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... r even more pain during her hyperthermia treatments. The hospice nurse, Janice, made a decision to speak with Henrietta's doctor about pain medicine behind Jim's back. She felt this was necessary, but it also was a very difficult decision to make. Often the family of the dying patient suffers denial, just like a patient may. Janice's promise to Henrietta to allow her to have a dignified death by removing the bandages across her chest before the response team arrived at the time of her death, was not met, but the discussion helped Henrietta all the same. "The authors submit that being included - both in information sharing and in decision making - is the crucial factor in an ill and dying patient's feelings of dignity" (1, p. 174).
Up until Janice made her promise to Henrietta, Jim had made all the decisions for Henrietta without really considering her desires. CHAPTER 6 William's initial rejection to hypnosis to control his pain withered as his pain grew stronger. After learning the hypnosis technique he found great confidence and happiness as he could now control some of his pain and also share his imagery with his wife. ""I treasure these days, my love" William whispered to Eva in the king bed one night. "We don't have many left, and being able to keep the pain away is such a gift. You must remember... "" (1, p. 194). His new feelings of control helped him deal with his death. "Wasted and dying, William seemed more a man then he had been for may weeks" (1, p. 194). Chapter Six notes discuss the alleviation of pain by administering drugs and when the limit should be drawn.
In William's case his pain control was very humane, but in such cases were hypnosis is not effective, pain control can be a difficult decision when you have to consider age, level of pain, and addiction issues. CHAPTER 7 .".. some people are bound by ties to the people who love them... In order to die they need some distance, some space in which they do their dying. They can't leave while people they love hover" (1, p. 215). Sandy waited to die until he had reconciled with his mother, as he knew both his parents didn't accept his homosexuality, but he also waited until no one was at his bedside to die.
Sandy's spiritual needs, as defined by Morgan (1, p. 235) were met through his lover, mother, and grandmother and he was just waiting for his moment alone. CHAPTER 8 This family's ability to accept John's dying condition enabled them to make the best of his last six months of life. The intimate moments and conversations this openness allowed them to share, will bring them happiness after his death. Rose, John's wife, wrote in her diary "We can still share some lovely moments - like a glorious sunset last night.
Dad called it a preview, and smiled. " (1, p. 267). In Joan's situation, her final opportunity to release some of her pain was during her eulogy for her father. The notes in Chapter Eight discuss views of death and misconceptions of a patients need to talk about dying. "Too often the people around him believe speaking openly would rob him of hope, not realizing his hope can and must lie in something other than an expectation of cure" (1, p. 276). This statement applies directly to Joan's inability to deal with her father's dying, when he was alive. CHAPTER 9 The nurse's role models in this story helped make her the person she was which enabled her to go on to start her own Hospice center. While keeping an unbiased attitude and watching what she said, she experienced many different cultures, religions and people.
As she reflects upon her life and the people she has touched, it is quite apparent how rewarding she has found her job and life. CRITIQUE In my opinion, I believe Jaffe and Ehrlich took a very organized approach to this subject in their book. I felt the Hospice is... section was particularly well done. A broad definition is usually helpful at the beginning of a book like this.
The fact that hospice was again defined in more detail throughout the book was helpful. The authors addressed the purpose of Hospice care simply, when they wrote "Hospice is comfort care, not care for cure" (1, p. 21). It's plain to the reader that the hospice caregivers are there only to ease the pain of the dying patient and not to give them false hope of recovering. Minnie's story in Chapter Two had the most impact on me personally.
I've always believed that aging / dying family members should be taken care of in outside institutions as to not burden the living. After reading her story my outlook has changed and I truly understand how valuable the remaining time can be with that dying individual. I also feel that this time together before the death helps the grieving process after the patient has passed away because the family is more emotionally prepared for their loss. In Chapter Three, the authors wrote "The deeper the love, the greater the suffering when the object of that love is lost" (1, p. 95). This statement is true, but certainly not fair to the individuals grieving. After losing my friend Adam this Christmas in a car accident, I relate specifically to this statement.
During his wake, I cried not only for my own loss, but also deeply for his mother and girlfriend who will never fully stop grieving for him. Fortunately, they have realized how valuable his time was with them and they can find comfort in knowing how much he was loved by all that attended his funeral and visitation. I enjoyed the reading about the various coping methods in the notes for Chapter Three and found them very helpful in dealing with my own grief. This was especially true of the journal writing. In Chapter Four, I was not surprised at the percentage of patients discussing suicide "But a lot of my patients - maybe nine out of ten of them - speak of it at some time" (1, p. 109). The variety of emotions someone must face upon knowing they are going to die must be exasperating, burdensome and fearful.
Suicide supplies an easy way to end the pain and confusion which they must deal with on a day to day basis. I agree that it was not Janice's (Joseph's hospice nurse) responsibility to dispose of, or question Joseph about his possession of pills. I do feel however, that if he had decided to use them that she would experience a large amount of guilt for not intervening. In Henrietta's case, I was disappointed with her doctor for not prescribing her pain medication sooner. A phone conversation between Janice, Henrietta's hospice nurse, and Jim, her husband occurred: "Janice, I have learned that you want to keep Henrietta doped up. Please understand that I do not approve, and she is not to have drugs.
You are not to discuss this further with Dr. Pemberton. Do you understand?" (1, 162). Jim should not have had so much control over her illness. Her doctor was not forthright enough with Jim and should have taken control of the situation earlier, without Janice's intervention. In Chapter Six, I enjoyed William's new strength he attained after mastering hypnosis and control of his pain.
In the notes "Fear of pain is compelling... Beyond its psychological power, evidence exists that pain and stress can inhibit immune function and may actually promote cancer" (1, 197). I don't believe the human mind can create actual physical disorders, such as cancer, but it may inhibit fighting a disease which is already present. It is unfortunate that homosexuals dealing with AIDS cannot find spiritual fulfillment from the Bible as it labels gays as sinners.
In Sandy's case he did not feel comfortable in his place with God, but he fulfilled his spiritual needs through his reconciliation with his mother and through the love given to him by his lover and grandmother. I agree with chaplain F. Driscoll's statement, that "perhaps the core of hospice work... takes place after symptoms have been brought under reasonable control; that the important thing is helping patients integrate their lives so they can die with some acceptance and satisfaction" (1, p. 233).
I found Chapter Eight the most thought provoking as it discussed our society's views of death with use of poems by Dylan Thomas and Arnold Toynbee. Their poems described our endless fight against dying and denial of death. "No longer do families want to deal with dying. They don't want its disruption in their bedrooms, their living rooms, particularly as the end nears" (1, p. 273). I did agree with this philosophy up until reading this book and learning about the positive aspects of caring for a dying loved one in your own home. When the time comes for me to make a decision such as this, I will be more knowledgeable and likely to accept and encourage this activity in my home. In Chapter Nine, the nurse recalls her memories in a truthful manner with pride and wisdom.
She admits her mistakes, "In that moment I destroyed a trusting relationship. I'll regret my mistake forever, and I've never, ever repeated it" (1, p. 290). The final message of this chapter by Howard Thurman was very touching with a lot of strong emotion behind the words "I share with you the agony of your grief... the strength of caring, the warmth of one who seeks to understand the silent storm swept barrenness of so great a loss. This I do in quiet ways that, on your lonely path, you may not walk alone... " (1, p. 294).
Reading Appendix A, I strongly agreed with Jaffe and Ehrlich's recommendations for more mandatory classes about religion, cultural, and coping with dying patients classes in the medical curriculum, because we cannot truly expect our medical staff to respond appropriately to everyone's needs without offending certain religious and cultural beliefs if we do not help them take a step in the right direction. In summary, my overall opinion of this book All Kinds of Love: Experiencing Hospice, by Carolyn Jaffe and Carol H. Ehrlich was excellent. This book challenged my morals and changed my views about in home care. It's reassuring that this kind of care is available not only for myself, but also for the people I love.
Bibliography Ehrlich, Carol H. , and Carolyn Jaffe (1997). All Kinds of Love: Experiencing Hospice. Amityville, New York: Baywood Publishing Co. , Inc.
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