Palliative Care Nurses See us in our Final Hours — These are the Life Lessons They've Learnt

ABC News | By Iskhandar Razak

Anne Myers was once confused and shaken by death.

After more than a decade as a nurse, including in hospital ICUs, her mother died.

"I'd seen a lot of deaths in my nursing life, but it was the closest human to me that had died," she said.

"It kind of sent me down a 'oh my god, I don't know what's happening to me', this grief I'm experiencing."

Soon afterwards, she became a palliative care nurse.

"I ended up just going down the path of 'what is death, what is death and dying all about?'" she recalled.

More than 15 years later, here's what she and other palliative care nurses have discovered on how to die well and live well.

Dead people visit you before you die – and if that happens, go with it

Anne-Marie Jackson has been a palliative care nurse for 26 years but began her medical career 40 years ago in the UK at a time of high fear and anxiety.

"Just when HIV and AIDS had come out," the Irish-raised nurse said.

"I've seen so many deaths, and not one has been the same.

"But you know, when death is imminent, some things, there's some things that happen."

One of those things can be feeling, sensing, hearing and even seeing the presence of others, who aren't physically there.

"People will see their dead relatives in the room," she said.

"And, you know, families will go and tell them that they're not seeing them. And I'm like, well, they actually probably are seeing them, because … it happens quite a lot."

Ms Myers said in her experience it was common and could be linked to the delirium that often sets in shortly before death.

"Within that delirium they will hallucinate, and see family members that have died," she said.

"They start saying 'Mum, mum' and they're 90.

"We always say to the family to support that, because whatever they are seeing, it can be a source of comfort for them. That they are going to meet whoever they haven't seen for a long-time."

Palliative care nurse Marita Rees said her own brother saw the presence of a long-dead family member in the room just before he died.

"It was quite amazing, because the person that he saw and what she said she was doing, it was just so true to what she would have been doing. It was almost a preparation type thing.

"You also see a lot of people hold on to life."

At the end, some patients hold on until they're ready

In her decades of nursing, Marita Rees has not only seen patients visited by the dead in their final moments — she's seen terminally ill people who should die within the week or the month hold on much longer than doctors expected, usually for birthdays or anniversaries.

"Many actually end up happening [die] on Christmas Day, because its almost like they have held on for Christmas," Ms Rees said.

"Definitely people hold on for people, family that are coming, travelling from somewhere else [to say goodbye].

"And then we've also seen people let go, when someone is not there. Like when someone is keeping vigil, and they leave the room just for a moment, and they'll go then…

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What Olympians Can Teach the Rest of Us About Pain

Lisa Marshall

Lying in an ambulance, her nose busted, gums sliced to the bone after hitting a barricade on her bike, Katie Zaferes had one question on her mind: How soon can I get back to training?

The World Triathlon Grand Final was 17 days away, and Zaferes was also competing for a seat at the Summer Olympics in Tokyo. So, a few days later, she was back at it, enduring the sting of the pool's chlorine on her mouth's 23 stitches and the dull throb in her face during runs and rides.

"It's not like I love pain, but I do kind of embrace it," said Zaferes, 35, who went on to win the world championship that month and take home a silver and bronze at the Tokyo Games in 2021. (She just missed qualifying for this year's Paris Olympics but is going as an alternate.) 

Remarkable as her story is, it is not, in the world of Olympians, uncommon. 

The history books are filled with examples of athletes triumphing in the face of seemingly insurmountable injuries. And injuries aside, the burn of pushing the body to its physical limits can, in itself, be a suffer-fest most people are unwilling to bear.

How do they do it?

"You could say elite athletes have a friendlier relationship with pain than the average person," said Jim Doorley, PhD, a sports psychologist with the US Olympic and Paralympic Committee. 

In fact, an overwhelming body of evidence shows that high-level athletes have a higher tolerance for pain: They take longer to "cry uncle." Some studies suggest they also have a higher pain threshold, meaning it takes more punishment for them to start to feel pain in the first place, and lower pain sensitivity, meaning they rank their pain as, say, a 4 when others subjected to the same hurt call it a 9.

Precisely what's going on in their brain and body is a matter of great interest to doctors, psychologists, and physical therapists. By taking a cue from people at the pinnacle of sport, experts say, we mere mortals can potentially get fitter, deal with adversity better, and even prevent or manage chronic pain…

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Do I Need a POLST and an Advance Directive?

By Barbara Karnes

There seems to be some confusion about advance directives and POLST forms (Physician Orders for Life Saving Treatment). Both are very important if you want to have input in your end of life decisions. So -- here is what you need to know.

Advance directives are legal documents that provide instructions for medical care. They only go into effect if you cannot communicate your own wishes. The two most common advance directives for healthcare are a living will and a durable medical  power of attorney.

A POLST is a set of portable medical orders prepared together with your doctor who will sign it. POLSTs have different names in different states - POLST, POST, MOLST, MOST, but all have the force of medical orders. POLSTs are specifically for the seriously ill and frail. POLSTs can travel with you and are honored by emergency medical technicians. POLSTs give specific directions about your requested treatments during an emergency if you cannot speak for yourself. It does not appoint someone to speak on your behalf. Many people put their POLST on their refrigerator so it can be seen by medical personnel should 911 be called.

Advance directives appoint an individual to make decisions on your behalf, whereas a POLST contains actual medical orders given by a physician. 

The POLST form complements an advance directive. It is not intended to replace it. An advance directive is still necessary to appoint a legal healthcare decision maker.

From the time we turn 18 until our last breath, we should have an advance directive in place. Once a person turns 18, parents have no legal standing. Most physicians will listen to parents' wishes, but many consider the legal ramifications and do what they think is best. IF there is ANY disagreement within the family as to care provided and choices to be made, then know the physicians will protect themselves and do what the “loudest” voice wants—which is generally to do everything to keep their special person breathing—even when death is sure to be the end result.

We are born, we experience, and then we die. We will all die, but not all of us will die the way we want UNLESS we have an advance directive and, at the appropriate time, a POLST.

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