Practical thanatology

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A practitioners approach to dealing with death and dying issues.

A practitioners approach to dealing with death and dying issues.

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  • 1. Practical ThanatologyFrank Meissner, MD, FACP, FACC, FCCP US Hospital, Zagreb
  • 2. Gilgamesh, where are you wandering?The [immortal] life that you are seeking all around you will not find. When the gods created mankind they fixed Death for mankind, and held back Life in their own hands. Now you, Gilgamesh, let your belly be full! Be happy day and night, of each day make a party, dance in circles day and night! Let your clothes be sparkling clean, let your head be clean, wash yourself with water! Attend to the little one who holds onto your hand, let a wife delight in your embrace. This is the true task of mankind. The Epic of Gilgamesh, ca. 1700-1300 B.C. US Hospital, Zagreb
  • 3. A Humanistic Model of Medicine SOCIAL BIOLOGICAL PSYCHOLOGICAL SPIRITUALCULTURE US Hospital, Zagreb
  • 4. LIKE GILGAMESH, MANY s Foolishly chase for every second of life s Fail to treasure the life we have s Fear the inevitable s Ignore the ‘perfection’ of the PRESENT s Deny MORTALITY US Hospital, Zagreb
  • 5. Sudden death vs Expected Death s Many say ‘I wish to die sudden’ s Death less fearful than a life of pain & suffering s Grief work harder for survivors of SUDDEN Death s Epected death can be ‘managed’ s Sudden death must BE endured US Hospital, Zagreb
  • 6. Anatomy of Dying s Disbelief/Denial s Rage/Anger s Bartering/Negotiation s Acceptance/Preperation s General emotional responses NOT a rigid progression US Hospital, Zagreb
  • 7. NOT everybody is ON the same wavelength s Hidden agendas s Past & secret guilts s Emotional dysynchrony s Impossible expectations s Unrealistic Faith US Hospital, Zagreb
  • 8. Family Dynamics s Consensus is VITAL s Consensus is HARD s Dying does NOT enoble or transform, IT amplifies basic personality traits s Meissner’s 1st Law of Thanatology- Terminal Cancer does not make EVERYONE noble US Hospital, Zagreb
  • 9. Stages of Bereavement s Shock & Denial s Depression & Disorganization s Reorganization, reengagement, and redefinition US Hospital, Zagreb
  • 10. Pathological Bereavement s Delayed grief s Inhibited grief s Chronic grief s Bereavement overload US Hospital, Zagreb
  • 11. What DO I Say! s Say what comes naturally s Say what YOU feel s Share of yourself s Give meaning to the death if possible s Ask for a precious memory of the loved one s ACCEPT Intense emotions US Hospital, Zagreb
  • 12. Facilitative vs Nonfacilitative Communication s ‘This must be painful for you’ vs ‘I KNOW how you feel’ s ‘This must be hard to accept’ vs ‘God had a purpose‘ s ‘Many feel angry at God at these times’ vs ‘Life MUST go on’ s ‘Tell me how you are feeling’ vs ‘Lets not deal with it now’ s ‘May I help?’ vs ‘He/She lead a full life’ US Hospital, Zagreb
  • 13. Conclusions s Deal from you Heart not your Head s Listen, Listen, Listen, Listen s Accept ‘Scary Emotional Intensity’ s Understand Cultural Differences US Hospital, Zagreb