"I'm dying." Help! Class on death?

J

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Hello,

I'm new to this site - not sure if this is even the right place to post this question, but I'm curious about something.

I work in an ED and have had patients tell me their "dying". Every single time, they died within an hour or two. I have had NO educational programs to help me respond to that type of statement. I've also had patients who have told me they "watched the resuscitation" and were correct in telling about details they could not have known of. Again, no training for that comment either.

So, my question is, do EMS providers have classes on death and dying or near-death experiences? Do you think they would or would not be helpful?

Any comments are appreciated!

Thanks,

J
 
Ummm. Well to answer part of your question, Yes. The stages of death and dying were covered in depth in my paramedic course. It’s very common for the very ill or dying to have a “sense of impending doom” and will tell you they are dying. It’s been my experience, if your patient tells you their dying, you better pay attention. I’d say 60% of the time their right. My typical response to that statement is "We're doing everything we can NOT to let that happen"

I can’t say that we covered any out of body experiences in any of my training / education. That’s a bit more into the spiritual side of things and most medical professionals tend to lean towards the scientific evidence.

This is a very sensitive area and I wouldn’t expect very many that are willing to get involved in this type of dialogue. There is loads of info online if you do a search.

Just my $.02
 
As far as I am aware, no there is no organized/canned class aimed towards EMS providers for death and dying. Edit - The 20 minutes spent on the 5 stages is usually so basic I'm not counting it.

Many college psychology programs have death and dying classes, but those probably require pre-reqs, and that may be a little more time and money intensive than you want. I know a couple of our hospitals have classes for friends/family members that are put on in conjunction with the local hospice program. That may be a bit more helpful. A long conversation with the chaplain/social worker/family liaison* may also give you some idea of how to respond.


*A secular conversation. Every hospital I have worked with has some version of this person and they tend to be very good at talking to dying people and their families.
 
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re

You can also become a Critical Incident Stress Debriefing member. I dont recall what all was taught as it has been at least a decade since I went through it, but I do recall dealing with death and emotions was a HUGE component of it.
 
Corky said:
You can also become a Critical Incident Stress Debriefing member. I dont recall what all was taught as it has been at least a decade since I went through it, but I do recall dealing with death and emotions was a HUGE component of it.
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If you do consider this PLEASE do some independent research on the effectiveness of the official CISD methods vs other methods. Some have been found to be more harmful than helpful.
 
Aidey said:
If you do consider this PLEASE do some independent research on the effectiveness of the official CISD methods vs other methods. Some have been found to be more harmful than helpful.
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Very true, a few articles hit the journals last year about this
 
My experience didn't parallel yours.

1. The majority of the people who died within an hour were unconscious or obtunded.

2. The majority of the people saying they were dying weren't.

3. The folks who were "at peace" with dying were not facing imminent demise, and had good hospice care/analgesia.

4. Never met a person who said first person and immediately after their near-death event that they went to any light, saw people, etc.

That said, use whatever resources you have to help define your questions about death and related subjects, and find resources to help you answer them to your satisfaction. I think this is a case where "truth" and "answers" are not one in the same.

Good luck.
 
My mom gave me a good book on it. I don't remember the title but I'll try to find it for you.

Some areas have programs that train their members to help family members immediately after a death or serious injury. Here we have TIP, Trauma Intervention Program. They are all volunteers. It's more focused on the family but they do get classes about the patients themselves as well. It might be worth looking into and seeing if you have anything like this in your area.

Also it might be worth a shot to contact local hospice services and see if they can point you in the correct direction. After all, their specialty is dying patients.

Like Aidey said, the stages of death/grief were covered in my class but they didn't go very in depth.
 
100% of my patients who have told me they're dying.... don't. How rude.
 
P.S- If a patient tells me they're dying they get a cheerful upbeat

"Nope! I have to save at least ONE today or they'll fire me."

"Nope! Too much paperwork!"

"I have a strict no dying in the truck policy. Don't make me dump you out on the side of the road!"
 
Thanks for the great information so far - much appreciated!
 
I use answers like Sasha's sometimes, usually when I don't think the pt is actually dying. There are times though when the pt knows they are dying, I know they're dying and they know I know.

On 911 calls I will ask if they have thought about the type of care they want and if they want to be Intubated, on a ventilator or have CPR. I explain they don't have to make the decision now, but that the doctor will ask them at the hospital.* I also will ask if they would like to speak with the chaplain/social worker/counselor person. It's surprising the number of people who call and day "I know something is very wrong and I've only got a couple of days left. I don't want any heroics, i just want to be comfortable." or "I didn't want kids to find me dead in couple of days" (not kidding on that one).

On transfers (usually hospital to the hospice facility) I've found one of the best things to do is ask them if they would like to sit out side for a few minutes (weather dependant). It seems like a funny way to respond to "I'm dying" but i have never had a negative response when I've said "I'm sorry to hear that. When we get there would you like to sit outside for a few minutes before we go in? ". The pts who are with it enough for that conversation know there is very little I can do for them and I'm offering one thing I can do that has great emotional meaning to them.

* For some reason the ER docs REALLY like this. I initially thought they would think I was over stepping but they have always been very thankful.
 
Aidey said:
I use answers like Sasha's sometimes, usually when I don't think the pt is actually dying. There are times though when the pt knows they are dying, I know they're dying and they know I know.

On 911 calls I will ask if they have thought about the type of care they want and if they want to be Intubated, on a ventilator or have CPR. I explain they don't have to make the decision now, but that the doctor will ask them at the hospital.* I also will ask if they would like to speak with the chaplain/social worker/counselor person. It's surprising the number of people who call and day "I know something is very wrong and I've only got a couple of days left. I don't want any heroics, i just want to be comfortable." or "I didn't want kids to find me dead in couple of days" (not kidding on that one).

On transfers (usually hospital to the hospice facility) I've found one of the best things to do is ask them if they would like to sit out side for a few minutes (weather dependant). It seems like a funny way to respond to "I'm dying" but i have never had a negative response when I've said "I'm sorry to hear that. When we get there would you like to sit outside for a few minutes before we go in? ". The pts who are with it enough for that conversation know there is very little I can do for them and I'm offering one thing I can do that has great emotional meaning to them.

* For some reason the ER docs REALLY like this. I initially thought they would think I was over stepping but they have always been very thankful.
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That's going to stick with me, thanks for sharing it.

I was also going to suggest hospice as a good resource. They have great literature and were top notch people. If you have time, it might even be good to volunteer.
 
We covered palliative care and end of life issues including supporting the both the pt and family's needs, physiology of dying, the psychology of dying and 'near death experiences'.

I found it very helpful. I reckon we could help more people, supporting them and their families at the end of life that we do pumping corpses full of adrenaline.

Aidey said:
On transfers (usually hospital to the hospice facility) I've found one of the best things to do is ask them if they would like to sit out side for a few minutes (weather dependant). It seems like a funny way to respond to "I'm dying" but i have never had a negative response when I've said "I'm sorry to hear that. When we get there would you like to sit outside for a few minutes before we go in? ". The pts who are with it enough for that conversation know there is very little I can do for them and I'm offering one thing I can do that has great emotional meaning to them.
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I knew a crew who took a palliative pt from home to the beach and opened the back doors of the ambulance to let the pt see the ocean and see some sunlight. A few minutes later they continued on to the ED where the pt died shortly after.

I think its one of the best stories I've ever heard.
 
Not everyone who says they are going to die is right, but it should raise your index of suspicion. We have a saying "when your patient says they are going to die, trust them." (Note that there is a big different from the hyperventillating 20 year old who says "I felt like I was going to die" and the 50 year old with chest pain who says "don't let me die.")

Also, be careful of the promises you make. If you tell a patient or a family member "they won't die/I won't let them die," there is a chance you could be wrong. So the family member feels mislead, as might the patient if they feel you told them they didn't have a serious problem and they are deteiorating. I tend to say something along the lines of "we're going to take good care of you." I also feel like Murphy's law says if you promise a patient they won't die, fate will kill them to spite you.
 
If you want a pragmatic and expedient way of both helping your patient and yourself in the face of death, look into mindfulness practice. You can generally find a buddhist or "secular" meditation center around to take free introduction classes. They are starting to use mindfulness practices in some hospitals with great results. It requires that you believe no specific dogma; just to be non-judgmentally present with your patient and their feelings, as well as your own.

http://www.insightmeditationcenter.org/support/end-of-life-companioning/
http://www.usatoday.com/news/health/2009-06-07-meditate_N.htm

Asa a Zen master might say: WAKE UP. Here, now.
 
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We participate in death

Formally and institutionally, within EMS you're not going to get a whole lot of guidance about death and dying. A few scattered resources here and there, fewer still that take you to the depth that this stuff usually calls for.

In fact, since this and other related topics have been and are discussed here, at EMTLife, this Forum could be a very potent resource for you to find your own way.

And if you're going to have a "goal" I would suggest that you explore your personal relationship with death. This takes years and you can't find a better place to do it than in this work.

What that takes is a conscious effort on your part to run your calls as best you can, "note" that something inside of you got rocked and then, later on when you have the clear space, take the time to look at it.

That could mean reading books, finding colleagues you can trust not to laugh at or minimize your experience and talk with them, get peer counseling or even volunteer to spend time with the dying.

I believe this work, for many of us anyway, asks that we face the inevitability of our own deaths.

The brave ones, anyway!
 
I took "End of Life Care" as a course for my upcoming Medic program. It was really informative on pallative care, family needs, stages of death (body processes), field trips included hospice, and had alot of guest speakers. Was a well rounded course in my opinion.
 
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