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Communicating Care at the End of Life


Carey Candrian

While health care at the end of life is changing, the language for talking about treatment options and patient preferences around the end of life is taking longer to change. This book carefully details the way language shapes decisions around end-of-life care. Using ethnographic research from two sites that offer emergency care and end-of-life care – a hospice and an emergency department – the author illustrates common themes around language use that serve as microcosms of the larger healthcare system in the United States. The sites have different purposes for providing care, yet the themes from both serve as guidance and reflection for other areas of caregiving.
The language used to talk about death holds consequences and opportunities for understanding and making decisions about care practices. This book uses personal stories and perspectives from patients, family members, and medical workers to paint a picture of some of the issues and tensions individuals and caregivers face. With an aging population – one that represents a major public health challenge in the twenty-first century – Carey Candrian argues that examining the care we provide for individuals, especially aging individuals, is fundamental to creating a developed, ethical, and engaged society.
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Chapter 6. The Messiness of Death in the Emergency Department


The rhythm in the ED is fast, loud, busy, and chaotic. Waiting rooms can be crowded and time can be pressing, yet providers struggle to make a difference in their care. And therein lies the tension. EDs follow a set of organizational practices and protocols. But at the same time a multitude of patients, conditions, and symptoms are to be cared for within tight time constraints. Therefore, providers struggle to manage the tension between following rigid time protocols and the sheer volume of patients, while providing care that responds to the unique circumstances of an individual’s life and health. In short, they struggle to make a difference in a system that endlessly suppresses differences through protocols, checklists, and standards. In their struggle, they manage this tension creatively by transforming their care practices.

In order to let you see and feel how life is at the ED, I have organized ED workers’ experiences around three ways of managing this tension, parallel to that at hospice. First, the providers manage the tension by their own ways of rehumanizing care practices that ultimately transform the work environment towards a specific purpose. Second, the providers refashion a different meaning of quality care that becomes more about time and trying to save patients rather than simply keeping them comfortable. Finally, they manage ← 89 | 90 → the tension by transforming care practices and refashioning quality, in light of the purpose in the ED that ultimately works to tame death.

These resolutions, like those...

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