Arizona has a very large elderly population, so issues about the end of life are often raised by people here, possibly more than in other parts of the country with younger populations. Patients themselves and their families are continuously searching for ways of making the last days of life as comfortable and serene as possible.
In a recent article published in the Arizona Republic (Sept 15, 2010) a study was reported indicating that people who die at home, with or without hospice care, fare much better than those who die in hospitals and ICU care facilities. Additionally, their relatives and caregivers also fare much better. There is a much less incidence of Post Traumatic Stress Disorders when patients are allowed to die at home.
Why such discrepancy?
As a psychotherapist and counselor, I have provided and continue to provide counseling to people at the end of their lives. My role is that of helping them accept and prepare for this last stage of life, not avoid it. This acceptance comes at the end of a process of fighting and resisting the fact that death is imminent.
The first reaction is often of denial, as people scramble with news so scary and overwhelming that they have no way of integrating. They want to believe that there has been a mistake somewhere, that the doctor was wrong. This happens not only to the terminally ill person, but also to his or her family members and caregivers. Each person struggles with his or her resistances, and worries about the other people involved. At times relatives avoid discussing death with a person who is terminally ill for fear of making things worse. At the same time, the terminally ill person may avoid talking about death in order not to upset the loved ones. So, nobody talks and death becomes the elephant in the living room: everybody knows it’s there, but everybody pretends it isn’t.
When denial is no longer possible, anger often sets in: “Why me?” “Why now?” “I don’t deserve this!”
But then, after denying, resisting and fighting, there is a time of reckoning, of coming to terms with this new reality. If this point is negotiated in healthy ways by the dying person as well as his or her loved ones, the last stage of life often becomes less of a battle and more of an opportunity to reflect on one’s life, remember, organize both emotionally and physically and prepare to let go.
Dying is part of life, and as such this stage needs to be seen as any other stage of life, not by avoiding it, but by confronting it. This is the time to make amends, to have closure where there was none, to say what needs to be said before it is too late, to think about one’s legacy and create opportunities to be surrounded by people we love.
This last point is the most important. Any situation where loved ones can be close, unencumbered by machines, tests, procedures and any other form of intrusion but where pain is kept under control and life for the dying person is made as comfortable as possible, is conducive to a more peaceful, serene and shared experience of letting go. After all, isn’t this what life – and death – are all about? To be dignified, connected to people we love and surrounded by them to keep fear under control are the best ways of saying goodbye to life and preparing for the journey ahead.