Medicine.org - Death, Dying, Grief & Bereavement

Nothing Is Certain Except for Death and Taxes

Fri, 12 Oct 2007 10:32:26 -0400

Benjamin Franklin said nothing in this world can be certain except death and taxes. We might debate Franklin about taxes (some people seem to get away with everything), but all agree that we will one day die. Sooner or later, no matter how healthy we have been, we will die.

There is less certainty when we try to define death. The definition of death has become increasingly hazy. Initially, a person was considered dead when they stopped breathing. Even cavemen could detect when this occurred. Then death took on a religious significance, and priests used to declare a person dead. When in doubt, they looked for signs of putrefaction. Then, with the advent of modern medicine, the new definition of death became when the heart stopped. Brain death became the method of choice in the 1960’s. This method was considered fool proof for several decades. When the brain and brainstem stop functioning, the rest of your body quickly dies also.

The Terminally Ill: What Type of Care Do We Provide?

Tue, 25 Sep 2007 14:29:16 -0400

Hospice care was introduced in the late 1960’s, as a result of witnessing deaths filled with pain and suffering.

By definition, therefore, hospice care is for those patients considered terminal who could benefit from a focus on pain elimination, easier breathing, and other management strategies to decrease suffering. For those patients in a Hospice program, death with dignity helps the family who must bear watch to the ultimate outcome. A bereavement program is part of any hospice, to help the grieving family after the loved one has passed.

No One Dies Alone

Mon, 06 Aug 2007 12:25:36 -0400

Hospice is a concept which has been around for several generations. In general, it was an outcome of the 1950's push to build hospitals, and the inevitable deaths which occurred in hospital beds (rather than at home). The sterility, detachment, and aloneness of dying in a hospital bed, made the advent of hospice a much more human way to help those transitioning to the other side.

A story, which is currently making the rounds on the group e-mail circuit, emphasizes the very personal interactions of hospice, through the eyes of a cat.

Dopamine May Help Respiratory Failure

Wed, 09 May 2007 22:16:52 -0400

As a neurotransmitter, dopamine has effects on both the central and the peripheral nervous systems through several different types of receptors that include stimulation, vasoconstriction, and elevated heart rate and blood pressure. As an intravenous medication, it is administered at a range of doses for a variety of conditions, including shock, heart failure, and renal disease. Recent research has found that low-dose dopamine also improves diaphragmatic blood flow and reduces diaphragmatic fatigue in acute respiratory failure; however, no previous studies have reported dopamine receptors in the muscle tissue of the diaphragm. Researchers examined the diaphragm muscles removed from 8 adult rats for evidence of the cellular expression of dopamine receptors. Specific receptor binding assays of dopamine to samples of the muscle tissue did not reveal detectable levels of any receptor types or sites. However, using a highly sensitive polymerase chain reaction technique for messenger RNA expression, evidence was found of the expression of 2 types of dopamine-specific receptors, known as D1 and D5, in diaphragmatic cells. This finding is the first to suggest that the diaphragm may contain dopamine receptors, helping to explain the positive effect of dopamine in treating respiratory failure.

Stages of Grief

Wed, 28 Feb 2007 10:19:41 -0500

Most people have heard of the stages of grieving, and accept the wisdom that one will process through denial-dissociation-isolation, anger, bargaining, depression, and acceptance. This was subsequently modified to be denial-dissociation-isolation, yearning, anger, depression and acceptance. The great Kubler-Ross was the creator of the stages of grief, during her work with dying patients. However, no one had ever studied whether these stages actually exist, until Yale researchers looked at the field of bereavement in depth.

End of Life: Missed Opportunities in End-of-Life Meetings

Mon, 29 Jan 2007 13:08:19 -0500

The 1997 report from the Institute of Medicine, Approaching Death: Improving Care at the End of Life, found widespread dissatisfaction with end of life care and many gaps in our scientific knowledge of this phase of life. In response, the National Institute of Nursing Research (NINR) sponsored a workshop on the symptoms of terminal illness, and NINR was later designated the lead Institute within NIH for end o f life research.

End of LIfe: Documenting End of LIfe Issues

Mon, 29 Jan 2007 13:04:21 -0500

End of Life: Withdrawing Life Support

Sat, 27 Jan 2007 19:29:10 -0500

The 1997 report from the Institute of Medicine, Approaching Death: Improving Care at the End of LIfe, found widespread dissatisfaction with end-of-life care and many gaps in our scientific knowledge of this phase of life. In response, the National Institute of Nursing Research (NINR) sponsored a workshop on the symptoms of terminal illness, and NINR was later designated the lead Institute within National Institute of Health (NIH) for end-of-life research.

End of Life: The Desire of Terminal Patients to Hasten Death

Sat, 27 Jan 2007 19:25:37 -0500

End of Life: Inconsistent Communication in Discussing End-Of-Life Issues

Sat, 27 Jan 2007 19:21:54 -0500

End of Life: Helping the Caregivers

Sat, 27 Jan 2007 19:18:04 -0500

New Orleans Suicide Rate Triples --Mental Health System Near Collapse

Mon, 03 Jul 2006 14:55:10 -0400

According to an article in the New York Times, June 21, 2006, New Orleans is experiencing what appears to be a near epidemic of depression and post-traumatic stress disorders, one that mental health experts say is of an intensity rarely seen in this country.

Recovering from the Loss of a Loved One -- A Better Understanding of Complicated Grief Leads to Clearer Treatment Goals

Fri, 23 Jun 2006 16:38:37 -0400

Complicated Grief (CG) is a debilitating clinical syndrome that can develop in the aftermath of the death of a loved one. Until recently, little has been known about it. Now a paper published in the current issue of Clinical Psychology: Science and Practice has offered the first conceptualization of CG. This can be used as a framework for its underlying conditions and for cognitive-behavioral treatment strategies.