End-of-Life Care



Most of us take first aid training to have the knowledge and skills needed in the event we have an opportunity to help someone. I have taken first aid courses and refreshers and participated in first aid competitions for as long as I can remember, but I never expected that all my training was preparing me for something life had in store for me.

First aid courses teach us to prioritize our own safety when approaching an emergency situation so that we may effectively help others. But what happens when the situation is not an emergency? What happens when a loved one who has decided to no longer accept cancer treatments asks you to be her primary caregiver so she can die at home?

My late wife, Laurel, had a long road to travel and lived with cancer for many years. She underwent successful treatment to remove cancer from her brain four times. With the fifth recurrence, she chose to stop the treatments she had endured for 19 years. Over the years my role as a caregiver evolved, and with the help of an extraordinary team of nurses and doctors I was able to provide some medical care to Laurel. The first aid training I had acquired helped prepare me to confidently supplement her care and, ultimately, enable her to die at home.




When the conversation about a home death arose, the first question I had to answer was "Can I handle it? Do I have the skills to keep her and my kids safe?" My answer, because of my training and the medical team's confidence in my abilities, was yes.

DAN's Basic Life Support and First Aid (BLSFA) course teaches us how to react and keep people alive in emergencies. What may not be apparent is that the skills learned from this training can help you provide care in other scenarios. Here is how my DAN training helped me provide palliative care:

BLSFA
  • Scene safety: I often needed to assess Laurel's room for hazards (e.g., Did she fall out of bed? Possibly break a mirror?) Before I helped her I would don my gloves to protect her weakened immune system as well as to protect myself.

  • Initial assessment: Laurel had weakness on the right side of her body from her many brain surgeries, causing her to tumble several times. After a fall I would perform a quick head-to-toe exam to check for any injuries.

  • Bandaging and wound management: There were many opportunities to practice these skills following Laurel's four craniotomies. I changed dressings to keep the incisions clean, applied new dressing to protect her from bed sores and kept injection ports clean and sterile.

  • Medical emergencies — seizures: With Laurel's type of cancer, seizures were frequent. Knowing how to respond to the initial seizure helped keep everyone calm. My skills also helped with her recovery following major seizures; sometimes it would take several days for muscle and verbal ability to return.

  • Temperature-related injuries: Near the end of her life, Laurel's autonomic nervous system failed, which affected her ability to regulate her body temperature. Being able to recognize and properly treat heat- and cold-related problems proved to be very helpful and prevented worsening of her condition.

  • Home emergency plan: When we decided that Laurel would die at home, we formulated Plans A through Z using the emergency planning skills I'd picked up in my training. This helped everyone know what to do in the event of various situations as they arose.

  • Lifting and moving: This was a skill I used daily when getting Laurel into and out of a chair or bed, rolling her for cleaning, changing dressings and for comfort. Knowing how to do this without injuring her or myself was very important.
Neurological Assessment
  • Conducting a neurological assessment: At each checkup, the doctor performed the same tests on Laurel that DAN's Neurological Assessment course teaches. I used these skills to determine whether her condition was improving or declining. Conducted weekly, these tests measured neurological function and over the months established a baseline for comparison, especially following events such as a seizure or brain surgery.
Emergency Oxygen
  • Oxygen administration: As divers we all know the benefits of oxygen. The doctor recommended that Laurel breathe pure oxygen for 30 minutes each day, if possible. I used my DAN oxygen unit for these treatments, which I believe helped speed her recovery following surgeries and seizures.

This is a short list, but it illustrates that while first aid training is typically undertaken to prepare us to react in emergencies, life can challenge us in ways we never imagined. The life-saving skills taught in these courses can easily be adapted and applied to other challenging situations your loved ones or other people in your life may face.

© Alert Diver — Q4 Fall 2015