Introduction

John Donne once wrote, “Death be not Proud”, referring to death as not being scary and powerful as people think (Shmoop editorial team, 2008). Is that the case?  Everyone at the end of the day is entitled to their opinions.

Literature review

I chose this topic because of a patient I had in clinical practice. To break down the topic, according to Suittie (2017), people find the meaning in life through four pillars, belonging (having support from friends, family members, partners, colleagues and even strangers), purpose (having long term goals in life that reflect our values and serve greater good), storytelling (being able to pull experiences in our lives into a coherent narrative that defines our identity), Transcendence (experiences that will us in wonder). Death is defined by the cessation of all vital functions: end of life (Merriam Webster dictionary, 2018). A terminal illness according to Curie (n.d.), is when someone have reached a point where they or their medical team, cares or loved ones understand their illness is likely to lead to their death. Patients with terminal illness face challenges such as physical pain, depression, a variety of intense emotions, the loss of dignity, hopelessness and the seemingly mundane tasks that need to be addressed at the end of life (Woo, Maytal & Stern, 2006).

I asked myself, “How can health professions engage with these patients without increasing their fear of death? And motivate them to live a meaningful life before their end of life?

Clinical experience

In clinical practice we come across different patient suffering from different conditions. While I was in one of my blocks in a tertiary hospital in Western Cape I had a patient who was suffering from osteosarcoma which is one of the most common types of cancer which starts on the bones and can spread to other areas of the body, patients usually live for about 5 years after diagnosis (American cancer society, 2018). The cancer on the patient started on the right knee and her leg was amputated above the knee due to its spread to the surrounding tissues, even though the patient was having chemotherapy. The patient was mobile and independent in all activities of daily living before she was diagnosed with cancer. She said she was scared and angry at the same time and being told by the doctor that she had cancer. According to The Guardian (2011), most patients show these emotions and some cry after hearing the news, one patient said that he felt like his quality of life has decrease and he is now ‘being careful” which was not the life wanted. Even though death is defined as the cessation of vital functions but most terminally illness patients die emotionally before the actual death. She was scared because she knew she might die in a few year to come and angered by the fact that she was not as independent as she used to be. When rehabilitation started she got frustrated easily because of fatigue and the fact that she was going to use assistive device. She would ask me about her condition if she was going to get better soon and it was difficult for me because I feared I might increase her anxiety about death,  and I often told her lets both try our best and we will see how things go. According to Woo, Maytal and Stern (2006), health professionals frequently feel uncomfortable confronting death because they relate to it and identify it with terminally ill patients and they try to resist talking about it in the name of professionalism. I think that might have been the case about me in that situation because some years I lost someone close to me from such illness. Or maybe I did not want to face the fact that someday I also will die, so I guess was protecting my feelings more than my patient’s well-being. Causing further psychological distress to a patients according to Woo, Maytal and Stern (2006), increases the degree of deterioration in one’s physical impairment. The question is did I indirectly prevent my patients physical deterioration by not discussing her condition? Or I was incompetent in terms of informing my patient about her condition?

Even though my patient was demotivated at first but when her family came to visit, her mood changed and she was co-operation more on the rehabilitation program. Which means one of the four pillars to achieve a meaningful life was addressed. According to The Guardian (2011), most of the terminally ill patients who we interviewed we able to live a positive life after they received support from the family members and loved ones. One of the patients said even though he has the support from his friends, brother in-law and health professionals but the thought of death when he is alone in bed comes back and he thinks about the people he wronged, he describes it as a suffocating feeling. This shows that sometimes a patient can have a meaningful life but the horror of death never goes away.

Lesson learnt

Through my clinical experience and the research I have done I learnt that listening and talking to the patient and involving the family, friends and a support group might help the patient.  I also learnt that by involving a multidisciplinary team will be helpful to the patient, but most importantly health professionals to tell their terminally ill patient to perceive themselves as living with the disease other than dying from it that will might decrease the death anxiety and increase some motivation. Maybe death might not hold so much power over us.

References

American cancer society (2018). What is Osteosarcoma? Retrieved: October 05, 2018, from: https://www.cancer.org/cancer/osteosarcoma/about/what-is-osteosarcoma.html

Curie M. (n.d). What is terminal illness? Retrieved: October 05, 2018, from: https://www.mariecurie.org.UK/who/terminal-illness-definition

Merriam Webster dictionary (2018). Death. Retrieved: October 05, 2018, from: https://www.merriam-webster.com/dictionary/death

Shmoop Editorial Team. (2008). Death, be not proud (Holy Sonnet 10) Summary. Retrieved October 9, 2018, from https://www.shmoop.com/death-be-not-proud-holy-sonnet-10/summary.html

Suittie J. (2012). The four keys to a meaningful life. Retrieved: October 05, 2018, from: https://greatergood.barkeley.edu/article/item/four_keys_to_a_meaningful_life

The Guardian (2011). Living with death. Retrieved: October 08, 2018, from: https://www.theguardian.com/lifeandstyle/2011/jun/19/living-death-terminal-illness-cancer

Woo, J. A., Maytal, G., & Stern, T. A. (2006). Clinical Challenges to the Delivery of End-of-Life Care. Primary Care Companion to The Journal of Clinical Psychiatry, 8(6), 367–372.