How We Die Now

Intimacy and the Work of Dying

Karla A. Erickson, OHSU WT116 E68h 2013

Important message, conflated with coercive politics. Many people celebrate birth and seek involvement, most deny death and avoid being involved. Workers in most senior care facilities learn to accept death and fully involve themselves with the dying.

The pseudonymous example, "Winthrop House", 10 city blocks in a small midwestern college town, is a CCRC continuing care retirement community dedicated to aging in place. My WAG is that it is actually Seeland Park & St. Francis Manor, 31 acres.

While a few for-profit institutions suck, families can suck too. Example of resident with advanced directive, ignored by executor who wanted to keep pension and house rather than let patient die with dignity.

• p21 "... Alzheimer's disease risk doubles every year after the age of sixty-five."

  • p41 correct statement "... every five years after the age of sixty-five."

• p68 Leading Age elder care facility organization.

• p99 example of family willfully neglecting to improve staffing coverage for bedbound patient in order to save money.
• p99 example of resident with advanced directive, ignored by person with medical power of attorney who wanted to keep pension and house, and kept resident in vegetative state for years.
• p121-2 when active dying begins:
  • Resident shows less interest in details about the wider world: sports scores, weather, the menu, the date, and the news.
  • Days, even weeks, prior to death, residents show declining interest in eating.
  • Residents often begin to talk about going on a journey.
  • Even among those who have been withdrawn for a long time, moments of clarity or clear speech -- often brief -- may occur. Some call these "awakenings".
  • Toes may curl.
  • Knees and lower legs may mottle and start to spot.
  • As the circulation of the blood weakens, the extremities begin to feel cool. The skin may lose some of its ruddiness, turning grayish or bluish.
  • Long after losing interst in food, residents may lose their sense of thirst and thus any interest in drinking even water.
  • Shortly before death, residents may develop what workers call a "death rattle". This is a crackling sound in the throat that can be alarming for loved ones and caregivers. As residents lose the ability or focdus to clear saliva from the airway, the saliva rattles in the throat.
  • Residents may reach up and out.
  • Breathing may become much slower, signalling the decrease of circulation in the respiratory center. Sometimes the breathing may even seem to stop, and very quiet sighs may follw, until the breath finally ends.