RP401– Dying and Death



Session Readings

 

Background

Coping with death and dying is often 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 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.

At its core, the experience of Death and Dying, 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.


Objectives:

  1. Identify your initial reaction to death. Recognize differences depending on the age of a patient, whether it is anticipated or unexpected, the location where a patient dies (Home vs. hospital, stateside vs. deployed)
  2. Explore the source(s) of those reactions, including:
  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.

Assignment
Prior to the session,  review 1-2 of the provided videos/articles, 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. 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.

Identify your thoughts and reactions, and come prepared to discuss:

  • 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 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
    • one’s experiences with death and dying growing up
    • one’s views on advance directives and end of life care (to include Hospice)
    • one’s religious views
    • advance directives, etc.

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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NPR"Still Point": A Mediation on Mothering a Dying Child - Emily Rapp The struggles and emotions experienced parenting a child with Tay-Sachs disease.
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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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Button PoetryDeceit & I RJ Walker performs this emotion-provoking poem about the large role that deceit undeniably plays in our lives and careers as a tool to save others from pain.
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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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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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family-medicineUnwinnable Hands A great narrative that uses the metaphor of playing cards to the experience of life, dying & death. Life is not about always having a winning hand, its about being able to play the cards that are dealt and having the courage not to fold.
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Session originally created by: Adam Saperstein | SOM/GSN, Uniformed Services University | Director, Reflective Practice | Family Medicine