One small step at a time

Yes, I did that presentation last month to the NICs, and I think it went well. I'll write up the particulars in a separate post, along with my plan to get this project actually rolling.

Until then, here's an article by Max Alexander that I came across in the March issue of Smithsonian magzine, "The Surprising Satisfactions of a Home Funeral." In it, Alexander compares the after-death care of his father in law with that of his own father. The two men died within just a few weeks of each other.

One was buried, one was cremated. One was embalmed, one wasn't. One had a typical American funeral-home cotillion; one was laid out at home in a homemade coffin. I could tell you that sorting out the details of these two dead fathers taught me a lot about life, which is true. But what I really want to share is that dead bodies are perfectly OK to be around, for a while.

Until we’re really rolling…

I noted in my last post (last month?!?) that my nurse manager supports my proposal to develop a core group of end of life care nurses in our specialty intensive care unit, based on the ELNEC curriculum. This group will have primary responsibility for caring for patients at the end of life, and we will be resources on the topic for our colleagues.

It’s a big unit, and we’re very busy pretty much all of the time. We have 20 beds, and 100 nursing staff. Our house staff includes a dozen and a half residents enrolled in a 6-year surgical subspecialty program; rotating fellows in critical care medicine and interventional radiology; and an ever-changing cast of medical residents rotating through for a taste of our specialty.

And we’ve started counting our dead.

Every few weeks for the last year and a half, we've sent out condolence cards to the families of the patients who died while in our care. We average 10 deaths each month, so a program to improve the end of life care that we provide makes sense.

But the wheels turn slowly in large university medical centers. Or maybe it just seems that way when a project I feel so strongly about is just one of many items on someone else’s agenda.

No, the wheels do turn slowly – slower than I’d like, anyway. But that’s the reality, and so here we are.

This project has been put on the agenda for next week’s all-day off-site meeting of the permanent NICs (nurses in charge), and it is important that this group understand the project and support its goals. I may have up to one hour to present the project and conduct a discussion, or as little as half an hour.

I’m flexible.

Our institution, like too many others, is addicted to the relentless and indiscriminate use of PowerPoint – a surefire way to bore an audience to tears and kill any chance for a useful and productive interaction. You know – teaching and learning, that sort of thing.

I’ve been fighting a lonely battle against this kind of foolishness. So, to answer those folks who may be asking, “Hey, will you be handing out any PowerPoint slides at this presentation to the NIC’s?” the simple answer is, “Fuck, no!”

There are much more effective techniques for presenting information, and I plan to draw upon them next week, and in the coming months. I’ll let you know how it’s going.

Also:

I was happy to learn about two new blogs today on the subject of palliative care – Pallimed, and HospiceNP. The network grows…

Bonus - a meditation:

Not quite rolling yet

My nurse manager has agreed to my proposal to guide the development of a core group of end of life care resource nurses in our 20-bed specialty intensive care unit, and we're working up the final pieces of the plan.

I want to use this site as an important part of the project. I'll include materials from the series of classes we'll be conducting, and hope that the participants will contribute posts and comments here.

One step at a time, though. Things often don't move as quickly in large institutions as I'd like.

Until then, I hope you'll read a very fine essay that I just came across at DailyKos. It's called "Wife," and it's a loving tribute by The National Gadfly to his grandmother. Here's a small taste:

In reality, the memories of the dead can never do justice to their lives. No monument or story or reverence can replace or recreate the impact of anyone. It is simply not possible. What we can do, is to do what they did - live, and do so with every ounce of care and commitment that we can generate. The greater the legacy we might wish to honor, the greater the commitment we share with those that live with us now.

Ted Kennedy, Living

Caroline Kennedy hugs her uncle, Ted Kennedy,
after both spoke at the 2008 Democratic National Convention.

I saw a Globe newsbox promo on this series recently, and said to myself, "They're starting the wake a little early."

Several of my colleagues and I were kinda glad that he went to MGH, then Duke, for his surgery. Not that we didn't want to care for him - we very much did. It would have been a privilege. But a VIP's entourage can be a real pain in the ass.

Yeah, he's gonna die at some point. He'll be gone, and nobody will ever fill the shoes he's gonna leave behind. Not another Kennedy, anyway.

But when he does die, I hope it's down in Hyannisport, with fine weather and a soft breeze off the ocean.

I hope the house is filled with a lifetime's worth of family and friends, drifting between the downstairs rooms and the big porch and onto the soft green lawn and into the driveway made from crushed clam and oyster shells crunching underfoot, all quiet and tearful, not from grief but from honor and respect and an appreciation of what they know is going to happen no matter how much they don't want it to.

I hope that the people who know and love him as father, husband, uncle, dearest friend surround him in his final hours and minutes, right to the very end, and that his death is as quiet and peaceful as a gentle exhalation, because surely he's earned at least that.

When Ted Kennedy dies, I'm going to take a moment to silently thank him for his humanity.

After that, as soon as I can, I'm going to pour myself a generous swallow of Tullamore Dew, and a pint glass of Harp or Guiness, or maybe half of each, to toast a life lived as fully as can ever be.

And then, life will go on. Not quite the same, of course. But it will go on.

Until that time, here's a toast to Ted Kennedy, living.

Thanks to mem from somerville for her diary at DailyKos that got me started on this thought.

Updated 2/21/09 by adding the last sentence, because he's not dead.