How do I deal with ‘end of life’?

We witness death in the course of our work, many of us daily. As professionals who must soldier on through the heartbreak of this ultimate loss, we can become immune to the inevitability of our own mortality. As Jim DeMaria reflects, sometimes it takes the death of a loved one to inspire us to think about our own end of life, and how we wish to depart.

I attended a “going-home ceremony” for a dear friend recently. I was inspired to write this article thanks to a profound, truthful statement the clergyman said in his fiery, passion-filled voice: “Funny thing about life…none of us gets out alive!”

As a nurse, I’m no stranger to death. Every human being will die—it’s a question of how, when, where and why. These are the variables that we nurses face almost every day while caring for our patients. Although we’re always hopeful and optimistic about each patient’s positive outcome, sometimes we pray that death will come for a patient before their loved ones are placed in the often grueling position of making monumental decisions about life and death. This brings me to the question “Are we allowed to die?”

In the current environment of DNRs, health care proxies and advanced directives, we would like to think that we have a say in the matter. These are supposed to be assurances for our wishes should we become incapacitated. As nurses, we often find that these wishes go unheard, unnoticed or even ignored. Family members who are put into the position of making decisions are often overwhelmed with emotional distress due to a large number of factors. They may feel obligated, or even guilted, into doing “something, anything” to “help” their loved one. They encounter the slippery slope of what is the appropriate amount of care and what is “too much” care.

Have we, as health care practitioners, become so cavalier in our thinking that we don’t acknowledge death as part of life? Should we keep people alive just because we can? I’d like to think that quality of life always takes precedence over quantity. In other words, if you can’t give me my life, or some sense of what it used to be, then don’t keep me alive just because you can. Death is inevitable. None of us can avoid it, no matter what we do. What we need is the ability to maintain some sense of dignity as we approach the end.

We have two obligations: We must make our own end-of-life wishes clear, and as nurses we must ensure that our patients’ wishes are met. These decisions are just as important as the many other decisions we make concerning our, and our patients’, health. I welcome your thoughts and your feedback.

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Jim DeMaria

James DeMaria, RN, BSN, is Vice President of Renal Care Registered Nursing Services, located in Nanuet, N.Y. Founded in 1991, Renal Care Registered Nursing Services provides acute kidney dialysis services to some of the northeast’s largest hospitals and caregiving facilities. While having had no formal business training, James has excelled as an entrepreneur, a role he must balance with his responsibility as a nurse, husband and father, and is always on call, explaining, “You never work harder than you do for yourself.” He is also cohost of “Nurse's Station,” a new audio podcast by and for nurses.

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4 Responses to How do I deal with ‘end of life’?

  1. Joanne

    I am for quality of life, not quanity. I have made my wishes known to my spouse and family and put it in writing. I hope when my time comes, there will be no arguments regarding the decisions that need to be made.

  2. Linda D.

    Everything you’ve said is so true. All of this is among the reasons for my being a hospice nurse. It’s been my job at times to help deal with the “slippery slope” when the end is getting closer and closer. It’s also why I’ve made my wishes very clear in writing, and my proxy is a dear friend who is also a hospice nurse and knows well my wishes.

  3. Leoda

    My calling in nursing has always been hospice and I finally had the opportunity to pursue that area of nursing. When talking with the latient as well as the family of the terminally ill, I often ask “if you have one week, one month, or even one year left to live,’how do you want to spend it?” That question generally helps the patient and family decide what course of action to take. In hospice, the focus is quality of life not quantity.

  4. Nurse Jimmie

    Still can’t find just one area I prefer over another? I love it all after 40 years and still counting! 😎