End of Life Decisions

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After working several years for a home health and hospice agency, I have cared for several hospice patients and have developed a deep appreciation for hospice. Ideally, I would want to go experience end of life in the comfort of my own home with hospice services. Realistically, however, death can occur in many forms and in emergency situations, I think the best person to help make decisions for me would be my fiancé, or a close friend that can make informed decisions. I believe that culturally, my family being Latino have traditionally relied on family members to help support one another on decisions like these, and without a doubt my family would appoint either their significant other, a sibling, or children as proxies. I have had discussions with my family members about end of life care, but have not officially completed advanced directives. I think as I continually bring up topics like these, my family has become more comfortable discussing this topic and it has become easier to have a serious conversation regarding end of life. When I tried talking to my family members about my personal decision of who my proxy was, they were a bit surprised to discover that I had not selected my parents as proxies. I believe it goes back to the cultural aspect of always using family members. I have decided to appoint a close friend, and my family was very surprised that it was not a family member, but they do understand my reasons.

A Trip to Remember

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Before leaving for the trip, our class learned some history about New Orleans, the culture, and the devastation Hurricane Katrina caused, but actually being in New Orleans and experiencing the culture and actually seeing the devastation that Hurricane Katrina caused was not something I would have ever expected to experience. What touched me the most about this trip was speaking with locals that had experienced Katrina and hearing their stories, speaking with professors who care so much about their community, hearing about the lawsuits against big oil companies to clean up and restore the wetlands, and reporters who wrote about the storm, issues, and politics of New orleans. In addition to all this, we were able to do hands on work to directly help the cause. I learned so much trudging through the swamp, identifying native and invasive plants, collecting data, learning to work with different teams, and overcoming many types of discomforts. Lastly, I left New Orleans with my eyes opened to the issues they face and the politics that go with it. I am now aware of the problems and hopefully will be able to make others aware too by education, more research, and political actions. I thank CSUCI and Dr. Anderson for the amazing opportunity to help, be involved, and to learn about this fragile area and its amazing culture and history.

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I got to learn how to cook a creole tomato sauce over shrimp and rice.

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Learning from the great Dr. Nelson from Tulane University about the levee system in New Orleans.

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Enjoying a wonderful evening at Woodlands.

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Got to meet an amazing trumpet player Irvin Mayfield.

End of Life Discussion

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My first true encounter with end of life was when my granddad passed away last February. In the last few months of his life he was experiencing progressive cognitive decline with dementia, multiple TIAs/strokes, physical decline such as being unable to care for himself, and frequent  ER visits and hospitalizations. Eventually he could no longer be cared for in his home, so he moved into a board & care, and eventually he experienced another stroke and developed pneumonia. He had been in the hospital for a couple days for this admission and we knew it would not be long. On the morning he passed I was woken up by my mother stating that the nurse at the hospital had called saying his breathing had changed and that we should go over. I was unsure of whether or not I would be able to witness his passing but I went to the hospital with my parents, grandmother, and aunt regardless because I knew I would regret not going. And I was very glad that I went; although it was difficult being there in his passing helped to bring a sense of closure and we were able to be there together saying goodbye.

Luckily before this had happened my mother had initiated a discussion with my grandparents regarding their wishes regarding end of life. With the information out in the open we did not have to worry about making the difficult choices when my granddad became ill and were able to focus more on the time left together. This event also prompted my mom to open the discussion regarding her end of life wishes and to create an advanced directive. She has shared her wishes with me and she has made me her secondary healthcare proxy after my dad due to my healthcare knowledge. My dad has not outright talked about this end of life wishes with me, but through talking with my mom she has shared that his views are similar. Neither of them want to prolong their life to the point living chronically with a breathing tube, feeding tube, etc. I feel the same way, and I suspect that the majority of us would agree after our experiences. I would 100% trust my parents, especially my mom due to her nursing experience, to make the right decisions for me if it were to come to it. However I have not had this discussion yet with my sisters, which would be a good idea to have next time we are all together.

Image: http://static.guim.co.uk/sys-images/Society/Pix/pictures/2010/12/30/1293727279713/Only-4-of-people-have-a-w-007.jpg

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Interview

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Elevator Talk

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Week 11 Homework

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In regards to end of life, I have very little experience with the subject from a family perspective. The most recent death in my family happened to my grandfather when I was 7 years old, so I barely remember the details from the event. One thing I do remember, however, is how my mother reacted after the fact.

 

My mother is very religious, and I think watching her father slowly decline neurologically and physically was very hard on her. She has told all of us in our immediate family that she does not want to be resuscitated if she dies, or put on life-sustaining measures (such as ventilator, tube feeding, etc.) if something were to happen to her. Interestingly, she has not signed an official DNR order yet, but she feels very strongly about the subject and doesn’t want to be kept alive artificially.

 

I feel like that has sort of rubbed off on me a bit, too. I’m not as religious as she is, but I’d definitely prefer not to be on a ventilator or kept alive by artificial feeding if I’m in, say, a serious car accident. If I went into cardiac arrest for some reason then yes, I would like to be resuscitated, but I’m not worrying about that too much right now. This topic parallels what we discussed in advanced assessment, and I’d like to iterate what I said during that discussion: if I were to find myself dying or in a resuscitative situation, I’d want my family around me. They’ve always been extremely supportive of me when I’ve been ill, and that has made those experiences better. I love my family very much, and having them be by my side in that type of situation would be very reassuring.

 

I’ve not heard too much about this topic from my peers in class. While I know some have had traumatic experiences with friends and loved ones being sick or passing away, I think that we as healthcare practitioners have learned to become much more resilient to those kinds of events. Not only have we become more resilient, but we have also become more empathetic towards those going through such difficult times, and that has made us much better nurses as this program has gone on.

 

Overall, this is a weird topic for me to be thinking about personally, but learning and thinking about it has definitely enhanced my ideas and feelings toward the subject of death and dying.

Looking back

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Posted from Camarillo, California, United States.

New Orleans is easily the most amazing place I have ever been and I will never forget my experience with the ESRM 492 class. I was inspired by the kind nature of the city’s residents, the phenomenal musicians, and the diverse culture that blessed New Orleans.

Exploring the French Quarter during our first days in town gave me an impression of the people native to the area. Absolutely everyone I encountered had a smile and kind words for the work the class was doing for the city.  Paul Sanchez strengthened this impression with his pronounced “thank you” to our class with free CDs and a public mentioning of our hard work. I was also inspired by the care that the city’s residents had for New Orleans and what it meant to their history, culture, and family.

Everywhere the group went, it seemed that there were street musicians, artists, and other performers that livened the scene. Every club, social establishment, or venue we visited had some of the most talented musicians I have ever had the pleasure of hearing. These musicians were well versed in the music history and culture of the city and assisted in making my New Orleans trip even more unforgettable.

The liveliness of New Orleans was most evident in the parades the city seemed to have most nights we were there. There were parades for St Patrick’s day and St Joseph’s day and a small parade for every wedding that took place in the quarter.  I was amazed by New Orleans’ friendliness with artists and street performers. Unlike Los Angeles, I can actually believe that a performing musician can make it comfortably in New Orleans.

The work the group did in the wetlands was grueling and labor intensive but impossibly rewarding for all of us when we thought about what the city meant to us and any body else who has ever experienced the crescent city.  We were reminded of this sentiment whenever a loud soul would shout CORNBREAD at the top of their lungs to raise moral in the swamp. That food will forever be a rallying cry for the group that took this trip to the beautiful New Orleans.

Vegetation transects are coming along! 

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Finally getting my vegetation transects going on the two burned slopes around CSUCI campus. Two down, two to go!