There’s a certain Slant of Light

There’s a certain Slant of light,

Winter Afternoons –

That oppresses, like the Heft

Of Cathedral Tunes –

 

Heavenly Hurt, it gives us –

We can find no scar,

But internal difference –

Where the Meanings, are –

 

None may teach it – Any –

‘Tis the seal Despair –

An imperial affliction

Sent us of the Air –

 

When it comes, the Landscape listens –

Shadows – hold their breath –

When it goes, ’tis like the Distance

On the look of Death –

There’s a certain Slant of light, (320)

BY EMILY DICKINSON

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Bring up end-of-life care to a family and you’ll be needing a knife to cut through the tension when you return to the room. As I’ve witnessed in the clinical setting, death is a sensitive subject but one mostly surrounded by ambiguity. People just don’t know what to do with it. It’s become a casual subject in my family. My mother has made it clear that she wants a DNR and her remains cremated after organ donation (assuming she’s a candidate) so that her ashes can be scattered on the hillside behind our house. There may be a few barriers to the latter part of her will… Sometimes these conversations turn into a joke. We don’t think death is trivial, but we also don’t think we have to fear it. My parents organized the logistics to prepare me and my siblings financially, emotionally and spiritually for the day they would leave this earth to be with Jesus. I think starting this conversation early can help reduce the discomfort of this difficult reality.

According to Barriers to Goals of Care Discussions With Seriously Ill Hospitalized Patients and Their Families A Multicenter Survey of Clinicians, nurses, residents and staff physicians identified the following as the greatest barriers to end-of-life goals and discussions: 1) family members’ or patients’ difficulty accepting a poor prognosis, 2) family members’ or patients’ difficulty understanding the limitations and complications of life-sustaining treatments, 3) disagreement among family members about goals of care, and 4) patients’ incapacity to make goals of care decisions (You et al., 2015). In addition, all three clinician groups perceived that it was part of their professional responsibility to participate in end-of-life discussions and goal setting (You et al., 2015). However, “staff physicians and residents were more willing than nurses, and staff physicians more willing than residents, to engage in communication and decision making about goals of care” (You et al., 2015). This study suggests an emphasis on helping clinicians improve communication about end-of-life care through training and classes, however, there were also reports of “discomfort in responding to the emotional reactions of patients” (You et al., 2015). Perhaps, it would also be beneficial to emphasize the psychological components related to these discussions to anticipate associated repercussions such as stress, guilt and emphatic fatigue. Early preparation is key in successfully and effectively achieving end-of-life goals and increasing quality of life as the patient transitions out of this life.

References

Dickinson, E. (1999). There’s a certain Slant of light, (320). Retrieved April 29, 2017, from https://www.poetryfoundation.org/poems-and-poets/poems/detail/45723
You JJ, Downar J, Fowler RA, Lamontagne F, Ma IWY, Jayaraman D, Kryworuchko J, Strachan PH, Ilan R, Nijjar AP, Neary J, Shik J, Brazil K, Patel A, Wiebe K, Albert M, Palepu A, Nouvet E, des Ordons AR, Sharma N, Abdul-Razzak A, Jiang X, Day A, Heyland DK, for the Canadian Researchers at the End of Life Network (CARENET). Barriers to Goals of Care Discussions With Seriously Ill Hospitalized Patients and Their FamiliesA Multicenter Survey of Clinicians. JAMA Intern Med. 2015;175(4):549-556. doi:10.1001/jamainternmed.2014.7732

 

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