Posts Tagged With ‘ Barbara Karnes ’

Terminal restlessness is a medical term for agitation as end of life approaches. It usually begins one to three weeks before death from disease or old age. The restlessness shows itself  by random body movements, hands picking the air or clothing, mumbling, talking but not making sense, by just not being settled and quiet. The person is now beyond expressing with words. There are few if any rational conversations. This restlessness can be a lack of oxygen to the brain but more likely it is just part of the natural way we die. We are all going to be afraid to some degree as we approach death. This... Continue Reading

Dear Barbara, I work for a hospice. We have had a couple of patients die by suicide. Do you have any suggestions on care for our staff as they are having difficulty processing these deaths?  Most people who can’t be fixed think about suicide in the months before death. Interestingly, very few actually do it. It takes a great deal of courage to end your life. BUT when they do, we as healthcare workers, tend to think “what could we have done to prevent this?”  I’m going to go out on a limb here and give you something to think about: Most of our patients (actually most people)... Continue Reading

First I’m going to switch from the word Alzheimer’s to the word dementia. Alzheimer’s is a specific disease associated with dementia. Dementia as defined by the Oxford Language Dictionary is a “condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking and often with personality change, resulting from organic disease of the brain”. The CDC states that dementia is “not a specific disease but is rather a general term for the impaired ability to remember, think or make decisions that interferes... Continue Reading

I just finished answering five comments from my YouTube video on Morphine. There is so much misunderstanding, anger, and outright hate surrounding hospice and narcotic use. Why? What has happened to cause such vitriol?  My first response is lack of education. Lack of time spent with primary caregivers and families teaching them about pain management at end of life. Teaching them about the signs of approaching death, teaching them what is normal and natural as death approaches. As I’ve said many times people don’t die like they do in the movies but unless we teach families the difference,... Continue Reading

Dear Barbara, what can you tell me about any differences in believers and non-believers as they approach death? It’s interesting, it seems that lately I have gotten several questions dealing with “believers” going  to heaven and “non-believers” being more frightened than believers. So here are my thoughts.  I realize I will not please everyone with my answer but here goes: I do not see a difference between “believers” and “non-believers.” Most of us, no matter our belief, approach death with an element of fear. We haven’t died before, it is the unknown, and it is scary... Continue Reading

We, who work in end of life care, offer guidance, directions, information, how-to’s and what-to-do’s but after the words are given and repeated over and over what do we do? What do we do when there is nothing more to say? What do we do when we have no answers to give? When no amount of knowledge can change what is happening. Nothing can affect what is happening. I vividly remember, even though it was probably 30 years ago, sitting by a young woman’s bedside. We were talking about, well actually she was talking about and I was listening to, her anguish of being so young and faced with dying... Continue Reading

As I write this, I am thinking I may stir up some feelings. Please remember my goal is to give you something to think about. Filling out an Advance Directive when you are healthy is different than filling one out when you are elderly or living with a serious illness. When we are healthy we look at life differently. We operate from an intellectual perspective. We think “if I am faced with a life threatening illness or am in a medical situation where I can’t be fixed, I don’t want a lot of tubes and machines keeping me alive. If I am not able to participate in life, just let me go”. OR... Continue Reading

I received a letter from a man who had been very ill. During some of that time he was delusional, confused, disoriented and agitated. His family has told him that during the time of his illness he was mean, uncooperative, a really nasty person. He is now puzzled by how he could possibly be that person they described.  As people approach death in the weeks, days, and even hours they can experience the same behavior this gentleman described. It has the medical name of terminal agitation. Why do we say and do what we say and do during times of intense trauma? I’m not a psychologist, but it seems... Continue Reading

I got a letter telling me that we, healthcare professionals and doctors, should not tell people they are going to die. The letter got me thinking about why I believe a person should be told, and also wondering if there are indeed people that don’t want to know.  Let’s start with people that don’t want to be told they can’t be fixed, that death is in their near future. If you don’t want to be told that kind of information then you definitely need to have an Advanced Directive stating your wishes. You need to have “the talk” with your general physician and with your family. If you... Continue Reading

Dear Barbara, How can I help my family decide whether to “pull the plug” on my ex-husband? He is on life support machines right now. Also can you give me some advice as to the Death Doula role for pulling the plug?  I don’t know the details of your ex-husband being on life support so I can’t give you specifics. What do you say? As an ex what is your relationship to your ex-husband’s family? Will they appreciate your input or resent it?  If you have no relationship or a challenging one then stay out of it. You have no place in decisions, even if he is the father of your... Continue Reading