Physician's Guide to Coping with Death and Dying

Physician's Guide to Coping with Death and Dying

Jan Swanson
Alan Cooper
Copyright Date: 2005
Pages: 216
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  • Book Info
    Physician's Guide to Coping with Death and Dying
    Book Description:

    In "A Physician's Guide to Coping with Death and Dying" Jan Swanson and Alan Cooper, a physician and a clinical psychologist with many years of experience, offer insights to help medical students, residents, physicians, nurses, and others become more aware of the different stages in the dying process and learn how to communicate more effectively with patients and their families. They also discuss the ways physicians and other caregivers can learn to reduce their own stress levels and avoid the risk of burnout, allowing them to achieve balance in their lives and be more effective professionally.

    eISBN: 978-0-7735-7210-2
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. List of Figures and Tables
    (pp. vii-viii)
  4. Preface
    (pp. ix-xii)
    • 1 Understanding Death
      (pp. 3-13)

      According to a Buddhist tale, a woman was unable to accept the death of her child. After asking many people in her village for help, she finally approached the Buddha, who said he could help her. Before he did so, though, she must bring him a mustard seed from a house in the village in which no one had ever died. She went from house to house, asking for the mustard seed, but could not find a single home untouched by death. When she finally returned to Buddha, she was empty handed. She knew the time had come to bury...

    • 2 Stages of Dying
      (pp. 14-38)

      Beginning in the 1960s, physicians and other theorists began to develop models of death and dying. The most popular is probably Elisabeth Kübler-Ross’s theory. Charles Corr, Barney Glaser, Anselm Straus, and Robert Buckman developed other theories. These theorists helped bring the concept of death and dying to the public and physicians’ attention (Copp, 1998).

      In her pivotal 1969 bookOn Death and Dying, Elisabeth Kübler-Ross described the five stages a person goes through when dealing with death: denial, anger, bargaining, depression, and acceptance (Kübler-Ross, 1969). When in denial, the dying person attempts to refute or escape the death sentence. The...

    • 3 The Physician’s Role in a Peaceful Death
      (pp. 39-61)

      A peaceful death. These three words conjure up as many images and responses as there are people. In order to explore this area as fully as possible, the authors focus on the following questions:

      What constitutes a peaceful death?

      What constitutes a unpeaceful death?

      And for those who have experienced the death of a loved one:

      Do you believe your loved one died a peaceful death?

      How was the physician involved in that death?

      Some of the physicians in the authors’ sample emphasized the patient’s emotional and spiritual state when deciding whether a death was peaceful or not. Sally Knox,...

    • 4 Treatment Options
      (pp. 62-70)

      Today, traditional and complementary medical treatments are both available to the ill. Patients are so inundated with options, that they may be overwhelmed when deciding what to do. As the authors show in this chapter, patients make decisions based upon their values, goals for the future, and past experience with illness. Here are some responses from the authors’ study:

      One cancer patient, Mike A., decided against chemotherapy; he felt that the treatment would not prolong his life and would also make him ill, preventing him from having quality time with his family.

      Johnny N., who had coronary artery disease, decided...

    • 5 Talking with the Dying Patient
      (pp. 73-89)

      When speaking with dying patients, physicians should try to be as relaxed and as natural as possible. They are more likely to appear relaxed if they sit at eye level with their patients and maintain eye contact. Once physicians develop trust, dying patients will find it easier to talk about what they want. Doctors should encourage their patients to talk and will do so if they tell patients that they want to hear their thoughts and feelings at this difficult time. Doctors must not interrupt or correct their patients; instead, they should focus their attention on their patients and acknowledge...

    • 6 Facing the End of Life
      (pp. 90-97)

      Not everyone in the authors’ sample was afraid of death. Alan Hamill, an aids physician who recently died, said, “I’d rather it not be messy, but I have little fear regarding death itself. I recently had a near-death experience. It was very calm, peaceful, and reassuring.”

      For most people, though, death is terrifying. Patients fear they may be extinguished into nothingness or that they will have to account to God for sins they have committed. The authors learned from those who participated in their study that what many people fear most is not the moment of death or death itself,...

    • 7 Death in the Emergency Department
      (pp. 98-103)

      When someone dies in the Emergency Department (ed), the medical team faces a special set of problems when they notify family members and then deal with their grief. The impersonal nature of the ed, the lack of a relationship between the physician and the patient and his/her family, and the suddenness of the death combine to make talking about the death to the family especially difficult (Rutkowski, 2002).

      An ed staff tends to be very busy handling everything from sore throats to twisted knees and everyone from accident victims to attempted suicides. Though not intentional, ed staff members may be...

    • 8 Death and Children
      (pp. 104-119)

      The death of child, adolescent, or infant is extremely painful and emotionally wrenching for families. Most parents will tell you the death of a child, whether just a toddler or an adolescent, is even harder to bear than the death of a spouse. The pain cuts much deeper because parents bring their children into the world, so the death means that they have lost both the child and a part of themselves. A childhood friend of JS died of renal failure when she was a teenager. Her father, who had adored his daughter, was devastated. He literally drank himself to...

    • 9 The Spiritual Needs of Children Who Are Dying
      (pp. 120-126)

      L.L. (Barrie) de Veber suggested that a chapter of this book be devoted to the spiritual needs of children who are dying. He believes, as do the authors, that the physician and health care team must look after children as a whole, because sick children are more than just their physical illness (de Veber, L.L., 2001, personal communication). In this chapter we consider spirituality and how it differs from religion. We will also discuss the spiritual needs of children and how children develop spirituality over their life span. Finally, we will address how health care professionals can help children meet...

    • 10 Physicians as Patients
      (pp. 127-130)

      Joan Lawrence, a psychiatrist in Queensland, Australia, and past president of the Royal Australian and New Zealand College of Psychiatrists, observes that physicians and their patients share a belief that doctors are superhuman, invulnerable to the ills of mankind, and thus immortal. Patients would like to believe that their doctors are never ill. Both doctors and patients alike are upset when a physician is sick. Lawrence cites the example of a colleague who, six months after his forty-ninth birthday, had a crushing pain in the centre of his chest. He ignored the pain for three days, even though his father...

    • 11 Coping with the Death of a Patient
      (pp. 133-148)

      The word compassion, which means “to suffer with,” comes from two Latin roots,comandpassion. When physicians feel compassion, they often bear a very heavy personal cost. When physicians open their eyes to death and grief, they may become aware, like the patient and family, of their own mortality. They may also realize their limitations as healers and remember their past or threatened losses.

      Many doctors deal with death by not becoming involved with their patients. In doing so, they deny themselves a richer perspective on life. As Richard Edlich and Elisabeth Kübler-Ross explained in an article titled“On...

    • 12 Physicians’ Self-Care
      (pp. 149-159)

      While physicians are very good at taking care of others, they often fall short when it comes to taking care of themselves. Self-care is especially important when doctors are taking care of patients who are dying or have died.

      Because physicians give so much emotionally, spiritually, and physically, they also need to give back to themselves. When they become too stoic, believing they can handle everything all the time, they risk burn out and depression, become prone to substance abuse, and may shut down their emotions and feelings for the sake of others. There are times when they have to...

    • 13 Dealing with the Guilt, Getting Rid of Shame
      (pp. 160-189)

      Everyone makes mistakes and many mistakes are insignificant. A doctor’s mistake, however, can cost a life. Americans tend to sue physicians for errors, both avoidable and unavoidable, in some instances causing them to lose their licences to practise. The American system also sometimes punishes doctors harshly for common complications, even if they made no medical errors. A person dying or experiencing complications and another person not wanting these things to occur can trigger a lawsuit. When doctors suffer unmerited punishments, they may feel a false sense of shame.

      While based on science, medicine is also an art. Physicians constantly refine...

    • 14 Problems in Coping
      (pp. 190-196)

      Dealing with death on a day-in, day-out basis, caring for gravely ill patients, and responding to the concerns of family members are all highly stressful and emotionally draining. Physicians need to be rested and alert when these situations arise. This is much easier written than done. The authors know many health professionals, including themselves sometimes, who suffer from bouts of insomnia. Sometimes these professionals are able to turn off the stress of the day. At other times the stress is too great and they simply cannot do so. They toss and turn, fretting over decisions they made during the day...

    • 15 Relaxation Skills, Meditation, and Visualization
      (pp. 199-204)

      Many people bury their anxiety; they pretend it will go away or sooth the tension with alcohol or other drugs. These behaviors will only work for a short term, if at all. There are safe and natural alternatives that can help people reduce their general level of anxiety and muscle tension, tension caused by a particular life situation, and anxiety and tension that interfere with healthy sleep patterns.

      Scanning is an orderly and effective way to pay attention to the pressure and tension points throughout the body. Scanning will reveal that certain areas of the body, such as the neck...

    • 16 Keeping a Journal
      (pp. 205-208)

      InOpening Up: The Healing Power of Confiding in Others, James Pennebaker (1990) explains how writing about life experiences can improve physical and emotional health. He discovered that writing about traumatic experiences for as little as 15 minutes a day reduces visits to a physician, improves immune function, and enhances performance at work. He argues that holding back thoughts and feelings requires a lot of energy. Over time, this energy expenditure stresses the body. Putting emotions into words brings about catharsis and relief and can help a person find meaning within a complex situation. Pennebaker suggests that the person focusing...

    • 17 Spirituality
      (pp. 209-215)

      Many physicians find that spirituality enhances their emotional and physical health, whether or not they believe in a personal God or belong to an organized religion.

      A sense of the spiritual can help a person better understand the meaning of life and care for others. There are many ways to break down the walls of the ego and become part of a bigger whole, spiritually speaking. Albert Einstein touched on this when he wrote:

      A human being is part of the whole called by us ‘universe,’ a part limited in time and space. We experience ourselves, our thoughts and feelings, as something separate from the rest, a king of optical...

    • 18 Opening Up to Others
      (pp. 216-220)

      A dying patient, especially one who is young, can cause emotional turmoil for a physician. JS took care of a man in his early twenties who died, in part, because he had not taken his antiviral medications on a regular basis. At times he would take the medications faithfully, then he would become discouraged and stop. Eventually he became resistant to all antivirals; he had a rising viral load and a very low cd4 count. His resistance to life-threatening illness was almost non-existent. JS felt a great deal of guilt about this patient’s illness and his failure to take his...

    • 19 Leading a Balanced Life
      (pp. 221-232)

      When the authors were in college, they were often asked if they felt “centered.” They never really knew what the word meant until they readCentering in Pottery, Poetry, and the Personby Mary Caroline Richards (1989). She wrote that when the clay is centered on the rotating potter’s wheel, the potter will make a perfect pot. If too much clay is on one side or the other, the pot will fall. Human lives are like that clay on the wheel. If there is too much of any one thing, life will be out of balance; it will fall.


  9. Epilogue
    (pp. 233-234)

    Being a doctor is a gift. Doctors are there when a person is born and when he or she dies. They share in the patient’s most intimate moments and know the patient’s fears and hopes. This is the gift from their patients. By learning how to handle these difficult times and by learning to listen and talk to their patients, doctors can learn about others and themselves and take full advantage of this gift.

    The authors ofA Physician’s Guide to Coping with Death and Dyinghave attempted to lay a foundation upon which physicians can build a caring and...

  10. Resources
    (pp. 235-262)
  11. References
    (pp. 263-278)
  12. Index
    (pp. 279-292)