Wednesday, April 26, 2017

What the hell, I'm gonna go with "Death Nurse."

I’m using my experience in nursing and end of life to build a business, and after much thought and several minutes with Google decided to name it, “Death Nurse.”

Well, officially, “Death Nurse, LLC,” once the lawyer finishes the paperwork.

A few of the few people I’ve told so far have been horrified, beginning with the lawyer.  She said it would scare off patients and families who could be potential clients. One colleague said it played right into several bad caricatures, while another just shook her head.

The ideas at the heart of this business have been percolating in my mind for at least the past 15 years, probably longer. I’ve been a nurse for over 40 (!) years, and always worked in high-mortality settings - hemodialysis, critical care, and hospice.

In mid-career I kept my RN current while selling application software, mostly to large pathology departments at academic medical centers. I really liked working with that group of physicians.

My personal encounters with death started early, thanks to a culture that didn’t think twice about dragging an entire first-grade class over to the convent, to pray the rosary in French while stuffed into a tiny room with several other grades, two radiators, no windows, and a dead nun.

I value this work. I enjoy it, am challenged by it, and still learn something and/or meet someone every time I turn around.

Patients and families need more and better from us, not less: from supporting simple advance care planning and basic community education, to guiding them through overly-complex health systems - both care and financial, to helping them articulate and achieve EOL goals that really matter.

Boomers are getting old, sick, and dying. It’s a demographic wave and the surf is most definitely up.

A “good death,” however defined, doesn’t just fall from the sky. As clinicians, we need to keep expanding our knowledge and raising the bar on our practice. We’ve got to give each other the kind of care and attention we provide to patients and families.

It’s also long past time for the community to step up. Joining a walk-a-thon or donating a watercolor to the annual auction are both well-intentioned gestures, but they’re also dollar-focused and low-effort, even passive, and underscore the community’s subservience to an agency, which most agencies no doubt prefer, when power in the relationship should flow in the other direction.

I believe that the real changes we need in care, both for advanced illness and at end of life as well as for the broader system, will come from patients and families, not from us, and certainly not from any system where we might be employed.

That kind of change starts with consumers who are truly knowledgeable and able to make informed choices.  

At one point in my planning, a friend’s guidance led me to develop what I thought was a clever 3-step strategy to achieve this vision for a better world: Awareness, Education, and Action.

I was convinced, “If people know about x, y, z, they’ll realize the need to learn a,b,c, so they can take control and blah-blah-blah. And I can help.”

My old Uncle Ernie had a saying about revelations: “A moment to utter, a lifetime to try and probably fail.”

I’m not giving up. I’ve barely started. Some of what I’ve tried so far has gone well, some less so, some even less so, and some other still worse. There are plenty more ideas bubbling but untried, so I don’t expect many dull moments, though probably a few dead ends.

But if I’ve learned anything at all so far, it’s that it simply isn’t possible to promote awareness, education, and action without first getting people's attention.

So, yeah, I’m going with, “Death Nurse.” We’ll see what happens from there. Now I need to work on a logo and business cards.