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Quality of Life at End-of-Life

End of Life
We must have this discussion. It is not just a healthcare term, but a serious reality. From my research on a blog Through Life and Death written by Shahina Lakhani, RN, MSN, I found out that the end of life can be, in a manner of speaking, life-giving for the patient, and life changing for the family members and loved ones.

Existential Needs
Ms. Lakhani explains that there is not only the body that needs addressing, but in many instances it's what she calls the existential complexities that need addressing just as much. In short, these are:

•closure
•meaning of life
•forgiveness
•safety and permission

Pain In Body and Soul
A report out of The Journal of Palliative Medicine was done on patients at the end of their life. When asked what was the most important desire they had was, almost all said they wanted:

1. Being at peace (existential)
2. Free of pain    (physical)

Before I began my research, I too, wrote down my top wishes.  Coincidentally, those were my top two, so it is evident that having peace of mind and not hurting physically is a universal human desire.  The study within the journal also revealed that professionals in this field are not well-trained in existential areas, but need to be. For when a person is trained in these important areas, helping the dying and their loved ones tie up loose ends provides opportunities for life review, and closure- bringing peace to the dying first, and also to the family who is left behind. 

The Ties That Bind Are Strong
However, it goes deeper. I found that closure could mean anything from personal forgiveness to complex interpersonal relationships. Addressing existential pain is key in helping the dying transition peacefully. In two compelling stories, the dying mothers would not let go, even when medical evidence and sound logic said that their body was no longer able to live, they held on by sheer will and spirit until each child was present at the very end to say goodbye the way the mother desired. One woman had eleven grown children who were loud and could not get along. The eldest in charge had been keeping the rest at bay fearing their presence would disrupt the peace. Sensing the problem, nurse Lakhani made a suggestion. Placing her own fears aside, the eldest daughter allowed each child in. Loud or quiet, they all said their goodbyes and the mother passed peacefully.  It was what the mother needed, and proves once again the strength of the will and the spirit- and the blessing that comes with a well-trained nurse!

Fear and The Meaning of Life
Some terminally ill patients fear abandonment and want to find meaning in life. Fear and not knowing life's purpose tilt people who are not sick. And it is known that those with unresolved spiritual issues among other life concerns, have a much lower quality of life at end of life. The story of the two mothers proves the presence and power of the human spirit.  A person's spirit in and of itself, needs nurturing daily to keep it healthy. 

Quotes
Time-tested wisdom by Ms. Lakhani:
End-of-Life is...

"Time to say loving goodbyes, not time to cut off ties."

"Time for reconciliation-not abandonment. Lovingly tying up loose ends- not creating new trauma!"

"Express genuine love - works magic!"

"We as human beings seek closure during major transitions." 

"Never believe in the status quo."
                    ~ Shahina Lakhani 

For the Family Members
Put fears aside and do what's best for the person dying to give them the best "last gift" so they can depart in peace. 

For the Healthcare Professional
A well-trained and well-grounded nurse, nurse-aide or hospice worker can be an invaluable asset during this time- or, an untrained worker can cause incalculable distress and heartache on both sides, which can be avoided. 
Ask yourself: "How can I make a positive difference in this situation?"  

When you help the dying and their families, you are doubling the gift. It's like throwing a pebble in a pond. You will positively impact countless people, and help benefit many generations. 

Love Stronger Than Death
This was not an easy topic for me to cover.  But after getting to know Shahina Lakhani's heart through her powerful stories, I am more at ease with the thought of End-of-Life, not less. Our healthcare system needs more trained professionals like her who are not afraid to use their heart and intuition to intervene (even when risking failure), when an opportunity arises.

Start Now
Begin reconciliations with relations, even if there is no sickness present. You can find help with clergy, psychologists, or just a good friend. I am committed to this myself. There would be more joy and better health if our closest relationships were at peace. Nurse Lakhani puts it so beautifully when she says "Reconnecting with loved ones seems to give the person in transition permission to let go peacefully."

Shahina Lakhani, RN, MSN- For over 25 years has been an educator, nurse practitioner and Hospice Nurse. She is a holistic change expert, helping people cope during major life change. Click Through Life and Death to visit the blog and read her entire Bio.

Editor's Note: Permission to use quotes given by Shahina Lakhani, RN, MSN






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