Caring for Patients with Life-Threatening Illness: The Professional’s Experience

Describe the common reactions we all have to death
University of Iowa Reference

Denial, numbness, and shock

 * This serves to protect the individual from experiencing the intensity of the loss.
 * Numbness is a normal reaction to an immediate loss and should not be confused with "lack of caring".
 * Denial and disbelief will diminish as the individual slowly acknowledges the impact of this loss and accompanying feelings.

Bargaining

 * At times, individuals may ruminate about what could have been done to prevent the loss.
 * Individuals can become preoccupied about ways that things could have been better, imagining all the things that will never be.
 * This reaction can provide insight into the impact of the loss; however, if not properly resolved, intense feelings of remorse or guilt may hinder the healing process.

Depression

 * After recognizing the true extent of the loss, some individuals may experience depressive symptoms.
 * Sleep and appetite disturbance, lack of energy and concentration, and crying spells are some typical symptoms.
 * Feelings of loneliness, emptiness, isolation, and self-pity can also surface during this phase, contributing to this reactive depression.
 * For many, this phase must be experienced in order to begin reorganizing one’s life.

Anger

 * This reaction usually occurs when an individual feels helpless and powerless.
 * Anger may result from feeling abandoned, occurring in cases of loss through death.
 * Feelings of resentment may occur toward one’s higher power or toward life in general for the injustice of this loss.
 * After an individual acknowledges anger, guilt may surface due to expressing these negative feelings.
 * Again, these feelings are natural and should be honored to resolve the grief.

Acceptance

 * Time allows the individual an opportunity to resolve the range of feelings that surface.
 * The grieving process supports the individual. That is, healing occurs when the loss becomes integrated into the individual’s set of life experiences.
 * Individuals may return to some of the earlier feelings throughout one’s lifetime.
 * There is no time limit to the grieving process. Each individual should define one’s own healing process.

Identify the key role and responsibility of the Palliative Care Team and how the team can help the student in future patient care.
* Pain * Shortness of breath * Constipation * Nausea * Trouble sleeping * Loss of appetite
 * [[media:ohsupalliative.pdf|OHSU Pallative Care Brochure for Families]]
 * A Pallative care Team can provide enhanced communication between a patient, their family and their medical team. They help in making difficult medical decisions at any stage of illness, and with emotional and spiritual support.
 * The provide expert treatment of symptoms, including:

Describe how personal experiences with death (family, friends) may influence physician responses to dying patients and their families.
Personal experience with loss may enable a physician to be more empathetic and help them find the appropriate words to comfort dying patients and their families. Personal experiences might also have the effect of over-sensitizing physicians, causing them to have a very emotional response which may not always be appropriate for the dying patients and their families. A physician must achieve a balance by demonstrating empathy without allowing his or her emotional response to take precedence in the situation.

Describe active steps a physician might take to work through his/her own issues with death in order to give better care to an individual patient or patients in general
A physician could take the time to think about what death means to them, and what it is that they might fear about it. If the physician has never personally dealt with death among their loved ones, they might take the time to think about how that would impact them and what they would feel and do in that situation. Seeking help from a counselor or therapist to work through the issues is always a good option that physicians should consider.