issues of illness, suffering and death. In this moving TEDx talk, he discusses how he approaches the discussion of dying and death with pediatric patients and their families.
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Session originally created by: Adam Saperstein | SOM/GSN, Uniformed Services University | Director, Reflective Practice | Family Medicine