Meeting the Challenge of Leisure - When faced with iii health

How can you help yourself or others when faced with a serious or terminal illness?

Alvin I. Goldfarb, M.D., former consultant on Services for the Aged, New York State Department of Mental Hygiene, notes the importance of self-esteem, self-confidence, sense of purpose, and well-being to a person who is seriously ill or dying. Supported by the idea, “I've led a good and full life,” older people can face a serious or terminal illness with dignity. Sometimes this acceptance may be almost an unspoken and tacit understanding between the aging and society to help the separation process along.

When a person is terminally ill, the chances are that he is not in severe pain. With the increasing supply of pain-relieving drugs and the possibility of sedation, very few elderly patients suffer greatly with pain. While a fear of death probably exists in most people, when death is actually encountered the fear is seldom overwhelming, even though it may deeply affect others directly involved with the dying patient.

Most patients are at least aware of the possibility of dying soon; those with lingering conditions are particularly adept at self-diagnosis. But more often, they notice a change in social relationships with friends, family, and medical personnel.

Patient-physician relationships can be vital in helping the seriously ill patient retain peace of mind. It is the physician's responsibility to give compassion and recognize fear, even when it is hidden. Likewise, he should respond to a patient's hidden wish to discuss his illness. Of course, there is no set formula for communicating with seriously ill patients. Each individual needs a different approach, and most physicians are sensitive to this.

Many physicians report that death, except in unusual cases, is not accompanied by physical pain. Rather, there is often a sense of well-being and spiritual exaltation. Physicians think this feeling is caused by the anesthetic action of carbon dioxide on the central nervous system and by the effect of toxic substances. Ernest Hemingway wrote, “The pang of death, a famous doctor once told me, is often less than that of a toothache.”

Stages of Death

According to physicians, people die in stages—rapidly or slowly, depending on circumstances. First comes clinical death , when respiration and heartbeat cease. The brain dies as it is deprived of oxygen and circulating blood, and biological death occurs.

Life can be restored in the moments between clinical death and brain death if circulation and respiration are continued through the use of medical devices that stimulate the heart and lungs.

After the brain ceases to function, cellular death begins. Life is not considered to be completely lost until the brain stops functioning. It is possible for surgeons to remove viable organs after biological death for transplant or other use.

Many clergymen and physicians insist that we need more honest communication about death, as such communication is probably the single most useful measure to avoid unnecessary suffering. Sound knowledge never made anyone afraid. And although death will probably always remain essentially a mystery, scientists will continue to search for a better understanding of its nature. By such means they may learn a great deal more about life.

The Autopsy

Family members adjusting to the death of a loved one may face the question of whether or not an autopsy should be performed. More and more, medical experts are underscoring the need for an autopsy as a means of confirming the cause of death. The postmortem examination may also “provide a reasonable context for accepting death,” according to Daniel W. McKeel, director of autopsy pathology at Washington University School of Medicine. From a family and genetic point of view, the autopsy may reveal information about specific conditions or medical problems in the deceased that survivors can use to guide their own health practices and concerns.

Contrary to some reports, the autopsy need not delay funeral arrangements or disfigure the body so as to require a closed casket. Autopsies are generally mandatory in homicide, suicide, burn deaths, deaths resulting from on-the-job injuries, operating room deaths, and questionable or un-witnessed deaths.