Friday, May 31, 2013

How to Enjoy the Last Few Months of Your Life Rule # 1: Forgive yourself!

Patients and family members often face feeling of guilt during the last few months of life. This feeling could include anything from guilt over previous encounters with loved ones to guilt over treatment options.

Forgiving yourself is a skill so few of us have the ability to accomplish. 

In the New Testament, Jesus speaks of the importance of forgiving or showing mercy towards others. Jesus repeatedly spoke of forgiveness, “Be merciful, just as your Father is merciful.” Luke 6:36 (NIV) “Do not judge, and you will not be judged. Do not condemn, and you will not be condemned. Forgive, and you will be forgiven.” Luke 6:37 (NIV) Jesus asked for God's forgiveness of those who crucified him. "And Jesus said, 'Father, forgive them, for they know not what they do.'" Luke 23: 34 (ESV)
Self forgiveness is extremely powerful and can help patients and their loved one to enjoy the last few months of life.

Here are 10 ways to forgive yourself
1. Accept your emotions
2. Let go of other people's expectations for you.
3. Stop punishing yourself
4. Practice self acceptance.
5. Love yourself and give yourself permission to heal.
6. Laugh more; it'll give you more freedom to stop taking it all so seriously.
7. Enjoy positive experiences consciously and don't seek to downgrade them.
8. Be grateful for what you do have – great relationships, a home, a family, an education, abilities, interests, hobbies, pets, health, etc. Look for the good in your life.
9. Be self-compassionate. Shift your thoughts to more fulfilling, value-focused things when negative reproaches arise.
10 Apologize if others have been involved and you have not already done so, or you have not done so genuinely. Only do this when you have changed your negative outlook and if doing so will not harm that person.

It's perfectly fine to say: "I am not proud of what I've done (or how I've devalued myself) but I'm moving on for the sake of my health, my well-being, and those around me." Affirming this is healthy and allows you to break the cycle of self-harm you've fallen into because you openly acknowledge what was wrong and the intention to set it right from now on.

If you’re trying to heal, learn to forgive. Forgive others without resentment and most importantly, forgive yourself. We all screw up but then we all breathe and cry and hurt, too. We’re all human.

Sunday, May 19, 2013

When should palliative team be involved in your care?

48 year old male got admitted to our hospital for stage 4 gastric cancer. He was previously followed in another facility. However, he was told that his choices were limited and hospice program was introduced.  He did not like the idea of withdrawing care and as such he came to our hospital for exploring other options.

End of life issues are difficult subjects for patients, family members and physicians.

1. When should palliative team be involved in your care?
2. How to improve communication with patients who want "everything"

1. When should palliative team be involved in your care?
  • Declining ability to complete activities of daily living
  • Weight loss
  • Multiple hospitalizations
  • Patient, family or physician uncertainty regarding goals of care
  • DNR order conflicts
  • Use of tube feeding or TPN in cognitively impaired or seriously ill patients
  • Patient or family psychological or spiritual distress
  • Admission from a nursing home in the setting of one or more chronic life-limiting conditions (e.g., dementia)
  • Two or more ICU admissions within the same hospitalization
  • Prolonged or difficult ventilator withdrawal
  • Metastatic cancer
  • Anoxic encephalopathy
  • Consideration of patient transfer to a long-term ventilator facility
  • Family distress impairing surrogate decision making

2. How to improve communication with patients who want "everything"
  • Family Meeting: where and who should be there
  • Pain Control
  • Risk and benefits of chemotherapy and radiation therapy - Should financial burden be part of decision making
  • Is hospice a happy ending
  • How to interpret studies on new chemotherapeutic medications.
  • What are risks and harms of hospice; Does hospice facilitate Death?
  • Do you screen for depression before hospice agreement? Do family members ever regret the decision of hospice?