Hospice News FALL 2 01 8
Praying for What We Get Creating a path to acceptance
I Chose Dignity The importance of making end-of-life decisions
Anniversaries and Special Days Coping with stress and unsettling feelings of the Anniversary Effect
I Chose Richard P. Holm M.D.
DIGNITY
The elderly late-80s gentleman came into the emergency room unconscious with the diagnosis of new stroke. The CT of the head indicated there was no bleeding into the brain or around the brain, so he had a blood clot, not a bleed that caused the acute brain injury. The symptoms began six hours earlier and the patient and his family just didn’t get him to the emergency room in time to try a clot-busting medication that can sometimes save the brain. The family and I had a long talk. The patient had been living alone in his home of 50 years, still daily visiting a nursing home to see his wife who had severe Alzheimer’s Disease. He had an advanced directive about which his family was aware. He had enjoyed a good life, his financial affairs were in order, he did not want resuscitation if this was required, and I remember his words, “That would be an easy way to go, so do not resuscitate. And what ever happens, no feeding tubes unless I have a reasonable chance of returning to a normal life where I would know what’s going on.” Our patient had significant brain injury, with no capacity to swallow or speak and minimal awareness. With the family’s agreement, we did not start intravenous fluids in consideration for brain edema that can occur in new strokes and gave it a little time to allow for the edema to reduce. Maybe that would improve the situation.
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This also bought some time to see if we are going to get any recovery or not. After the third day, the writing was on the wall, and his chances for long-term life, if he survived the first week, would require a feeding tube. The family directed me to follow his advanced directive and allow a natural death. Over the next nine days he gently slipped away, no feeding tube, no respirator, no suffering.
Take home message: 1| Make an advance directive and use it as a
communication tool to talk about end-of-life choices with your family.
2 | Realize that the patient’s choice is primary.
If the patient is not capable, the family chooses for the patient and their obligation is to respect the patient’s prior expressed wishes or do their best for him by directing his care in the way he would have chosen. Sometimes this may mean pushing against what the care-providers want to do.
3| Because of no advanced directive, and because
families don’t realize their responsibility to respect the dying patient’s wishes, too often feeding tubes are placed and what might have been death with dignity becomes a prolonged misery.
brookingshealth.org
Prairie Doc® Announces New Book This past August, Richard P. Holm, M.D., founder of the Prairie Doc®, announced his new book “Life’s Final Season: A Guide for Aging and Dying.”
been where Holm has been, living daily with the hope, fear, and emotional roller-coaster of this experience.”
“I wrote this book for those who are aging, which means all of us,” said Holm. “This book addresses issues to help the well, the sick, those who are dying and those caring for elderly persons in the final season of their lives.”
V.J. Smith, best-selling author and speaker from Brookings, S.D., recommends Holm’s book. “Do you want to read a book that will truly change your life? Then read this one,” he said.
Well into the process of writing his book, Holm at age 67, was diagnosed with cancer of the pancreas. His book tells of surviving his initial battle with the aid of chemo therapy and surgery. The cancer returned and Holm was back on chemo this summer with his second surgery in October. “This is one tale I never thought I would tell,” said Holm. “I was a half-marathon-running, spiritually healthy, family man. I had abundant friends, more interests and activities than I could accomplish. I was a person at minimal risk of an early death, or so I thought.” Holm explains his book is more about living than dying. “Some chapters are written specifically to reduce the fear of death, but the intent of this book is that it be a guide to help individuals and caregivers in our quest to age and to eventually face dying with courage, grace, dignity and even enthusiasm.”
“Not just for the elderly, this book will be lifeimproving no matter your station in life,” said Jim Engelbrecht, M.D., rheumatologist from Rapid City, S.D. A native of De Smet, S.D., Holm retired after practicing medicine for nearly 40 years in Brookings. He and his wife, Joanie Holm, R.N., C.N.P. have four adult children and continue to live in Brookings where they are active members of the community. Together with illustrator and co-author Judith Peterson, M.D., Holm authored a previous book titled, “The Picture of Health: A View from the Prairie,” published by the South Dakota Agriculture Heritage Museum in 2008. “Life’s Final Season” is now available at Amazon.com, the South Dakota Art Museum in Brookings and Zandbroz Variety in Sioux Falls.
“This book is ‘sacred ground,’” said oncologist, Catholic priest and medical missionary William Fryda, M.D. “Obviously, none can speak with any experiential voice until they have actually
For more information on the book, follow the Prairie Doc® Facebook page facebook.com/ThePrairieDoc and website prairiedoc.org/book.html.
Over 60 people attended an end-of-life presentation on Aug. 30 hosted by Brookings Health System Hospice in Brookings. Hospice Medical Director Dr. Richard Holm, M.D., started off the afternoon by discussing content from his new book, “Life’s Final Season: A Guide for Aging and Dying.” Maggie Callanan then continued the afternoon. She is a world-renowned speaker on topics relating to the care of the dying as well as coping strategies for hospice staff and volunteers. She is the co-author of the celebrated book, “Final Gifts: Understanding the Special Awareness Needs and Communication of the Dying,” and “Final Journeys: A Practical Guide to Care and Comfort at the End of Life.”
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Praying Gregg TeBeest Chaplain
for What We Get
I have found that there is a common complaint among elderly hospice patients. I often hear them say, “I’m ready to die. I don’t want to be a burden to my family. I pray and pray that God will take me. But I’m still here. I guess I’m not praying the right way.” For people of faith prayer is very important. And it should be. It’s the primary means of communicating with God. In some cases – the life and death cases – prayer is all we have. So we pray and we ask God for help. The frustrating thing about prayer is that sometimes we don’t get the answers we’re looking for. Or we seem to get no response at all. And we begin to wonder: Does prayer really do any good? Is God listening at all? Does He even care? I recently came across a story that illustrates what I am thinking. Matt and Jackie, both musicians, became close friends. As a drummer, he would play back-up whenever she sang with
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the worship band. Matt’s deepest desire was to teach God’s Word and perhaps enter the ministry. Their common interests drew them closer. As a high-school junior, Jackie hoped to attend the same out-of-state university as Matt. Then the unimaginable happened. Matt was diagnosed with advanced lymphatic cancer. Jackie says, “I had great faith that God would heal Matt. He had such a passion to be a pastor, teaching others. I knew God wouldn’t take his life because Matt could make such a difference in this world.” So she prayed for his healing. In September of Jackie’s senior year, Matt died. Jackie responded with anger and disbelief with God for seemingly not answering her prayers. “Initially, I blamed God. Later, I blamed myself, thinking I didn’t pray hard enough, or maybe I accidentally missed praying one day.” When we pray and people die (or don’t die in the case of the elderly) we may wonder what’s wrong
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with our prayers. Or we may wonder what’s wrong with us or with God. What sort of an extra-special, super-powered prayer is needed to make everything turn out the way you want it? There are people who pray and are healed. There are people who pray and die. It doesn’t make sense or seem fair. Do some get “the breaks” in prayer while others don’t? Is that the way God works? I heard someone say that instead of praying for what we want we should learn to want what we get. “Nobody gets the breaks in prayer,” he said. “We get what God in His infinite love and foreknowledge sees fit to give. That’s not always the same as getting what we want. But it ought to be.” I understand what is meant by wanting what I get but it’s still difficult, especially if wanting what I
get means death, especially the death of a loved one. So if wanting what we get is too difficult, then perhaps praying for what we get is the answer. Put another way, we pray with the attitude that we will accept whatever it is that God chooses to give. But acceptance does not mean resignation. Writer, lawyer, and life coach Iyanla Vanzant has said, “Acceptance does not mean you agree with, condone, appreciate, or even like what has happened. Acceptance means that you know, regardless of what happened that there is something bigger than you at work. It also means that you know that you are okay and that you will continue to be okay.” Acceptance and faith, then, go hand-in-hand. If we can learn by faith to accept what we get, then perhaps we can begin to think of prayer differently and just continue to pray.
Do not see acceptance as a weakness. Accepting a situation does not mean you are giving up. Acceptance simply means that you recognize and understand your current situation. Acceptance allows you to be free from the shackles of denial and move forward in life, creating a new path and a new life for yourself.
Brookings Health System Hospice would like to acknowledge with appreciation the following donations (received July through September 2018): In Memory of Arlen Rosvold William Parriot Trust Della & Junior Neumiller Donna Diedrich Jane Rosvold In Memory of Leroy Voss Paul & Leila Muzzey
In Memory of Lori Knutsen Eudale & Carol Ringgaard Donations from: Dr. Tim & Mary Minton Harms Oil Company Van & Barbara Fishback Dale Larson
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Anniversaries & Special Days Denise Larson Hospice Social Worker
Anniversary Effect, sometimes called Anniversary Reaction, is defined as a unique set of unsettling feelings, thoughts or memories that occur on the anniversary of a significant experience (Serani, 2011 pg 1).
The anniversary of a loved one’s death will become a reminder of your loved one and can be a very difficult time for you. Other times that may have a significant impact will be their birthday along with holidays such as Thanksgiving and Christmas. These special days can be especially hard as they include many moments of precious memories. It’s important to remember that reactions to anniversaries, birthdays and special holidays are a normal response for someone who is grieving. These special occasions can trigger intense feelings related to the loss that has been experienced. Some people begin to dread the holidays and anniversaries because of the overwhelming feelings of sadness that can accompany them after the death of a loved one. Most friends and family will be unaware of how important this day can be. Anticipation of an anniversary date can be stressful so grieving individuals may want to let people know the importance of the day. Research confirms that an anniversary reaction exists among those who have lost a loved one. The researchers found that grieving individuals started reporting increased sorrow as the anniversary date approached. Emotions such as sadness, loneliness and restlessness increased along with the presence of feelings of helplessness, exhaustion and anger. Some of the behaviors ranking highest on the list were an increase in crying and a reflection on the death (Echterling, Marvin & Sundre, 2012). There are ways to help deal with an anniversary reaction of a loved one’s death. As these dates approach, it can be helpful to make a plan and decide how to spend the day. Do you want to go to
work or maybe take the day off? Another idea could be to schedule some time with friends or family. Journaling or talking to a trusted friend or family member, visiting the cemetery, attending a memorial service or spending a quiet day of reflection are all possible options. Taking care of yourself will need to be at the top of the “to do” list during this time. Anniversary reactions may vary in their length of stay. This means the emotions that impact the anniversary of a loved one’s death may last hours, days or weeks. This can be a difficult time. A grieving person may experience a great deal of emotional pain. For some, it will be like re-experiencing all the events surrounding the death. There is no timetable for grief. Anniversary reactions may continue to happen for years, but will decrease in their intensity as the years pass. If the grief intensity does not subside, then consulting a grief counselor or therapist may be something to consider. Understand that even happy moments may renew a sense of loss. Losing a loved one changes our lives forever. Anniversaries and special days remind us of those moments related to the loss of a loved one. Remembering special times can help us hold our loved ones close in our memories and help us move through the process of grieving.
“What we have once enjoyed deeply we can never lose. All that we love deeply becomes a part of us.” -Helen Keller Echterling, L. G., Marvin, C. & Sundre, D. L. (2012). The Anniversary of the Death of a Loved One. The American Counseling Association. Retrieved from http://www. counseling.org Serani, D., (2011, May 19). The Anniversary Effect. Retrieved from http://www.psychologytoday.com
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brookingshealth.org
Support Our
LIFESAVERS! The need for emergency services continues to grow within the Brookings community and surrounding area. From 2009 to 2017 the ambulance service realized a 40% increase in call volume. To help build the new Ambulance Station & Education Center, Brookings Health System Foundation has launched the SUPPORT OUR LIFESAVERS capital fundraising campaign. The Foundation’s overall goal is to raise $200,000 to help offset 20% of the total building cost. The new facility will include a garage, living quarters, supply storage and an education center that will host community training classes like First Aid and CPR. Access to emergency care is what everyone in the Brookings area should expect and receive.
You can help make a difference! Visit brookingshealth.org/SupportOurLifesavers to support the new Ambulance Station & Education Center by donating today! Call the Foundation at (605) 696-8855 for more information.
NATIONAL HOSPICE AND PALLIATIVE CARE MONTH – NOVEMBER 2018
A Program that Works. A Benefit that Matters.
As Medicare’s first proven coordinated care model, hospice is a program that works. For more than 35 years, the Medicare hospice program has helped people spend their final months at home, surrounded by family and friends, with comfort and dignity. In an increasingly fragmented health care system, hospice shows how health care can – and should – work at its best. Your priorities are hospice’s priorities.
MyHospiceCampaign.org #MyHospice
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Hospice News is published by Brookings Health System. This publication in no way seeks to serve as substitute for professional medical care. Consult your physician before undertaking any form of medical treatment or adopting any exercise program or dietary guidelines.
We Extend Sympathy
to the families of patients lost July through September 2018: Donna Ahlers
12/28/55–8/2/18
Merle Marlette
Gerald Bjerke
7/14/34–8/12/18
Roger Prunty
1/14/29–8/28/18
Lyle Bjorklund
3/31/35–7/20/18
Mary Rahm
11/10/26–7/3/18
Linda Bliss
3/14/46–7/26/18
Arlen Rosvold
10/6/35–7/12/18
5/22/52–7/1/18
Kenneth Schaller
6/11/26–9/23/18
6/6/15–7/8/18
Robert Sneesby
5/20/29–9/6/18
7/2/44– 9/13/18
Gale Thomassen
1/30/41–8/7/18
Jeannie French Irene Groon Sandra Hogate Ronald Holter Manley Kirby Audrey Lee
9/20/33–9/7/18
Doris Tucker
11/6/31–7/27/18
3/4/42–7/7/18
Thomas Tyler
6/6/54–9/24/18
3/13/35–9/9/18
Shirley Wiese
8/14/28–9/6/18
11/18/38–9/16/18