Death and dying

Death and dying are events with which, you will at sometime, have to cope. For the most part, the patient will probable be elderly and you will console yourself with the understanding that "he lived a long life." Keep in mind, though, that there may, very possibly, be a "better half" to this patient. A "better half" that must now go on living, without his/her best friend. It's been suggested that when a spouse loses his/her mate, that the first words spoken to the surviving spouse by a member of the resuscitation team, after resuscitation has been withheld, are words that the survivor will remember forever. But the team can't just pack up their gear, walk out of the house, and ignore the poor survivor. Something has to be said. Just understand the impact that your words will have. You might want to start by suggesting that "We have to talk. It's not good." Go on to explain, in simple terms, exactly what condition the patient was in when you arrived.

Continue, by explaining what was done, and maybe what wasn't done (and why, if you can.) Make sure that the survivor knows that everything that could be done for the patient was done. And, even if the survivor did something that may have added to the failure of the effort, assure him/her that they (him/her) took the appropriate action under the circumstances.

Death and dying

To lead them on any other path will only create a life of guilt for them. At some point, you will have to tell them that their loved one has died. You need to be specific, and use the word "died" or "dead." Euphemisms like "passed on," "no longer with us" will only serve to confuse the survivor. You may want to offer to accompany the survivor to the bedside of the patient, for the purpose of saying "good-bye." Watch the survivor very carefully during this entire event. If the information is turning into a critical event for the survivor, stop, give them some time to digest the information that has been offered to that point, and ask if they are ready to hear more. Do not rush the process. Do not force any information or action on the survivor, that they feel they are not ready for.

Also, do not discount the effectiveness of non-verbal communication. A caring hand on the shoulder or a caring hand offered for holding, can say more than words are capable. Keep in mind that you may have a second patient on this scene, the surviving spouse. If you "push" them, they might become a patient a lot sooner than they would had you given them the time that they needed. Finally offer information about what's going to happen next. For this reason, it's best if, before hand, you are aware of what local protocol is, regarding unattended deaths in your area. Offer to call a family member, church pastor, close neighbor, someone, who can spend some time with this individual. They are probably going to need an adjustment period into the concept of living alone. It a "new trick" for an old dog. Be prepared to deal with a whole room full of different emotions. From grief, to rage, anger, denial, despair. Don't be surprised if some, or all, of it is directed at you. Do not let your guard down. Do not allow yourself to be hurt or injured by this individual. It's common practice throughout the States that a police officer be present at such an event (unattended death.) If you feel threatened, "invite" the officer to move closer to you.

If your patient isn't dead, but dying. Don't lie to them. Answer direct questions with direct answers. Half-hearted denials are easily detected by patients, and the patient's imagination, left to create "the worst" will do just that. Explain, in simple, detailed language, exactly what can and will be done for them. Impress them with your professionalism. They will draw comfort from it, knowing that if they are unable to care for themselves, that you (and the rest of the team) will do it for them. Find obvious "positives" to bring to their attention, but don't make stuff up. During a class at the squad building, a man burst through the door, and SCREAMED, "I've just been stung by a bee." His obvious concern was that he was highly allergic to bee stings, and he was afraid that soon, he wouldn't be able to breath. We walked him to the back of an ambulance, and "hooked him up" with some oxygen, called the dispatcher and a squad was summoned. We returned to the patient to assure him that he would be at the hospital in a very short time.

While talking to him, we noticed that he was talking in long stringy sentences through the oxygen mask. He was told that the emergency was going to be treated like a full-fledged emergency, but we wanted him to "know" something. "What's that!" was his response. "Right now...., you're breathing," was our reply. The patient cocked his head, took a few easy breaths, looked us in the eye and said, "You're right." He immediately relaxed, and that relaxation served to protect him. You see his heart rate decreased. The flow rate of blood through his body slowed. If there was venom in his blood, and he was allergic to it, it (the venom) was moving through his system more slowly, giving us more time to get him to the definitive care that he needed. All because the "obvious" was brought to his conscious awareness. He thought he was dying. If your patient is confused or disoriented, do not play into any delusions, and make every effort to orient the patient. If your patient is a substance abuse patient, you'll need to become educated in "body language." Look for small signals of irritation. Restlessness, staring, clenched fists. More on that later.

If you find yourself overwhelmed by the number of patients that you suddenly have, you are probably in the middle of a mass casualty incident. Get help. Lots of it. If you are aware that a mass casualty incident exists, and you are alone, because the rest of the team hasn't yet arrived, do not enter the scene. You cannot accomplish anything by yourself, and until you have adequate resources this scene must be considered unsafe for you to enter. Wait. We'll get into more of that later, too.

As treatment modalities unfold for different types of patients, we will alert you to the specific dangers (if any) associated with the patient or the environment in which you are working, Hopefully, that will help solidify the information about the danger by associating it with either a certain type of patient or a certain environment.

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