RP101 – Dying & Death (Jan 2019)



Session Readings

 

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.

Learners in this curriculum have had 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, think 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, and this will help you to identify the sources of your reactions. You can also consider how exposure to death and dying via movies, TV, or video games influences your context.

At its core, the experience of dying and death, for those who remain alive, includes a sense of loss, and sometimes, as providers, as sense of failure. 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.


PANELISTS

Dr. Tracey Murray, DNP, is a Dean and Professor of the College of Health Professions, Director of the Health Centers, Coppin State University, Baltimore, MD.

Dr. William Rowley (RDML, ret) is a retired USN vascular surgeon, who also held the jobs of deputy commander of NNMC Bethesda, Commanding Officer of NH Camp Pendleton and NMC Portsmouth, and ultimately served as Fleet Surgeon for the US Atlantic Fleet, amongst many other roles.

Dr. Grigory Charny, MAJ, USA, is an emergency medicine physician, course director for Combat Medical Skills and Gunpowder MFP201, and an Assistant Professor in the Dept of Military and Emergency Medicine at USU.


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

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. Consider a lesson you learned either from the panelists or the resources, and think about how you might specifically take action around it.

Make sure to also include:  What question would you want to bring to the group discussion to further explore?

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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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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New York TimesHelping patients face death, she fought to live A palliative care doctor, faced with extensive metastatic cancer, grappled with what she recommended for patients and what she wanted for herself - which was treatment and cure, at all cost.
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New York TimesHow long have I got left? A young neurosurgeon describes his struggle with living and dying, in the framework of incurable cancer.
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The New YorkerLetting go What should medicine do when it can't save you? Dr. Atul Gawande examines the way doctors try to approach death and dying - sometimes well, often inadequately.
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TED_light_200x200Dying Well Is there a way to talk about death candidly, without fear ... and even with humor? How can we best prepare for it with those we love? This hour, TED speakers explore the beauty of life ... and death. When you click on the link, you can see all the little segments or listen to the whole thing. It's lovely.
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New York TimesHow Doctors Die: Showing Others the Way by Dan Gorenstein A doctor’s personal account of finding the courage to break the pattern and stop fighting.
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Session originally created by: Adam Saperstein | Uniformed Services University | Admissions Medical Officer, USNA | Assoc Prof. Family Medicine