Prime Time Replay:
Elaine Glass, R.N.
on Palliative Care and Near-Death Awareness
MsgId: *breakthrough(1)
Date: Wed Apr 9 20:51:08 PDT 1997
From: moderator At: 206.80.182.216
Hello. This is the moderator, Madeleine Lebwohl, welcoming you to tonight's interview with Elaine Glass.
MsgId: *breakthrough(2)
Date: Wed Apr 9 20:56:14 PDT 1997
From: Elaine At: 140.254.128.20
Hi Madeleine! Glad to be back with you tonight.
MsgId: *breakthrough(3)
Date: Wed Apr 9 20:57:22 PDT 1997
From: moderator At: 206.80.182.216
Hi, Elaine! Good to see you.
MsgId: *breakthrough(4)
Date: Wed Apr 9 21:03:33 PDT 1997
From: moderator At: 206.80.182.216
Tonight I'm talking with Elaine Glass,R.N., an expert in palliative care. Elaine works at the James Cancer Hospital and Research Institute at the Ohio State University in Columbus, Ohio. Elaine, let's start by discussing how palliative care is used in a hospital setting.
MsgId: *breakthrough(5)
Date: Wed Apr 9 21:05:50 PDT 1997
From: moderator At: 206.80.182.216
MsgId: *breakthrough(6)
Date: Wed Apr 9 21:06:06 PDT 1997
From: Elaine At: 140.254.128.20
Palliative care is just becoming recognized as a specialty in medical practice. It's primarily used for pain and symptom control to alleviate the distress of chonic and terminal illness.
MsgId: *breakthrough(9)
Date: Wed Apr 9 21:08:34 PDT 1997
From: moderator At: 206.80.182.216
As I understand it, some of the key aspects of palliative care include helping the patient with the spiritual and psychological aspects of chronic illness. How do you approach these issues?
MsgId: *breakthrough(10)
Date: Wed Apr 9 21:14:37 PDT 1997
From: Elaine At: 140.254.128.20
Palliative care is a team effort. Therefore a social work counselor and a spiritual care coordinator work with the patient on these issues after they do a comprehensive assessment on what the concerns of the patient are.
MsgId: *breakthrough(11)
Date: Wed Apr 9 21:17:52 PDT 1997
From: moderator At: 206.80.182.216
Maybe at this point we could talk a little about the condition of these patients -- their mental state, their prognosis, their view on quality of life and expectations for the coming months.
MsgId: *breakthrough(12)
Date: Wed Apr 9 21:21:00 PDT 1997
From: Elaine At: 140.254.128.20
Of course, it depends on the person, but many people actually "come alive " during their dying. Cardinal Bernadin called death his friend -- from the stand point that he acheived an even closer relationship with God while he was ill. Some people don't want to know the specifics of how much longer they have. Plus it is often difficult for the doctors to predict. A good strategy is to "get your affairs in order" -- the business side of it, so that your mind is at ease and free to work on some of the harder stuff.Regarding the quality of life issue, most people want their pain controlled, they don't want to be a burden to their families, and they want to do some of the things that they are interested in.
MsgId: *breakthrough(15)
Date: Wed Apr 9 21:32:27 PDT 1997
From: moderator At: 206.80.181.202
And what is your direct involvement with patients at this point?
MsgId: *breakthrough(16)
Date: Wed Apr 9 21:38:09 PDT 1997
From: Elaine At: 140.254.128.20
One of the things that I work on is the "fun" stuff - what do they want to do that is positive? Thinking about their illness and problems all the time will keep them from having a good quality of life. So, I try to get them out of that negative rut. For example, the top thing that one of my patients wanted to do was to surf the Internet. So, I helped her get her computer working and made calls to get her a server, etc.
MsgId: *breakthrough(17)
Date: Wed Apr 9 21:43:37 PDT 1997
From: moderator At: 206.80.181.202
The issue of pain management seems very important in how chronic or terminally ill patients use their time. How does palliative offer an alternative to assisted suicide?
MsgId: *breakthrough(18)
Date: Wed Apr 9 21:45:56 PDT 1997
From: Elaine At: 140.254.128.20
If the pain is not controlled, the patient cannot do the other things that are important to them. Palliative care keeps the patient's pain under control so that they have a good quality of life until they die. People who want assisted suicide usually have some pain problem -- either physical, emotional or spiritual.
MsgId: *breakthrough(19)
Date: Wed Apr 9 21:48:15 PDT 1997
From: moderator At: 206.80.181.202
The combination of drugs used for these patients can be a unique mix of opioids and anti-depressants. Can we talk about how the patients react to these strong medications?
MsgId: *breakthrough(20)
Date: Wed Apr 9 21:50:34 PDT 1997
From: Elaine At: 206.80.181.202
One of the patients' primary goals is not to be sleepy. Using less opioids and adding other drugs like anti-depressants usually prevents the sleepiness and still relieves their pain. The anti-depressants are particularly helpful with nerve pain. Anti-convulsives were also discovered to decrease nerve pain.
MsgId: *breakthrough(22)
Date: Wed Apr 9 21:52:45 PDT 1997
From: moderator At: 206.80.181.202
Can all physical pain be controlled with these medications?
MsgId: *breakthrough(23)
Date: Wed Apr 9 21:55:21 PDT 1997
From: Elaine At: 206.80.181.202
Very severe pain sometimes has to be controlled with opioids and a sedating drug. Essentially the patient is asleep. On one patient, where we used this combination, while she was asleep for two days we also gave her a steroid which decreased the swelling around her spine and decreased her pain. To make sure that the steroids worked, we gradually woke her up, and the steroids were effective and she no longer needed the sedating medication, and she went home and she lived for another two months.
MsgId: *breakthrough(24)
Date: Wed Apr 9 21:56:37 PDT 1997
From: moderator At: 206.80.181.202
In the terminal patients that you work with, do they talk about death in any heightened way?
MsgId: *breakthrough(25)
Date: Wed Apr 9 21:58:28 PDT 1997
From: Elaine At: 206.80.181.202
These experiences are called near-death awareness. They oftentimes appear to be confused. But if the people who are with them listen closely and ask them to tell them more it begins to make sense. Listening closely and encouraging the patient to continue to talk is important because the patient oftentimes talks in symbols. Some common themes are traveling, describing relatives who have died, having knowledge when they will die, and being able to chose when they die.A nurse who I worked with went to visit a patient whom she hadn't seen for a while. And the nurses told her that the patient was in a coma and had not spoken for a week. Betsy went in to talk to her anyway because people can still hear when they are in a coma. While Betsy was talking the patient woke up. The patient asked Betsy if there was a child on the unit. Betsy told her that we do not take care of children in this hospital. The patient told her to go check. Betsy was told that a child was admitted to the emergency room during the night and was sent to that floor to be stabilized so they could be sent to the children's hospital the next morning. However, the child died during the night. So Betsy went back into the room and asked the patient how she knew there was a child on the unit last night.
The patient said two angels had come to pick her up but they told her she had to wait because they had to pick a little boy up. They said they would be back in two days to get her. Betsy asked her what they looked like, and she said they were pink lights and she could hear them speak but she could not see faces or a mouth, but they spoke clearly. The patient told Betsy she was not at all afraid to die now, and she looked forward to going with them when they came back. The patient closed her eyes and slipped back into a coma, and died two days later.
Sometimes when family members try to keep it a secret that someone else in the family has died, the dead person will visit the dying person so the family loses their secret.
MsgId: *breakthrough(32)
Date: Wed Apr 9 22:10:37 PDT 1997
From: moderator At: 206.80.181.202
Have you had a direct experience with patients describing angels to you?
MsgId: *breakthrough(33)
Date: Wed Apr 9 22:13:16 PDT 1997
From: Elaine At: 206.80.181.202
The son of one of my patients was an executive, and he thanked me for sharing the Betsy story with him. He was sitting at his mother's bedside the day before she died, and she was in and out of consciousness. She woke up at one point and said that he had an angel over his head. He said if he hadn't known about Betsy's story, he would have thought his mother was confused. Instead, he asked her to tell him about the angel and they had a conversation about the angel being good and he and his mom felt very close at that point.If people are interested in learning more about near-death awareness they should read a book called Final Gifts by Patricia Kelley and Maggy Callanan.
MsgId: *breakthrough(35)
Date: Wed Apr 9 22:15:42 PDT 1997
From: moderator At: 206.80.181.202
What are patients' reactions after they communicate these experiences to you?
MsgId: *breakthrough(36)
Date: Wed Apr 9 22:16:21 PDT 1997
From: Elaine At: 206.80.181.202
They experience a great sense of peace, and they're not afraid of dying.
MsgId: *breakthrough(37)
Date: Wed Apr 9 22:18:07 PDT 1997
From: moderator At: 206.80.181.202
But it doesn't seem that everyone has these death awareness experiences. Can this be elicited? Is it thought of as positive for the patient to try and bring it out in them?
MsgId: *breakthrough(38)
Date: Wed Apr 9 22:20:51 PDT 1997
From: Elaine At: 206.80.181.202
Nurses and other health care providers, like especially chaplains, need to be aware of these experiences, so they don't blow them off as confusion. Encouraging the patient to talk about what they're seeing or experiencing will elicit more information. That's why palliative care is so important. If the patients' physical pain is controlled, if they are comfortable enough to have these spiritual experiences.
MsgId: *breakthrough(39)
Date: Wed Apr 9 22:23:11 PDT 1997
From: moderator At: 206.80.181.202
Many of the patients who chose assisted suicide seem to be in great pain, and have a sense of hopelessness. There seems to be a lack of general knowledge about palliative care. What is being done about that?
MsgId: *breakthrough(40)
Date: Wed Apr 9 22:25:19 PDT 1997
From: Elaine At: 206.80.181.202
Dr. Ira Byock, is president of the American Academy of Hospice and Palliative Medicine. He just wrote a book earlier this year called Dying Well, the prospect for growth at the end of life. And as he is promoting his book throughout the country he's encouraging physicians to learn palliative care or at least consult with another physician who is skilled in palliative care.
MsgId: *breakthrough(41)
Date: Wed Apr 9 22:26:41 PDT 1997
From: moderator At: 206.80.181.202
Why has palliative care taken so long to become an important issue in medical care?
MsgId: *breakthrough(42)
Date: Wed Apr 9 22:28:48 PDT 1997
From: Elaine At: 206.80.181.202
Doctors have traditionally been trained to fix things, and the patients personal goals are secondary to the medical goals. An example is when you're admitted to the hospital, you give up your job, your family has limited visitation, etc., and with palliative medicine, the patient's personal goals come first. It's very difficult for a physician to make that switch.I attended a lecture today by Dr. Byock, and he said that palliative care physicians need to come out of the closet and start professing the importance of the spiritual, emotional and social issues that dying patients have. The patients' goals must come first.
MsgId: *breakthrough(44)
Date: Wed Apr 9 22:33:05 PDT 1997
From: moderator At: 206.80.181.202
Thank you, Elaine, for joining me tonight on Breakthrough Medicine.
MsgId: *breakthrough(45)
Date: Wed Apr 9 22:34:08 PDT 1997
From: Elaine At: 206.80.181.202
Thank you for having me, Madeleine. It's always a pleasure talking with you.
MsgId: *breakthrough(46)
Date: Wed Apr 9 22:36:40 PDT 1997
From: moderator At: 206.80.181.202
It's been a pleasure, Elaine. Please join me next week when I talk with Dr. Leonard Cole, an expert on biological warfare. Good Night!
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