Viewpoints

How we should all be treated at end of life

Music used to de-stress and calm dementia patients

Therapist Nicole Johnson and Eskaton in Sacramento are part of a pilot study in California nursing homes, using iPod music to de-stress and calm patients with dementia/Alzheimer's. With help from family members, they develop a personalized music p
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Therapist Nicole Johnson and Eskaton in Sacramento are part of a pilot study in California nursing homes, using iPod music to de-stress and calm patients with dementia/Alzheimer's. With help from family members, they develop a personalized music p

Mounted outside every room at my father-in-law’s memory-care center were glass cabinets with photos of each resident’s earlier life. In Nachum Meyer’s case, one snapshot showed him as a dashingly handsome man in his 20s, when he was trying to make it as an actor.

Other shadow boxes pictured lean men in their military uniforms during World War II, and vibrant women in nurses’ garb. Many wedding photos showing copious amounts of shimmery white satin.

 
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The idea is probably to remind the staff that their often vacant-eyed clients are real people with rich, romantic histories. Maybe the caregivers are reminded that one day, they might be in a place like this, and think about how they’d like to be treated.

In Meyer’s case, though he was generally calm, clear-eyed and semi-coherent, he’d lost too many verbs and nouns to tell them that he had started a beach carnival along the shores of the Mediterranean, owned a New York night club and once had been a gunrunner.

What they knew was that, depressed by boredom, the death of his wife two years earlier and the loss of the pride and independence he’d fiercely guarded, the 90-year-old with the hard-to-pronounce name spent much of his time sleeping or wishing aloud for death. By and large, the staff left him to do so. He felt humiliated to find himself there. While he was more mobile, fit and coherent than other residents, he also had a propensity to wander, dangerously, and needed a locked facility. Family visits were his only happier times.

So it was hard not to feel a sense of release and perhaps even thankfulness when his death wish came true late last month, the result of a sudden brain bleed. Something else to be thankful for: The emergency room doctors didn’t rush to insert a food tube or hook him up to a respirator. Instead, they called his family and asked what the advance medical directive called for – which was to leave him be.

Many readers have written to me in recent weeks to tell harrowing stories of hospitals that didn’t respect the wishes of dying patients or their relatives. Jim Cramer of Davis is still rightly upset about the ER doctor who, despite the directive and the family’s objections, galloped down the hallway to perform some heroic measure that had no real chance of success, while Cramer and the oncologist chased after him.

My father-in-law was among the luckier ones. Though he didn’t enter hospice, the hospital placed him in a palliative care unit. Semi-conscious, visited by friends and relatives, he drifted through the next couple of days until death.

Maybe we’re getting better when it comes to allowing people to die, at least when they are savvy enough to know their options. What we haven’t found yet are ways to make the last months and years of the very sick more comfortable and meaningful. We warehouse many of the elderly in places that try their level best, but allow the elderly to shrink into near-nothingness.

The last stage of life is exactly that – a stage of life. How do we want to live it?

Karin Klein is a freelance journalist in Orange County who can be contacted at karinkleinmedia@gmail.com.

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