Join SevenPonds each month as Tani Bahti, RN, CT, CHPN, offers practical on-hand guidance to demystify the dying process. As an RN since 1976, Tani has been working to empower families and healthcare professionals to have the best end-of-life experience possible both through education and the development of helpful tools and resources. As the current Director of Pathways, Tani is also the author of “Dying to Know, Straight Talk About Death and Dying,” considered by SevenPonds to be one of the most practical books on the topic. Founder Suzette Sherman says this is, “the book I will have at the bedside of my dying parents some day, hopefully a very long time from now.”
When asked what she wanted for lunch, Shirley quickly replied, “Ice cream!” She winced when her daughter reprimanded her. “Mom, you know you have to watch your sweets. You have to eat something healthy.” At age 92, Shirley was dying of heart failure. For the past eight years, her daughter had provided meticulous caregiving and a carefully monitored diet.
When a person has had to manage their diet a certain way in order to control their blood sugar, cholesterol and the like, it feels unnatural, even like hastening a death, to be told those old ways can now be discarded.
But here is what I often saw in my years in hospice: As the body begins to shut down over time, insulin and many heart medicines are often no longer needed — almost as if the dying person is given a final gift in the last months and weeks of life. And as the need for medication wanes, many tasty dietary choices become available again.
The intention of indulging in these previously forbidden foods is not to hasten death, but to respond to the body’s changes and focus on quality of life as defined by the person who is ill. Favorite foods also play a role in nourishing the spirit.
I put myself in their place. I don’t want anyone telling me what I can and cannot eat. I love sweets. I love chocolate. I get that from my mom. As she declines into her Alzheimer’s disease, her taste buds crave the stimulation of that which is either very salty or very sweet. All I have to do is mention chocolate and her eyes light up, accompanied by a big grin and smacking lips through which pass the happy noise of “Num!”
The owners of the adult care home where she resides pride themselves on providing a healthy diet. Lots of fresh veggies, free range chicken, no pre-packaged or processed foods, and only low fat, low salt sauces. Desserts are often fruit or something of the low fat and low sugar variety. An approach to be admired and appreciated, for sure! But not as one approaches her final months or weeks.
The staff removed the bags of chocolate I had placed in my mother’s room because “she would leave the table and go into her room to eat them”. I say, “Good for her! I would do the same!” and they step back in surprise. Her appetite is now limited and nothing makes her happier than tasty desserts or salty nuts. Her blood sugar is fine, and the minimal swelling she gets in her feet is relieved by elevating her feet. Benefit certainly trumps burden when considering her desires and quality of life.
If I do have the rare patient whose blood sugar still spikes after eating “forbidden” foods, (creating other risks) the medical team works with the family to adjust the person’s medicines to match their intake, making sure they have a choice of what to eat and enjoy their food. It promotes their sense of empowerment and decreases depressive episodes.
So when I am on my own death bed, nobody better take away MY ice cream!
If you want to enhance my of quality of life, let me eat dessert first! Better yet, enjoy some with me and we will both be smiling.
Take a look at a copy of Tani’s book “Dying to Know — Straight talk about Death and Dying” to help demystify the process and find words of wisdom on many aspects of dying.