MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Death Maiden' source. Wed, 08 Oct 2008 18:43:17 +0100 http://deathmaiden.blogspot.com/2008/09/last-24-hours-illustration.html Sorry for the long silence on this blog. I have been spending my time off-line drawing comics as a new creative outlet, which has taken up the time I used to spend writing this blog. Lately, I have been starting to draw illustrations pertaining to the end-of-life and I thought it would be appropriate to start posting these on this blog. Definitely a change of pace from this blog's former content. (Source: Death Maiden) Death Maiden blogs http://www.medworm.com/rss/comments.php?id=1815220 Tue, 23 Sep 2008 01:10:00 +0100 1815220 http://deathmaiden.blogspot.com/2007/12/great-cremation-ground.html One of my colleagues just came back from a trip to India and told me about a place called Manikarnika Ghat, also known as "The Great Cremation Ground."According to Hindu mythology, being burned here provides an instant gateway to liberation from the cycle of births and rebirths. Karmic bonds are suppose to be burnt along with the body, which is how one is liberated from needing to be rebirthed. It is said that the funeral fires at the Manikarnika ghat have been burning for thousands of years. A constant stream of corpses come to this ghat to be burnt, day and night. According to my colleague, most corpses do not get enough time to burn properly and are often unceremoniously dumped, half burnt into the sacred river. I have never traveled to India, but if I do, this certainly seems like an interesting place to check out. (Source: Death Maiden) Death Maiden blogs http://www.medworm.com/rss/comments.php?id=1096111 Fri, 14 Dec 2007 19:01:00 +0100 1096111 http://deathmaiden.blogspot.com/2007/09/estimating-time-of-death.html I am not in the practice of having to estimate time of death, as generally patients in the hospital are being watched routinely, and thus the time of death is already known. But I am on a list serv where someone posed a question that elicited this link. I thought the link was an interesting resource and might be useful to others, so I thought I'd post it here. This link is to a tool for estimating time of death, according to the Method of Henssge. It is based on temperature and puts into account various environmental factors including clothing. Check it out. (Source: Death Maiden) Death Maiden blogs http://www.medworm.com/rss/comments.php?id=858239 Tue, 11 Sep 2007 00:07:00 +0100 858239 http://deathmaiden.blogspot.com/2007/04/your-truth-dementia-and-grief.html I apologize, once again, for my on-going silence on this blog. I've received a number of emails from readers encouraging me to post again. I appreciate the dedicated interest in this blog from my readers.I recently attended a fascinating lecture on dementia and grief. Inspired by this lecture, I am going to pose a hypothetical scenario for your consideration. As per my standard format, after the scenario, I am going to ask some questions and will later post my response to the scenario.Mrs. Horton is an 86 year old with middle stage dementia. She is no longer able to recognize family members nor dress herself. She is able to walk, using a walker, and frequently gets lost in the hallways of her nursing home.Mrs. Horton's 61 year old son recently died of heart attack. Prior to his death, her son had come to visit her in the nursing home at least three times every week. Mrs. Horton was informed repeatedly of her son's death, but she does not have the short-term memory to retain this information. She asks where her son is multiple times every day.1. Do you repeatedly inform Mrs. Horton that her son died, even though this news is distressing to her? Would telling her the truth be retraumatizing her or banging her over the head with the news?2. Understanding that disclosing this news can be distressing to both Mrs. Horton and to the bearer of this news, what are some different ways you might respond to her repeated request for her son? (Source: Death Maiden) Death Maiden blogs http://www.medworm.com/rss/comments.php?id=569059 Wed, 25 Apr 2007 04:00:00 +0100 569059 http://deathmaiden.blogspot.com/2007/01/thank-you-blue-h-news.html blue-H-sign Originally uploaded by miaadams. I have been rather neglectful of this blog as of late. Despite my silence, I am delighted to report that Blue H News picked up one of my blog posts and published it in the January 2007 issue of their newspaper.Thanks so much for the press, Blue H News! (Source: Death Maiden) Death Maiden blogs http://www.medworm.com/rss/comments.php?id=463152 Mon, 22 Jan 2007 08:38:01 +0100 463152 http://deathmaiden.blogspot.com/2006/10/your-truth-chemical-vs-physical.html Another hypothetical scenario for your consideration...This patient is an 86 y.o. female with dementia who is actively dying. She has become delirius, but still has the strength to get out of bed and is at a high risk for falling and injuring herself from the fall. In addition, she has a intravenous (IV) line that is being used for pain medicine that she keeps trying to pull out. The doctor has suggested the use of sedating medications to keep her from pulling out her line and from falling. But the family states they would like to keep her alert and thus they refuse the medications offered. Instead, the family prefers that wrist restraints are applied, tying the patient to the bed rails to prevent falls and to prevent the IV from being pulled out. NOTE: Both types of restraints are avoided while the family is visiting, but the family leaves to sleep at night.1. What education could be offered to the family to ensure they are fully informed of the options to ensuring this patient's safety?2. What other options might be considered beyond pharmacological or physical restraints?3. What are your own feelings about chemical verses physical restraints and how might these feelings impact your attitude towards this family's decisions? (Source: Death Maiden) Death Maiden blogs http://www.medworm.com/rss/comments.php?id=463155 Wed, 04 Oct 2006 11:06:00 +0100 463155 http://deathmaiden.blogspot.com/2006/08/grief-written-word.html As I've mentioned before, JennyNYC and I have been working on a poetry project where we write a poem a day to one another. We are now up to about 115 poems. Though I haven't been keeping up to the every day pace the past week or so, I am still getting a lot out of the experience - both in expressing some of my more uncomfortable emotions creatively and in the inspiration that has come from reading Jenny's words. This is one of Jenny's more recent poems that she consented to letting me post on this blog.Griefby JenniferA mother comes in one day at the end of her rope.Her two ten year old twin boys,who I've been seeing for therapyalong with their mother,are driving her nuts."Ever since their dad diedit's gotten worse and worse!" she explains."Their dad used to make all the rulesand make sure the boys followed them.Now there are no rules,and it's gotten out of hand.They're nice boysbut I can't live this way."The mother and I sit down and think up rules.I tell her to stick with the basics,both for rules and for consequences.The boys join us in my office,and we talk about how it is at home.It turns out they don't like the chaos either.Then I bring up the rules,and after reading a few of them,like, "No cursing,"and "Brush your teeth before bed,"the twin who is usually the unemotional, "tough" one, Sean,throws himself onto the floor,curls up into a ball,and begins to sob.It's late evening in the clinic,and his lone, heartwrenching cryfills the empty hallways,as the three of us listen and look,frozen witnesses,shocked, worried, and awkward.Sean's twin, Johnny, says, "C'mon, Sean,these rules are easy," but Sean can't hear him,lost in a painful moment.Johnny muses aloud,"He's crying more than he ever hassince Dad died."Johnny and the twins' motherslowly ease themselves to the floor beside Seanand put their arms around him.Knowing Sean's usual distaste for physical affectionI tense up, fearing that Sean will lash out at them.But instead he allows his family to hold himproviding comfort and sharing in the painful knowledgethat his father is not coming back.This is such a beautiful and moving poem. I can relate to this trigger for grief from my own personal experience with my divorce. I thought I'd worked through my grief, as my divorce happened over six months ago now and I've started dating and just generally feel much more centered and like myself again. But then my childhood best friend's grandmother died. She was a big part of my childhood. She was rather eccentric and being around her always put a smile on my face. Since my maternal grandmother died when I was young and my paternal grandmother lived in Florida (and was still living up a wild, youthful life), this friend's grandmother was much like a grandmother figure to me. But the trigger that came from her death had nothing to do with her really. I wrote and sent a condolance card to my childhood best friend. As I went to sign the card, I faltered. I hadn't signed a card since the divorce. For nine years, I had sent dozens and dozens of birthday cards, anniversary cards, graduation cards, and such - all signed with my name and my ex's. This was the first time I signed a card with my name alone. Alone. Solo. In moments like this, the last six months feel surreal, like a dream. How my life can change so drastically from the life I lived over the last nine years. I spent nearly a third of my lifetime with my ex. The things I am grieving are manifold. On top of the loss of the relationship and the family we had become, there is the loss of an identity - the loss of that "Me AND You" at the end of those cards. (Source: Death Maiden) Death Maiden blogs http://www.medworm.com/rss/comments.php?id=463159 Sun, 27 Aug 2006 15:38:00 +0100 463159 http://deathmaiden.blogspot.com/2006/08/your-truth-i-want-to-drive-her-home.html "Your Truth" is a series of posts I have written describing end-of-life scenarios. These scenarios are in some way controversial - either due to an ethical dilemma or a particular communication challenge. Please read the scenario and then offer your thoughts on what you might do in this circumstance. Although these scenarios are all based on real-life situations, they are fictionalized so as to protect the anonymity of the person(s) whom the scenario was inspired by.In this next scenario, we have a 82 y.o. Russian female who had a stroke that left her non-responsive (she is unable to speak nor move and her gag and corneal reflexes are absent). She had end-stage renal disease prior to the stroke. She is still in the hospital. The doctors have given her a prognosis of days to weeks to live. Her family, per her written advanced directive wishes (rare to have these done, but sometimes we're lucky enough to know what the patient would want), has decided to stop dialysis and start her on hospice care. The family would like to take her home to die.The family is afraid, however, that she will die during the ambulance ride home. They are strongly opposed to her dying in an ambulance and so they would like to drive her home in their minivan. Despite education regarding the perceived improved comforts that would come with the ambulance ride (bed, pain medicine, gurney ride into the home), the family remain committed to driving her home themselves. Now keep in mind that the minivan is not equipped with a bed and the patient would have to be phycially lifted into the minivan. Due to hospital liability issues, the nursing supervisor reports no hospital staff may help her into the van and therefore the patient must be transported home by an ambulance.What might you do? What are the potential positive and negative ramifications of either option? (Source: Death Maiden) Death Maiden blogs http://www.medworm.com/rss/comments.php?id=463161 Sat, 19 Aug 2006 03:22:00 +0100 463161 http://deathmaiden.blogspot.com/2006/08/death-penalty.html My blog is about death and dying, in general. But also as death has pertained to my own personal life. This has led this blog to focus largely on the issues of:-ethics-spirituality-symptom management-grief-issues with facing mortality...and more.Today, I met a paralegal who works for an attorney defending prison inmates on death row. I am opposed to the death penalty, personally. I have been opposed to it primarily on the basis of its misuse - the fact that those whom are executed are disproportionately minorities. Inspired by my conversation with this paralegal, I decided to check out what the death experience is like for these prisoners. Having read about the actual process of euthanasia (that's really what it is) used in these cases, I feel even more strongly opposed to the death penalty. I will attach the link here, but I caution you, the descriptions of methods of execution found here are profoundly disturbing. (Source: Death Maiden) Death Maiden blogs http://www.medworm.com/rss/comments.php?id=463163 Fri, 04 Aug 2006 09:12:00 +0100 463163 http://deathmaiden.blogspot.com/2006/07/expired-poem.html JennyNYC and I have been working on a poetry project. We have been writing one another a poem every day for 100 days now. I think part of my silence on this blog has been due to this new creative writing outlet. But I thought I'd share the poem I wrote last night. It's not my best piece of writing, but the subject certainly seems pertinent to this blog."Don't leave me," he nearly beggedin fearas he reached out his hand to me.His frail body was failing him.His wife at his bedsidespoke the feeling they both shared."I was scared." She says the wordswith her back to meas she walks away from the bedside.I massage his feetto calm his nervesand he falls right to sleep. Two nights later,I return to work,looking forward to seeing him again.Having bonded over thetouch of his hand in mine.Having felt a connectionin his need for my companionship. As I walk onto the floor,my heart sinks.His room is vacant.The note on the clipboard reads,"Transfer/DC to:expired." (Source: Death Maiden) Death Maiden blogs http://www.medworm.com/rss/comments.php?id=463169 Mon, 31 Jul 2006 22:50:00 +0100 463169 http://deathmaiden.blogspot.com/2006/07/thank-you-advance-for-nurses.html Just a quick thank you to Terri Polick for including me in her recent article on nurse bloggers in Advance for Nurses. (Source: Death Maiden) Death Maiden blogs http://www.medworm.com/rss/comments.php?id=463171 Tue, 25 Jul 2006 10:15:00 +0100 463171 http://deathmaiden.blogspot.com/2006/07/from-mystic-odes-of-rumi-via-5th.html Our death is our wedding with eternity.What is the secret? "God is One."The sunlight splits when entering the windows of the house.This multiplicity exists in the cluster of grapes;It is not in the juice made from the grapes.For he who is living in the Light of God, The death of the carnal soul is a blessing.Regarding him, say neither bad nor good,For he is gone beyond the good and the bad.Fix your eyes on God and do not talk about what is invisible,So that he may place another look in your eyes.It is in the vision of the physical eyesThat no invisible or secret thing exists.But when the eye is turned toward the Light of GodWhat thing could remain hidden under such a Light?Although all lights emanate from the Divine LightDon't call all these lights "the Light of God";It is the eternal light which is the Light of God,The ephemeral light is an attribute of the body and the flesh....Oh God who gives the grace of vision!The bird of vision is flying towards You with the wings of desire. (Source: Death Maiden) Death Maiden blogs http://www.medworm.com/rss/comments.php?id=463173 Mon, 24 Jul 2006 09:30:00 +0100 463173 http://deathmaiden.blogspot.com/2006/07/symptomatology-itching.html For a list of symptoms I have reviewed in previous posts, please go to this symptomatology of dying link.The next symptom I will address is itching (also known as pruritis). There are a number of reasons people who are at the end of life may experience itching. Some of the most common causes include:-side effect of opioids-uremic itching secondary to kidney failure -jaundice secondary to liver failure and/or biliary diseaseIf the itching is presumed to be from opioids, then switching to a different opioid may be effective.Uremic itching is more difficult to treat. The exact physiology of the itching is as of yet poorly understood. Therefore treatment approaches may move forward through trial and error.Some of the medications that may be trialed for uremic itching and for itching related to liver failure include topical products such as:-hydrocortisone cream - this antiinflammatory is very mild. If it's not effective, stronger steroids such as betamethasone 0.10% 15 grams twice per day may be used. However keep in mind that the stronger steroid puts the skin integrity at higher risk of breakdown.-Lidocaine ointment 5% which numbs the surface of the skin.-Sarna lotion, which is Camphor 0.5% and Menthol 0.5%, cools and moisturizes the skin and may help with mild itching.Some oral medications that may be trialed include:-Atarax (25 to 100 mg four times per day) is an antihistamine used to treat anxiety as well as for itching. It is primarily used for itching due to allergic reactions, but may be helpful with other types of itching.-Benadryl, like Atarax, is best for allergic itching, but may be trialed as a supplement to other modes of treating pruritis. Antihistamines also make you sleepy. Some patients may report some relief if they are able to sleep through the itching.-Questran (aka cholestyramine) is prescribed specifically for itching related to liver failure. It binds to bile acids in the intestine. This prevents their absorption, and the cholestyramine/bile acid complexes are eliminated in the stool.Ursodiol (300mg twice per day)is a bile acid used to dissolve gallstones. Because it dissolves gallstones, it is suggested that it may also help with itching, but the effect is minimal.-Doxepin (25mg daily) is an antidepressant/anxiolytic medication that has been used for pruritis. One of the side effects of the medication is peripheral neuropathy, which may be why it's been tried for this use.Small studies have suggestd acupuncture may be effective in treating uremic itching in patients with chronic renal failure. Whether or not this may extend to patients at the end of life has not been studied.See this link for more information on over-the-counter products for itching. (Source: Death Maiden) Death Maiden blogs http://www.medworm.com/rss/comments.php?id=463157 Sun, 02 Jul 2006 19:56:00 +0100 463157 http://deathmaiden.blogspot.com/2006/07/ethical-issues-at-end-of-life.html If you are a regular reader of my blog, then you likely know that I have a passion for ethical dilemmas. Perhaps you even participated in a debate on one of my Your Truth posts.I was recently asked to give a lecture on Ethics at the End of Life. Although I am passionate about ethics, I'd never given a lecture on the subject before. Having recently graduated from my Master's program, I dutifully prepared Power Point slides on concepts such as autonomy and choice, advanced health care directives, medical futility, quality of life, double effect, the spectrum of hastening death, moral distress of nurses, and the four-box method.I *love* to teach. And no matter what the subject is, I always maximize interactivity between myself and my audience. Personally, I learn best when I am awake and I have a suspicion this is true for others. ;-) Fortunately, ethics is a subject that easily lends itself towards a lively discussion.I have been wading through my email inbox, now that I'm done with school. I apologize to those of you whose emails have been sitting unanswered. I'm doing my best to get through them now. During this sorting of emails, I came across a link to an on-line excerpt from William Colby's book, Unplugged, where he writes:"When surveyed, the majority of us say that when our dying comes, we hope to be at home, free from pain, surrounded by loved ones, and not hooked up to machines. In the abstract, that's likely true. We also very much want to be hooked up to those machines right up to the very moment when the doctor is sure that those miraculous tools can't fix us. Trying to find that exact line is no easy business."This thought seemed particularly relevant to my last blog post, as well as to the discussion / lecture I gave this past week.In the 1970's, it was accepted practice that any and all interventions should and would be taken to prevent death no matter how extreme the intervention (Drought & Koenig, 2002 - no, I'm not old enough to be speaking from personal experience, so yes, I used a reference for this). But as technology has advanced, we have vast and ever-growing means of keeping people alive, even while their bodies are otherwise failing them. As a result, ethical considerations in making decisions about treatment have become increasingly complex. This was a point I stressed in my talk; William Colby speaks to this in his book as well. Although technology has advanced dramatically, we are still no better at predicting when death will come. In my post asking how you'd like to die, not one of you said that you wanted to die hooked up to machines in the ICU. Why or why not? If given the choice - to be kept alive as long as possible, but then to die in the ICU connected to machines or to possibly die prematurely but die peacefully at home, which would you prefer? (Source: Death Maiden) Death Maiden blogs http://www.medworm.com/rss/comments.php?id=463179 Sat, 01 Jul 2006 15:22:00 +0100 463179 http://deathmaiden.blogspot.com/2006/06/presence.html Before I walk into a patient's room, I take a moment to gather myself. I take a few deep breaths and center myself. I am very conscious not to bring any stressful or hectic energy with me into a dying patient's room.Today, as I was meditating, I felt that same shift. I felt myself coming to my center. And it occurred to me: I'd never practiced this same "presence" for *myself* before - I've only done it for my dying patients. What if I practice "presence" in all of my interactions? Okay, well, that may be an unrealistic goal, but how lovely would that be? Being present for myself this evening was incredibly powerful.The power of presence has been discussed and written about in all kinds of disciplines - from Buddhist teachings to nursing research (unfortunately, I cannot put my hands on the nursing articles I have in mind).So often, new nurses shy away from dying patients, citing, "But I don't know what to say!" Being present and bringing compassionate energy into the room is far more effective and valuable than any words.I have decided to spend some time focusing on my spiritual practice. Since my divorce with S, I've felt rather off-center. First there was the major adjustment to living alone for the first time in my life (aside from one month back in 1995). Then I got involved in a whirlwind of a romance that crashed and burned as abruptly and as passionately as it shined. The sorrow over that second relationship ending within four months of my divorce gave me a new-founded shyness about relationships, which is perhaps just what I needed to step away from dating altogether to really spend some time alone with myself. I went on a few more dates to try to give it another shot, but recognized almost immediately that I was not fully present to the experience of the dates. I was frantically going through the motions of the dates to escape being present with my grief. So now, here I sit with myself. And the grief is far more tolerable than I had feared. Oh, the waves crash down on me pretty hard at times. But they pass and I am not running away from them all of the time. It's much less tiring to just sit still and feel.So what does this new spiritual practice look like?Well, it's not all about meditating. Today, after work I went on a bike ride in the park. The weather was lovely. Being surrounded by trees always feeds my spirit, as does writing on this blog. Surfing can be a spiritual experience for me as well - surrendering to the waves, the awe of the vastness of the ocean, my powerlessness.Thank you all for listening / reading and thank you for coming back after my long bouts of silence. Now that I'm done with my Master's degree, I suspect I will be posting more often, once again. (Source: Death Maiden) Death Maiden blogs http://www.medworm.com/rss/comments.php?id=463177 Fri, 30 Jun 2006 04:50:00 +0100 463177 http://deathmaiden.blogspot.com/2005/02/death-arts.html I just came across an interesting site of death paintings. As a result, I kind of either got inspired or went mad (you decide) in a search for what other art representations of death are out there. Here is a sampling of both the good stuff and the diversity of what I found:This is an outstanding website dedicated to death in art with excellent images as well as text by the webmaster: Pollefeys. Mr. Whiting has done an incredible job of photo-documenting death rituals in American society. From tombstones to Roadside Memorials. Definitely a must-see website!About.com's directory of death in the artsnecromantic's arts sectionThe sexualized comic representation: Lady Death The superhero comic Golden Warrior who goes by the name Death Maiden. Okay, that is not at all how I picture myself! :-)Although this site didn't offer any pictures, if you're ever in Pennsylvania, definitely check out the Museum of Mourning Art. I know I will!The following are sites for death-related art recommended by readers like yourself. Please let me know if you come across other interesting sites relating to death in the arts.Mark Ryden link recommended by artist Mari Naomi.Dear Death link recommended by blogger JennyNYC.And in honor of Edward Gorey, whose death-related art was also recommended by artist Mari Naomi, here is a quiz I found called What horrible Edward Gorey Death will you die?You will be sucked dry by a leech. I'd stay awayfrom swimming holes, and stick to good oldcement. Even if it does hurt like hell whenyour toe scrapes the bottom. What horrible Edward Gorey Death will you die? brought to you by Quizilla (Source: Death Maiden) Death Maiden blogs http://www.medworm.com/rss/comments.php?id=463153 Wed, 09 Feb 2005 18:45:00 +0100 463153 http://deathmaiden.blogspot.com/2004/05/symptomatology-of-dying.html Some of the symptoms of dying that I have mentioned in previous posts:One to three months prior to death:-Anorexia -Spiritual Distress-Nausea & Vomiting-Fatigue/increased need for sleep-withdrawal from the world and from people (increased introspection / talking less)-malodorous woundsOne to two weeks prior to death:-Confusion-Picking at Clothes / Tubing-Seeing / Talking to the Deceased-Terminal Restlessness/Agitation-decreased blood pressure-increased or decreased pulse-skin color changes – pale or blue-increased perspiration / body temperature changes-sleeping most of the timeDays or Hours prior to death:-Fixed stare (Eyes glassy, tearing, half or fully open) -Death rattle-Wavering level of consciousness-surge of energy / restlessness or no activity-irregular breathing / periods of apnea-weak pulses / cool extremities-decreased urine output & incontinence-cannot be awakened (Source: Death Maiden) Death Maiden blogs http://www.medworm.com/rss/comments.php?id=463175 Sun, 30 May 2004 06:34:00 +0100 463175 http://deathmaiden.blogspot.com/2003/11/spirituality-death.html Some of My Postings on This Subject:-Presence-Spiritual Beings Having Human Experience-Last Minute of Life-My Spiritual Awakening-What Feeds Your Soul?-Emotional Growth-Life After Death-Hospital Chaplains-Spiritual DistressLinks to Sites Addressing Death as it Pertains to Specific Religions:-Catholic-Chinese Buddhism-Hindu-Judaism-Muslim-Neo-Pagan-Romani-Tibetan Buddhism-Woodland Burial Society (Source: Death Maiden) Death Maiden blogs http://www.medworm.com/rss/comments.php?id=463167 Wed, 12 Nov 2003 17:48:00 +0100 463167 http://deathmaiden.blogspot.com/2003/11/grief-links.html Some of My Postings on Grief:-Grandma's Kitty-Laughing with Bobby-Ghost of Grief-Grief of Others-Grief of Divorce-Shakespeare Sonnet on Grief-Music Thanatology-Kitty's Final Hour-Betty Carmack Quote-Steal Magnolias-Life After Death 2-Grandma's Will-Speaking at Memorials-Ghosts-Package from Florida-Children and Grief-She Asked me Not to Weep-Cultural Influence on Grieving-Grief of the Dying-How to Sign a Sympathy Card-My Maternal Grandmother's Death-Grief as Ocean-Supporting a Friend Through GriefLinks to Outside Resources:Beyond IndigoChildren & GriefGay WidowsGrief-NetThe Gifts of Grief - the film (Source: Death Maiden) Death Maiden blogs http://www.medworm.com/rss/comments.php?id=463165 Wed, 12 Nov 2003 17:43:00 +0100 463165