Death and Dying: Before and After Stages Essay

Each new day begins with a sunrise. It brings to earth a new dim that has never been seen before. The new light starts small and gradually reaches its peak in the vast sky. It nourishes the land, provides warmth and comfort, and inspires epic tales. As the day periods the light slowly sinks behind the horizon leaving behind brilliant splashes of color as if to reflect upon its accomplishment, but the pallet of colors give quickly dissolve to black as the light leaves the sky to go to enters unknown. Even though the day was bright and created wonder it moldiness give way to the tranquil, mysterious, and cool night. honourable as the dawn must give to the night each birth must yield to an pointtual death. The night, like death, holds a sense mystery and peacefulness for some. To others it invokes all the horrors found in the scariest nightmares. While creation may find ways to prolong the inevitable, each must yield to the waning light and go into that which he may have no k nowledge of prior to the journey. It is a journey he will take hold al hotshot. He will be naked of all his earthly possession including his body. Only his soul will be allowed to pass into the dusk the time of night. My friends, he must ruin and yet you must live on. As with every story, death too, has more than one perspective. The lone warrior who must take the solitary journey and the spectators watching the eternal sun get dressed two have their story about the corresponding shut upt, but each story is unique.The anxious(p) and their family do non have to face the uncertainty and often dire mental process alone however. Organizations such as RMH Hospice Care can help both the expiry and their loved ones. Any mortal that has a terminal diagnosis, and is non expected to live for more than six months is eligible for Hospice assistance. Hospice Care helps to alleviate the stress that is encountered during the dying process by taking a holistic salute to treatment. It often severs as an educational tool to the somebody and their family. Hospice similarly provides awareness of the options that are available to the dying person. They as well as seek to educate the community and wellness care workers.The word hospice comes from the root word for hospitality in Latin. In basicterms Hospice style to provide hospitality to the dying person and their family. This means giving palliative or comfort care to the dying and helping their loved ones in many ways. Hospice absorbs provide medications to the clients that help to alleviate pain, ease suspire and treat depression that accompanies the process of dying. The nurses as well as educated the family so that they can understand better what is happening with their loved ones. Hospice workers also provide some focusing to the family and patient. After the death they continue to keep in touch with the family.Historically nuns were caring for the dying persons in monasteries prior to the construction of hospitals. The word hospital also comes for the Latin word for hospitality. In the late sixties a doctor named Dame Saunders applied the term Hospice to the care of the dying (History of Hospice Care The National Hospice and alleviatory Care Organization). She would also introduce the practice of caring for the dying to the United States. matchless of the purposes hospice serves is to help the dying person and their family to work with the stages and processes of accepting the situation death will occur and to provide help for the family after the death of their loved one. Hospice workers are aware of and educate about the stages that Elisabeth Kubler-Ross introduced to the realm of death and dying.The dying person experiences intimately the process of dying that Elisabeth Kubler-Ross identified, but their loved ones who are left behind after the death experience the grief associated with the loss of a loved one must complete the tasks of sorrow identified by William Worden in order to achieve an acceptable quality of life without their loved one.Everyone reaches a point in their life when they understand that they will die. Some propagation this revelation comes as a part of a terminal disease diagnosis. Other times it is simply the realization that their age is greater than the time they have left. When the time of death is near those who are dying often begin working though a process that Elisabeth Kubler-Ross presented in the late sixties. She identified five steps that the dying person works done. These steps are now looked at as process because a person may go between the steps and in various orders (L.Bee &Bjorklund, 2005). Kubler-Ross identified denial, anger, barraging, depression, and acceptance as the processes that dying person experience. defence mechanism is simply denying that one is close to death. The person may continue to present the illusion that there is nothing wrong with them. A woman with breast pubic louse was observed by h er friends as refusing to have surgery, and sought out several second opinions. A man in hospice care because of prostate cancer may tell the nurse who is making a home visit, I dont know why you are here I am fine. One particular client who lives in a nursing induction with several levels of care has recently been locomote to the special care unit because of his terminal check off and the new requirements of care. He is in deep denial despite his diagnose of terminal lung cancer. He has tally no effort to commission a will. He has established no aliveness will or a person to act as his index number of attorney should he be unable to make decisions concerning his medical impoverishments or finances. He has even refused to meet with the social worker. His daughter is currently sledding through legal process to obtain power of attorney.She requested Hospice care for him. A hospice nurse met with him, and he agreed to sign consent and keep his current DNR status active, but he stated, I am only doing this so Sally will leave me alone. He still refuses to fill out the wish playscript given to him by hospice. The wish book allows for the dying persons to write down wishes they would liked honored as they are dying and after they are dead. It is assumable that he tones there is no need to designate this information because he is fine.Denial from family members can also be seen. Aides and nurses who go to the homes of the hospice clients report denial from family members as a part of their observations.At a home visit one hospice nurse has met opposition from the daughters of a 59 year old man in the Hospice platform. She is reluctant to sign important written document because daddy is gonna live a long time still, despite his need for high amounts of oxygen and advancing congestive heart failure. Another man, observed at an assistant nutriment facility in Harrisonburg by a nurses aid working on the special care unit, response to his 69 wifes terminal c ancer diagnosis and recent move to the new unit by saying those dn doctors they dont know anything anyway. Shell quilt through this. Shes been through worse. He is reflecting upon the beginning time she was diagnosed with cancer 6 years ago. This time howevershe has chosen to not go through the aggressive treatments for her cancer.Anger is another process identified by Kubler-Ross. Anger refers to the feelings felt once the person realizes they are dying. It is only natural for a person feel aggravated at the loss of their most precious asset. Anger is sometimes seen in sudden outburst. An elderly woman at an assistant living facility who is normally peaceful and quite was observed by a student throwing her slight glass birds in her room and cursing immortal a few days after receiving bad news from her doctor. In the same facility the student was confronted with a green man who has AIDS. He was almost unapproachable because of his hatred of persons with much life ahead of the m.Anger is not restricted to the dying person only. Family members experience this emotion as well. A middle age man whose wife is visit frequently by a hospice nurse due to the effects of the end stages of terminal cancer curses God for taking his wife preferably of someone who had done terrible deeds. He clenches his fist and looks to the sky as if to challenge God himself. Anger is reflected in family members of an elderly woman who has suffered a fall as the result of neglect. The fall caused much trauma for the woman, and it became evident she would not recover from the damage. Her family vocalizes their anger and feelings of unfairness to the aides who care for their mother in the special care unit.Bargaining is the offer of a sacrifice in return for more life. The dying cancer patient may ask God to grant him life until the end of the holiday season, and he will ask for nothing else. A little woman in a hospice care program asked God to grant her enough time to see her garde ns bloom one last time. This too was a last request. Another gentleman promised good behavior and greater religious commitment in return for a longer life.Bargaining is also seen among family members. They are willing to give up a hazard in order to preserve a loved ones life. For example the middle age man losing his wife to terminal cancer inform asking God to allay his wife, and take his instead. He also promised to be a better person and give more money to the church. To show that he was serious he donated several thousand fromthe sale of property to the church. His sincerity and hurt made the observer want to cry. He was clearly trying to save his wifes life.Depression affects the mental health of the dying. Depression in the dying is a reaction to the disorder of their life created by the disease and because of the realization that they must prepare to meet death (Strickland, 2005). Depression in the dying person is often observed by caregivers in the form of the refusal t o eat, not going out, refusing to see other people, and showing no interests in hobbies they one enjoyed. The man with congestive heart failure often enjoyed building small wooden toys. When asked if he had been in his workshop lately he said, No, just have not felt like it. Not really much point. The young man scathe from AIDS has not turned on his playstation in a month. He used to play several hours a day. His mother has offered him several new games. acceptation of ones death is not the same as giving up. It is actually the act of accepting death in a manner that allows for the need reflection of the life lived. The middle aged woman with terminal cancer put her affairs in order, made all her own funeral arrangements so her family would not have to, and dictated her living will and estate will to her attorney. She has judge her own mortality. An elderly woman has sold property she does not use, started giving away(p) her possessions to family members, and is writing her memor ies in a journal.She also decided to empty her bank account and split the money between her five grandchildren. With a evil little smiled she said, Now the greedy lawyers wont get a dime of it.During the last week of his wifes life the middle aged man came to accept his wifes very near death. He quit asking for her life to be extended. When he asked for the nurse and aide to join him in prayer he now prayed for comfort and a peaceful going away for his wife. He asked for guidance in the days after her death. He also asked her what she precious to be buried in. He knew she was a particular woman when it came to dressing.A person or family member can experience these stages in any order. They may also experience more than one stage at once. For example the man with congestive heart failure had accepted the fact that he would in short be dying,but he still bargained for more time. He wanted to live though his daughters wedding. He felt he could die in peace if he could attend his youn gest daughters wedding. Anger was the first reaction to one womans terminal diagnosis, but instead of bargaining she went into depression. Her depression was often mixed with angry actions. If she bargained it was in her personal space and time. On the eve of her death she became afraid to be alone, and she verbalized for the first time her acceptance of death. I do not want to die alone. Please stay with me, she asked several aids in the nursing home she lived in. The young man with AIDS knows he is dying and he is quick to state I am going to die soon, and he has signed a DNR form, made request for his funeral, and signed his property over to his mother.He show acceptance by the above mentioned acts, he is still very angry and considers himself unjustly persecuted by the Gods, he can be heard often barraging for more time, and is severely demoralise. The only stage he seems not to be in is denial. It is possible in the depths of his mind he may still try to convince himself that he normal, well, and has many years to live. Denial was once an issue for him however, for nearly six years he refused treatment for HIV because he did not want to admit he was carrying the virus in his blood. He pursued numerous second opinions.Family members queer the same fluidity in the stages indentified by Kubler-Ross.The daughter who refused to sign important papers for her father because she felt he was not in the dying process eventually agreed to sign them. However she stated, I do not think he is dying, but I need the help so I will sign them. The family angry because of the neglect that lead to the terminal condition of their mother never let go of the angry feelings even though they moved through the four other processes. The middle aged man was depressed during the time his wife was dying. He also bargained with God despite being angry with him. In a few cases the family members simply accepted the fact their loved one was dying. If there were any of the other stages present they hid their feelings very well. In these cases the dying person was very old, had lived a full life, and there was not the presence of terminal illness.Once the loved one has passed away the tasks of mourning and recuperating from the loss is displace on the survivors. William Worden has establishedfour tasks of mourning. These tasks must be met in order for the survivors to return to the quality of life that they experienced before the death of their loved one (Worden, 2001). These tasks, unlike Kubler-Rosss stages, are worked through in order.Wordens first task requires that the lamenters accept the reality of the loss, (Worden, 2001). Worden acknowledges the reality of death is tough to accept even if the death was anticipated. In post-death visits done by Hospice this is most common seen in a verbal form. The daughter of the man who died from congestive heart failure remarked upon a comment made by an observer about the toy train her father had made, Daddy is- I mean was always good with his hands.She had a seriously time accepting the fact her father was dying, but is working into accepting his death. The middle aged husband who lost his wife to terminal cancer also showed signs of making the adjustment to accepting his loss. He would often say its what she wouldve wanted me to do, or she was this and she use to do that. A woman whose husband recently passed made the comment that was my husbands favorite ice cream, at an ice cream social event at her assistant living facility.sometimes this type of speech is noted before the person has passed away. Visitors of an elderly man who was in his last few hours of life were overheard saying, He was a good man. Nurses in nursing homes also do the same type of behavior. She was sick, even though she is still sick, and he wanted to die peacefully, despite the fact he has not yet passed away.Funeral homes often help with the acceptance as well. The remembrance cards are written in past tense. Funeral di rectors give the option for an open shut in funeral or viewing. The practice of being able to view the body of their loved one often helps people to accept their loss as reality. The ideas that are associated with a funeral and funeral parlors also help the surviving members to come to terms with the fact a loved one has died.Wordens second task involves the chore of working through the grief, (Worden, 2001). heartbreak can include both physical, emotional and behavior aspects. It is often referred to as the pain of loss, the empty space in myheart, and nothingness. Family members can become depressed after the loss. A newly widowed woman refuses to eat, and stays in her room. Prior to her husbands death she was active within the assist living facilitys community As the weeks turned to months she began eating at every meal, and once again participating in the activities. Occasionally she will even make small humorous remarks about all the time she has now that she does not have to worry about her husband.Adjusting to the changed environment is the third tasks in Wordens four tasks to mourning the loss of a loved one. The changed environment is the places where the loved one is missing from. The home, or apartment, and place of work are examples of the environments that experience a change when a person dies. When a widow allows for the removal of her husbands clothes from her closet she is making a small change in the environment to reflect its change. In the case of the man who passed from the effect of chronic heart failure, his daughters removed the hospital bed from the living room, and returned the sofa and book cases.The same occurred in the house of the middle aged man whose wife died from terminal cancer. Part of this change was prompted by the fact that the hospital beds were rentals from medical supply companies. The nurse who did the follow-up visit to his home noted that the man had chosen to completely rearrange his living room after the hospita l bed was moved. He also purchased some new furniture for the room. His daughter took to only setting the formal dining room with three table setting instead of the four place settings. The imbalanced of the table settings contrasted greatly with the theme of symmetry in the room. All the decorations and furniture in that room was bought in pairs and arranged evenly. The table looked odd with its mismatched number of place settings. The granddaughter has removed all the blankets from the sick room (her reference to the living room) because they were only for sick people.Adjustment to the changed environment can sometimes be problematic when the environment the person occupied most during their last days were in a nursing home. Because rooms in a nursing facility are often in high demand the rooms have to cleared and cleaned quickly. In some cases this change occurs with hours after the person death. This can be upsetting to familymembers who may have wanted to spend some quite time among their loved one things. Nurse aids often report that it makes them feel like the person meant nothing to anyone when the rooms are cleared and cleaned quickly. Even though the nurses only spend a short amount of time with the person their personalities often lend to quick attachments. Sometimes nurse aids will take keepsakes from the person room, with family permission of course. One nurse aid was given a house plant by the family of a resident she grew very close to. She still talks about the plant and the person frequently despite the passing of two years.The fourth task is to emotionally relocate the deceased and moving on with life, (Worden, 2001). To accomplish this task the mourner must acknowledge that while they will never forget or renounce their love for that person, there are other they can love (Worden, 2001). An example of this can be seen when a widowed person after sometime meets, falls in love with, and marries someone else. They understand that they will alway s love their first spouse, but they have accepted and properly mourned their loss.That being done they are able accept and give love to another person. Parents who have experienced the loss of a child may choose to become pregnant and have another child. They have not forgotten the child they once had and loved. They simply now realize that they can still have the love for the child that has died and for a new baby. A widow who goes out and seeks meaningful relationships among her peers so as not to be socially separated is allowing for some of the empty space in her heart to be filled with the love and understanding found in the new friendships.When a person is in the twilight of their live they must work through stages like those attributed to Elisabeth Kubler-Ross. Along with the dying person the family also experiences the emotions linked with these stages. The dying person and their family may not experience the stages of denial, anger, bargaining, depression, and acceptance i n order or at the same time. The person may experience more than one stage at a time.Once the sunset has set on a persons live their family members are left with the chore of accepting the loss and mourning the dead. William Worden setforth four tasks of mourning that if completed successfully the mourner will be able to return to the quality of life they experienced before their loss. The mourner must accept the loss, master their grief, acknowledge changed environments, and relocate the deceased. (Worden, 2001)While part of the grieving process starts before the death, and can be experienced with the dying person, the tasks of mourning are solely up to the survivors to complete. It is unknown what stage if any the deceased experience after their death. This is a heavily guarded secret only imparted to those who make the journey into the great unknown.Works CitedGina Copp RGN, D. M. (1998). A Review of Current Theories of Death and Dying. Journal of Advanced Nursing , 382-390.Kipp, S. W., & Kemp, E. (n.d.). Consumer Awarness of the Legal Obligations of Funeral .L.Bee, H., & Bjorklund, B. (2005). The Journey of Adulthood. Boston Pearson.Ph.D., T. A. (2007). The Human Odyssey Navigating the dozen Stages of Life. New York Sterling.Strickland, L. A. (2005). The last DanceEncountering Death and Dying (7th ed.). New York, New York McGraw.Terry, W., Olson, L., Wilss, L., & Boulton-Lewis, G. (2006). Experience of Dying Concernc of Dying Patients. Internal Medicine journal , 338-346.Worden, W. (2001). Grief Counceling and Grief Therapy A Handbook for the Mental Health Professional. New York Springer Publishing Company.