Death & Grief

At what point are you really dead?

Cessation of breathing Cardiac arrest (no pulse) Pallor mortis, paleness which happens in the 15120 minutes after death Livor mortis, a settling of the blood in the lower portion of the body Algor mortis, the reduction in body temperature following death. Rigor mortis, the limbs of the corpse become stiff and difficult to move Decomposition, the reduction into simpler forms of matter, accompanied by a strong, unpleasant odor.

What is Death???
Permanent Universal Nonfunctionality

Permanent cessation of all biological functions that sustain a living organism

Pioneer In Thanathology
Elisabeth KblerRoss Swiss American Psychiatrist

5 Stages of Grief

Denial

Acceptance

Anger

The stages, popularly known by the acronym DABDA

Depression

Bargaining

Bereavement and Grief

Bereavement : mourning: state of sorrow over the death or departure of a loved one. Grief : is a reaction to a major loss. It is most often an unhappy and painful emotion.

Symptoms : Kubler Ross Model (5 Stages)

When do we grief?
Death of loved ones Terminal ilness End of a significant relationship Common stage of mourning- recognizing a loss and continues until a person eventually accepts that loss. People's responses to grief will be different, depending on the circumstances of the death.

Types of Grief & Loss

Anticipatory mourning : the process of grieving,
adapting, and coping that a person engages in when a loved one is reaching the end of life. Sudden Loss : Grief may be particularly traumatic following a sudden, unexpected death when a persons normal coping mechanisms are overtaxed by the tragedy. Complicated grief : which often necessitates the help of a mental health professional, is prolonged, intense grief that interferes with a persons ability to function over time.

Expectations
It may take a year or longer to overcome strong feelings of grief, and to accept the loss.

What happens when one is unable to accept the loss?

Grieving Process
Shock and Denial Intense Concern. Despair and Depression. Recovery

Abnormal Grief

Abnormal, often referred to as complicated grief, is found in only 3 to 25 percent of loss survivors. There are different types of abnormal grief: Chronic grief the grieving person has trouble finding closure and returning to normal activities over an extended amount of time.

Delayed grief the intentional postponement of grief. Sometime this is related to

other life events or losses that drain ones ability to work through the grief process.

Disenfranchised grief often occurs when a grieving persons loss cant be

openly acknowledged or is one that society does not accept as a real. Examples include losses related to AIDS, miscarriage, or loss of a homosexual partner.

Exaggerated grief intense reactions of grief that may include nightmares,

delinquent behaviors, phobias (abnormal fears), and thoughts of suicide.

Sudden grief when death takes place very suddenly without warning. Sudden
grief can lead to exaggerated reactions and posttraumatic stress disorder (PTSD).

Five Identities Of Grievers

The nomads : - not yet resolved their grief and do not

seem to understand the loss that has affected their lives. The memorialists : - committed to preserving the memory of the loved one that they have lost. The normalizers : - committed to re-creating a sense of family and community. The activists : - focuses on helping other people who are dealing with the same disease or with the same issues that caused their loved one's death. The seekers : - adopt religious, philosophical, or spiritual beliefs to create meaning in their lives

4 Stages of Mourning
Accept the Reality of the Loss Coming full face with the reality that the person is dead and will not return is the first task that needs to be completed. Without accomplishing this, the grieving person will not be able to continue through the mourning process. Work Through the Pain Grief is painful, physically and emotionally. It is important to acknowledge the pain and not suppress it. Adjust to the New Environment in Which the Deceased is Missing This may require adjusting to the roles that the deceased once carried out. If it is a spouse that has died, it required the bereaved to accept their new identity as a widow. Emotionally Relocate the Deceased and Move On While the bereaved will never be compelled to totally give up on the relationship, the goal is to find an appropriate place in their emotional lives for the deceased. This requires a letting go of attachments so new relationships can begin to form.

Treatments
Family and friends can offer emotional support during the grieving process. Sometimes outside factors can affect the normal grieving process, and people might need help from: Clergy Mental health specialists Self-help groups Social workers The acute phase of grief usually lasts up to 2 months. Some milder symptoms may last for a year or longer. Psychological counselling may help a person who is unable to face the loss (absent grief reaction), or who has depression with grieving.

Physician Response to Death

A date with the angel of death : -moved by the the deaths of the strangers for whom they care, -powerfully affected by the deaths of patients with whom they have forged close relationships. - believe that the death of a patient is the fault of their own and a failure to make a change.

 Nearly 15 years ago, the Educating Physicians in End of Life Care (EPEC) project had outlined a 7-steps communication process that may help physicians approach patients and deliver them the bad news:
Preparing Choose a strategic quiet, comfortable and private location
and time where there will be no interruptions. Ask the patient and decide who else should be in the discussion.

Assessing Find out what the patient already knows and wants to
know. Try to understand how the patient perceives the medical situation and his knowledge on the subject. Elderly patient will usually ask us to consult their children instead. Warning Alert them of the impending news. I have some bad news usually helps. Make sure this is done once the patience is relax and comfortable. Describing Present the facts in a succinct but caring way using simple understandable terms. Do not talk for too long and do not present all the facts in a wholesome way.

 Pausing Between intervals of describing the facts, take a moment

for the patient to settle down and digest the information. Ask the patient if he or she understands what has been said and what is his or her current thought. Answer their questions politely and softly. Validating An opportunity to be a caring physician. Pay close intention to the patients emotions and reactions. Is there any presence of trembling, fiddling, irritation, or there is no reaction at all? Listen to the patient, even complains. Like a mother caring a child, ask the patients feelings and try to comfort them. Share their pain and sympathize their situation.

Planning End the discussion by presenting a follow-up treatment

plan. It can be done on the following day if the patient is unready for it. Present the patients with available options and it is important to prevent any misunderstanding.

TheEnd