Barbara Karnes

Yesterday we put our seventeen year old cat to sleep. Euthanized is the proper term but “put to sleep” has a peaceful feeling and killed has an awful feeling. I work with dying situations all the time, 42 years to be exact. But this was personal, this was our Danger cat. (I know, a totally inappropriate name for the biggest scaredy cat I’ve ever seen. Husband Jack thought the name would give her courage.)  Over the years we’ve had many animals: dogs, cats, rabbits. All have been indoor, live with us animals. Yes, even the rabbit was cage free and lived in the kitchen. I’ve seen death,... Continue Reading

Most medical professionals will try to keep you alive even though they know they won’t succeed. Because that is what they are taught to do.  Do you want it any other way? Do we want it any other way? Yes. We do, at least I do.  I want the medical profession, the medical model we find in doctors’ offices and hospitals, to do everything possible to help me not only regain my health, but to return from an illness with the energy and ability to enjoy life.  It doesn’t have to be perfect. Running, jumping, or even going back to work. But I do want to be able to respond, to enjoy, to feel,... Continue Reading

When I started in hospice, in its beginnings in the late ‘70s, hospice met all end of life care needs. In fact, hospice was the only healthcare service meeting any end of life needs. However, most people had never heard of the concept. Fast forward 40+ years. Hospice is widely known for providing end of life care. It has grown in size and in its original scope of services. Even its definition of “end of life care” is changing, and 40 years later, hospice is not the only game in town. End of life doulas and palliative care have become part of the end of life care being offered.  Hospice provides... Continue Reading

Dear Barbara, My father is 95. He has been in pretty good health but has started sleeping a lot in the day and is not eating very much. Is it possible that this may be a sign that the end is near? Your blog says sleeping more and eating less is a sign that relates to months before death. There are two ways to die, fast or gradual. There are two kinds of gradual dying. One is from disease (it can take months), the other is simply old age (it can take years).  With old age and no active debilitating disease process, all the signs of approaching death (less eating, more sleeping and gradual decline... Continue Reading

The sacred moment of death – that is the goal for those of us who work with end of life. Guiding, supporting and teaching those present what is normal in dying and what is not. What is fixable and what is not. What is painful and what is not. What to do and what not to do. What to say and what to be silent about. All the work we do leads up to the moment of death. Our goal is to guide and support those present through the moment the last breath occurs. How do we do that? How do we support and guide? We first give information. We teach the signs of approaching death. Teach what is normal and... Continue Reading

How do you tell someone something they don’t want to hear? Very carefully and with compassion in your words. In thinking about the answer to the above question I have two different answers. Those answers depend on who is delivering the information. Physicians: Nobody wants to hear they can’t be fixed, treatment is no longer working. BUT, it is your responsibility, as a physician, to tell a person whatever “bad” news you have determined. “I am having a difficult time fixing you. The medicines, the plan of treatment is not doing what we had hoped.” A part of a physician’s responsibility... Continue Reading

I’ve been thinking about funerals. Doesn’t everyone? Maybe not. What does a funeral do? It honors the person that has died and brings support and comfort for the living. Funerals are about people coming together, a “send off” kind of gathering and sharing support for the beginning of our grieving journey.  We used to lay the body out in the living room. Family and friends came to our home, paid their respects to the one that died and gathered around the grieving. Sometimes church and clergy were involved but often not. Gradually, as we became more “civilized,” our end of... Continue Reading

Dear Barbara, Working in hospice, I always had a terrible time with —  do I stay in contact with the family after the death? I think staying in contact with a family after the death is a personal practice and option. Most of the time there is another patient and family admitted to our full schedule and we get caught up in “there aren’t enough hours in the day” living.  I do think it is healthy for us to attend the visitation of our patient. It brings us closure and is appreciated by the family. The visit is our way of paying respect to the patient and family. It is also... Continue Reading

I received a letter from a woman whose father recently died. She explained all the surgeries, medical interventions, TPN, gastrostomy,  multiple catheters, medicines, and hospitalizations that she, her father and their family dealt with over an 18 month period.  She lamented that no one in the medical arena, except one woman who used to be a hospice nurse, talked with her or her family about her father dying. There were many different medical interventions offered. As horrific and overwhelmingly sad as this experience was for this family, I’m sorry to say it really is quite typical of our... Continue Reading

Dr. Bob Lehmberg, husband of Jennifer O’Brien, author of The Hospice Doctor’s Widow, used the term “Precious Time” with his palliative care and hospice patients and families who were dealing with end of life situations. I LOVE that phrasing “Precious Time”.  What does it mean? Doctor Bob’s definition was “Precious Time is a type of time, a distinct period of life. Precious Time may indeed start upon the life-limiting diagnosis or it may start as death nears or becomes imminent. It is a gift to recognize that you have entered into Precious Time with a loved one.” In our medical... Continue Reading