Death Anxiety

13 Oct

After discovering a lifeless bird or cat at the roadside a young child may ask of her parent why the animal is dead.  Then after processing the answer will follow up with “Will I die?”  Later as teenagers, we may engage in risk taking behaviours such as drug taking or drinking and driving – as if testing the boundaries of our existence.  At some point we will encounter the reality of death as a friend or grandparent dies.  Throughout our adult life we commonly ignore the existence of the door ‘over there’ without actually acknowledging that some day we will be passing through it.  The door may become exquisitely clear as when your parent or child dies but then we quickly hasten to conclude our death is a long way away at some time far in the future.  Pay it no attention and it isn’t really there seems to be a common mind set.  We even build elaborate mental processes to soften the reality.  Many religions have us simply passing out of this life into another.  Regardless of what happens to us as and when we die, there is a thread of anxiety about death that runs throughout our living years.  For some this anxiety becomes very profound after being diagnosed with a life threatening illness.  This anxiety may then be heightened when the physician recommends that the patient be transferred to a palliative care ward or a hospice.

Regardless of the reason, caregivers in palliative situations all have agendas when dealing with patients.  Director’s of care are actively engaged in coordinating the medical services patients receive, physicians treat outstanding medical issues, nurses tackle the day-to-day personal care, chaplains seek to address religious concerns while family and friends visit with issues related to personal relationships.  In each of these cases the intent is to assist the patient, yet everyone in some way is asking for something from the person approaching death.  Be it information on pain levels, bowel function, drug reactions, crises of conscience or legal matters, the patient is asked to give of themselves.  Many of these interactions do little to reduce death anxiety.

The Hospice Education Institute is a U.S. based non-profit organization whose mission is to inform, educate and support the delivery of hospice programs.  They suggest that there are five principal methods for addressing patient anxiety in palliative care settings.  They are counseling, visualization, cognitive methods, drug therapy and relaxation therapy.  Palliative pets can play a role in this last category.  For animal lovers approaching the end of life, contact with the familiar positive interactions with pets helps to normalize the hospice environment.  In the case of a palliative pet and the volunteer that brings the animal to the hospice, the role is simply to give of themselves.

On numerous volunteer visits when entering a hospice room with Abby, the first expression I have seen on the face of the patient is one of concern.  I can almost hear them thinking.  ‘An unknown person is entering my space.  What do they want?  Why are they here?  What now?’  However, when they see the dog, a smile spreads across their face and they are suddenly eager to engage.  As the hospice coordinator of volunteers at the hospice where I attend is often wont to say, ‘There is no I in volunteer’ and the role of the volunteer and the palliative pet is simply to give without thoughts of outcomes and expectations.  And that is what dogs do.  In bringing the familiar to the room, the dog brings comfort and relaxation.  Conversations initially focus on the dog, the patient’s pets present and past.  Later, as trust is established, the conversations often become more wide reaching, all at the pleasure of the patient.  The opportunity for a patient to physically engage an animal whose essence is just ‘to be’ is the key factor in reducing anxiety during a visit from a palliative pet.  As discussed in the Health Effects blog at this site, pets have been clinically shown to reduce stress and anxiety levels.  In my experience, unlike watching a television program or listening to a radio which act more like distractions from mental and emotional states, the act of stroking a dog quietly resting on the bed engages the mind of the dying to live in the moment and carefully explore the reality of what remains of their lives.

Please feel free to comment below!

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