My Metta Institute Presentation

Improving the Experience of Dying Patients and their Families

 in the Emergency Setting

Hello, Aloha and Namaste – welcome to this training about how we, as caregivers and providers, can bring renewed and invigorated meaning to providing and caring in the seminal moments of our patients and their families lives. The dying process can often be less then peaceful and very difficult. My invitation to all of us is to make it our goal to improve the physical and spiritual treatment of the dying patient and their families in the hospital Emergency Room (ER).

For the purpose of this training we focus solely on patients who are expected to die and not the sudden, unexpected or traumatic death (however, some of what we will discuss is useful in all circumstances). We will discuss the purely physically based task first and then the manner in which we approach and carry out those task with an emphasis on the spiritual aspect. The integration of the heart, mind and body is paramount.

Part One

The Physical / Task Based Care of the Dying Patient and their Family.

The following points are largely task based. The mind / intellect approach is hugely important in the ER as it pertains to assessment and treatment options – all essential to quality patient care. However . . . our cognitive ability and listening skills are vital to feeling what is happening in our body to tap our deep intuition about what may be going on with our patient and their families – more on this in the second part of our training.

Pure task based ideas can include:

• move to a quieter room if possible and transferring out of the ER
• if possible go one to one with this patient (ask for help!)
• lower the lights, provide extra chairs for family (check in with the patient/family)
• page palliative care team & involve them as quickly as possible
• inform staff about this pt, use placards, disturb the patient/family as little as possible
• Create a 'spiritual crash-cart' (toolbox) that has electric candles, tissues, signs, CD player, tape for family pictures, etceteras
• work with kitchen to provide 'comfort food' (tea, coffee, water, cookies, etc.)
• provide the family with a booklet on what to expect during the dying process
• inquire / assist family in after-death care (rituals such as washing the body)
• Lets take five minutes and add to this list. What can we do better?

The pitfall of a task based approach alone is that it disallows for the spiritual care / needs of the dying patient and their family. Only focusing on task allows us, as providers, to protect ourself from the difficulties and/or pain inherent in dealing with the spiritual needs of the dying patient and their family. The takeaway lesson for all of us is to not just get caught up in task. Most of the essential task listed above can be accomplished fairly quickly. This is important so we can move on to what I consider our most important focus.

Part Two

An Inquiry into Spiritually Centered Care of the Dying Patient and their Family.

In Part One our focus was task based. But we know the dying process calls for much more than simply performing robotic task on a check off list. It is paramount for us to remain centered and present so we are better able to care for our patients and their families. So let us ask and inquire . . . how do we remain centered and present? How can we care for this patient and their family beyond just the physical task despite the busy demands of our environment?

• How we move through the room affects the mood and atmosphere and hence the experience of the patient and family. Don't rush, move slowly, deliberately.
• Don't focus on trying to 'fix' every single issue – just sit with it.
• We can stay present and focused on loving kindness as Ram Dass teaches us by repeating, 'I am loving kindness, I am loving kindness'. Don't just mindlessly repeat this – be sure to reflect and focus on each action performed with loving kindness.
• Integrate your heart, mind and body in your care. Listen to your intellect, feel what your body is telling you and let it speak through your heart.
• Create and envision the patients room as a sacred space. Be mindful that many of our prior task are carried out in the support and creation of this space.
• Pause before we enter that sacred space to acknowledge that another human being is dying. Pause to breath, honor this moment and patient, enter the room in a 'not knowing or doing' space. This is no matter what your task is – even if a simple 'to do'.
• Do enter the room to be present and available.
• Rather then doing each time you enter, focus more of a felt sense of listening and being.
• Once again, let us add to this list to improve our understanding.

Charlie Garfield brought this up in his April 2013 talk:

Listen from the heart.

Speak from the heart.

Act from the heart.

Summing it Up!

All too often in the emergency environment we become task focused. However, the dying patient provides us with a special and sacred opportunity to really nurture, respect the process and be deeply present. We must remember that we are all in the process of dying, it will be us someday and in this moment we have a unique opportunity to approach this patient and family in a different than usual way.

The challenges we face are how to do this within the demands of our respective workplaces. It is my hope and our goal to integrate both the doing and the 'being'. I hope that our time has been thought provoking and has laid out the beginnings of a road map for you and your patients to take that 'road less traveled by'. I invite and welcome any questions or thoughts that you would like to share.