As uncomfortable to face as it is inevitable, dying is an intensely personal experience—no one would argue that. Yet, that perspective fails to take into account the fear and uncertainty that engulfs family and friends.
Dr. Karl Ahlswede knows this anxiety firsthand. In fact, he welcomes it into his office when so many others opt to look away. His Wynnewood practice is centered on end-of-life advocacy and palliative care for patients and their families coping with the painful task of preparing for death. While some level of therapy is involved, that’s not Ahlswede’s primary goal—nor is it his specialty. Rather, he asks the tough questions that must be addressed from a practical standpoint, making the process a healthier experience for all.
“Some people faced with this decision want to utilize every single technology available until their heart stops beating,” says Ahlswede. “Others say they never want to go to a hospital for treatment, and that they want to pass in their own home in a comfortable situation.”
Once everyone is on the same page, dialogue is honest, informative and more comfortable. “It’s that initial conversation about the D-word—death or dying—that’s really the most fearful aspect. Most don’t express this fear, and they do the most harm by not doing anything,” Ahlswede says.
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Ahlswede got his start in the medical field in 1988, unsure what specialty he wanted to pursue. At first, surgery felt like the best fit, but the young doctor had a nagging desire to do something more than simply save lives. He wanted to improve them, as well. “But in the mid-1990s, there really wasn’t anything in the palliative medicine field,” he says.
As he continued his surgical career in the cardiac intensive care unit at Lankenau Hospital, the field of palliative care expanded. By the late ’90s, the opportunity had presented itself to tackle the bigger issues. Ahlswede was board certified in hospice and palliative medicine in 2008. A year later, he was recognized by the American Board of Surgery as one of the first surgeons to earn such certification.
Since founding his practice in July 2010, Ahlswede has observed a startling, if unsurprising, resistance to coming face-to-face with the end-of-life process. “People aren’t familiar with the process of dying,” he says. “They don’t know what happens, how long it’s going to take, or the things that happen along the way.”
Pain management, treatment options, pharmaceutical intervention and managing daily schedules all fall under the palliative-care umbrella. So do more serious considerations, like knowing when enough is enough. Ahlswede also serves as an expert set of eyes and ears in an emergency.
Ahlswede recommends his services for anyone over age 18, regardless of an individual’s medical history. “The younger you are, the likelihood that you’ll be faced with a life-threatening medical condition is not great,” he says. “But the stakes are even higher if you’re unable to communicate your wishes to family members and medical professionals.”
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Medical doctors, psychologists and theologians alike have long examined the effects of prayer, music, laughter and other therapies on the mental and physical well-being of sick and dying patients. Whether the results have been conclusive or not depends on whom you ask. There’s little debate, however, over the effectiveness and benefits of end-of-life counseling.
An August 2010 study in the New England Journal of Medicine examining Stage IV lung cancer patients found that those who received palliative care had a better quality of life and improved mood than patients assigned to standard care. Fewer patients in the palliative-care group had depressive symptoms. The median survival rate was also longer among those receiving early palliative care than those in the other group, which received more aggressive rounds of standard care.
A March 2010 study published in the British Medical Journal revealed similar results—that advanced-care planning improves the end-of-life experience and patient and family satisfaction. It also reduces stress, anxiety and depression in surviving relatives.
While some might believe that a stoic perspective is best for his job, Ahlswede begs to differ. He notes that everyone shares in the same grief and, ultimately, the same healing.
“I can’t look at a patient suffering and not feel it myself,” he says.
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Tips for Those Facing End-of-Life Decisions
Facing a terminal illness brings challenges. Here are some ways to help yourself.
• Look at the ways you’ve coped successfully with difficulty in the past.
• Think about what you want and what you don’t want during end-of-life treatment.
• Examine your priorities and values, and share them with those you love.
• Communicate with loved ones. You may want to reconcile old disagreements or concerns.
• Take tangible steps like establishing advance directives to ensure that your wishes are followed and your family is supported.
Types of Grief and Loss
1. Anticipatory mourning. When a person or family is expecting death, it’s normal to anticipate how one will react and cope when the person eventually dies. Many family members will try to envision their life without that person and will mentally play out possible scenarios, which may include grief reactions and ways they’ll mourn and adjust after the death.
2. Sudden loss. Grief experienced after a sudden, unexpected death is different from anticipatory mourning. The loss may exceed the coping abilities of a person, which often results in feeling overwhelmed and/or unable to function. Though one may be able to acknowledge that loss has occurred, the full impact may take much longer to fully comprehend.
3. Complicated grief. There are times when grief does not progress as expected and dramatically interferes with a person’s ability to function. Depression and anxiety may be prevalent and prolonged, while thoughts, feelings, behaviors and reactions may seem to persist over long periods of time with little change or improvement.
Source: National Hospice and Palliative Care Organization (caringinfo.org)
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