End-of-life dream can be nightmare for caregivers

Not all end-of-life dreams soothe the dying. Researchers found that about 20 percent were upsetting. Often, those who had suffered trauma might revisit it in their dying dreams. Some can resolve those experiences. Some cannot.

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When should doctors intervene with antipsychotic or anti-anxiety medication to best allow the patient a peaceful death? For the Hospice Buffalo physicians, the decision is made with a team assessment that includes input from family members.

Dr. Christopher W. Kerr is a Hospice Buffalo palliative care physician who researches the therapeutic role of patients' end-of-life dreams and visions. He said, "Children will see their parents in an altered state and think they're suffering and fighting their dying. But if you say, 'She's talking about dead people, and that's normal. I'll bet you can learn a lot about her and your family,' you may see the relative calming down and taking notes."

Without receiving sufficient information from the family, a team may not know how to read the patient's agitation. One patient seemed tormented by nightmares. The Hospice Buffalo team interviewed family members, who reluctantly disclosed that the woman had been sexually abused as a girl. The family was horrified that she was reliving these memories in her dying days.

Armed with this information, the team chose to administer anti-anxiety medication, rather than just antipsychotics. The woman relaxed and was able to have a powerful exchange with a priest. She died during a quiet sleep several days later.

This fall, Donna Brennan, a longtime nurse at Hospice Buffalo, would check in on a patient with end-stage lung cancer who was a former police officer. He told her that he had "done bad stuff" on the job. He said he had cheated on his wife and was estranged from his children. His dreams are never peaceful, Brennan said. "He gets stabbed, shot or can't breathe. He apologizes to his wife, and she isn't responding, or she reminds him that he broke her heart. He's a tortured soul."

Some palliative care providers maintain that such dreams are the core of a spiritual experience and should not be tampered with. Dr. Timothy E. Quill, an expert on palliative care medicine at the University of Rochester Medical Center, calls people with such views "hospice romantics."

"We should be opening the door with our questions, but not forcing patients through it," Quill said. "Our job is witnessing, exploring and lessening their loneliness. If it's benign and rich with content, let it go. But if it brings up serious old wounds, get real help -- a psychologist, a chaplain -- because in this area, we physicians don't know what we're doing."

ActiveStyle on 02/08/2016

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