Hola a tod@s, my dear Friends.

Someone very special visits today this blog. A new friend, or maybe not so new, who lives at the end of the world in the Scottish land although she is from Cataluña. Elena Lorente is a nurse and has a beautiful and full of sensitivity blog: De Tots El Colors, a blog about the care of the Invisible, Intangible, the essential.

Maybe the scientific method is just the opposite. Perhaps not all may need explanation. We should look and listen more with our heart. Things are as we are.

Welcome to IC-HU Project, I believe that we can learn a lot from you. For the time being, keeps alive the flame that lit Yasmina on Tuesday…

This is her post. Enjoy it!

It never seems the right time to address the issue of death with patients either in primary health care either in hospital care. 
Dying well is a right and just as we talk about quality of life and organize care around this premise, quality of death should also take their place in care plans.

In the community health approach, if we sit down to talk about death with chronic patients calmly, if we listen what it means for each one to die well, we’ll help to improve their quality of life. 

Regarding hospital care, it is often assumed that if the patient does not ask is because they don’t want to know. But the reality is that maybe never have found the right time to do it because we have never given, or do not know how to ask the question, or they feel fear about the response, which does not necessarily mean that they do not want to know.

We also assume that patients already sense or know when death is near. Why then mulling the issue? With that excuse we lighten our load, we silence our conscience and we turn our back to the patient. We forget that this “no action” contributes to building an invisible bubble of isolation and loneliness in which, perhaps, is the most important act of life; to die. 

Is it ethical to silence the reality of approaching death, denying that information to the patient by our inability to address the issue? Is it ethical to provide it only to the family? Do we belong that information? Who are we protecting?. 

On the other hand, if it is a mistake to assume that patients do not want to know, it’s also a mistake to think otherwise. How do we do then? Starting to combine other verbs besides “to do”. Beginning with “to be, to listen, to observe, accompanying”. 

We have to learn how to interact therapeutically, creating adequate space, finding the right time to see what the patient wants to know, how far wants to know, and with who wants to share that information. We also need to learn to respect their decisions, and not judge. 

In addition to being good at all levels to patients, and professionals, we would be acting from the ethics of care, avoiding unnecessary interventions, and probably reducing health care costs. 

Good death can never be the result of improvisation.  Stopping to think and listen before acting is often the greatest challenge in the emergency department, acute and critical; but it may be what makes the difference.

Elena Lorente.