Atul Gawande’s breakthrough book, Being Mortal tells us the ultimate goal, after all, is not a good death but a good life to the very end. Elizabeth Kubla- Ross tells us the death is really in parts called five stages.
A Care Manager or Geriatric Social worker can be a midwife through these five stages to a good death, reaching towards joining the ultimate midwife team, hospice.
The Acceptance phase of death occurs when people finally are able to cope with the mental, social, physical, religious and financial effects of their disease, a heavy load In the disease process and acceptance process, this is the period of time after a medical procedure such as chemotherapy, radiation or surgery. The client’s response to treatment is being monitored. Recovery does not always mean remission, but instead, it is the ability to accept and deal with the struggles of their illness.
A Story About the acceptance phase Mr. Murphy
William accepted his coming death while in the hospital. He had 4 physicians’ who were treating him aggressively for renal failure with dialysis. He was 93 and refused to sign a DNR. The doctors discovered what they thought might be a tumor. However, they were afraid the biopsy procedure would be too radical for his age. So they kept up the dialysis.
The care manager appealed to the nurses for help when the physicians would not intervene. A nun appeared – it was a Catholic hospital- and said, ” the nurses called me to go around this problem. Talk to the head Dr. about ordering palliative care.” The Care Manager did.
Sure enough, after the care manager talked to him that physician ordered palliative care. Then one by one one the 4 physicians came to Bill’s bedside and talked softly, asking him to accept that he may have cancer and the biopsy could not be done. The last, a gentle urologist, held his hand and talked of letting go and accepting he would die. He agreed to stop the dialysis.
Bill accepted his death reluctantly wanted to live to watch his 3 great grandchildren grow. The urologist ordered palliative care and Bill changed the DNR with the help of his son. Hospice met with the family and all agreed to move William to the son’s home with 24-hour care and hospice to die.
Gwendolyn LAZO Harris MA, CT, Seniors at Home, San Francisco and Diane LeVan MA both highly expert care managers, created a seminal chapter “Palliative Care and End of Life Care Manager ” in my book Care Manager’s Working With the Aging Family