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Monday, January 18, 2010

A human skull

Death and Dying in TEOTWAWKI, by Snowman

Most of the SurvivalBlog.com articles focus on the "how tos" of living in or preparing for survival situations. We all understand these needs. However, there has been much less discussion on preparedness for death and dying. I have worked in the medical profession since 1975. I have worked with people in various stages of death and dying in hospitals, hospices, operating rooms, clinics and accident sites. While most of us are doing as much as possible to prepare and stay alive in bad situations we know that our options may be greatly limited in future scenarios. Death and dying are two examples. Initially, I thought that this subject would be too abstract or "soft" in comparison other "how to" articles. However, after some consideration it seems that I was wrong.
Death, dying and bereavement make take very different forms in future scenarios. Our society generally requires a fairly orderly approach to these issues. Much of this process is sanitized in the form of body management and dying locations.. Aside from accidents, civilians usually die in hospitals, hospices, nursing homes or their own residences. We have witnessed many recent natural disasters that displaced thousands. Many of those died in strange or makeshift environments. Families and friends often find closure at a planned funeral. Some have the benefit of resolving bereavement issue with clergy or counselors. How do you suppose that will change in TEOTWAWKI? Many of those services will either be nonexistent or deferred to the most skilled family member. You might be that "go-to" person. The sanitized funerals of today will look very different tomorrow. Death and dying will become a more visible. This is was the case in Europe during the Great Plague in England in the 1600s.

This country has gone through years of pandemic planning in corporate and government sectors. I have been on some of the planning committees at those levels for pandemic preparedness. Government plans for the dead and dying in a full blown pandemic are very real and very ready. Large institutions (i.e. prisons) have purchased or at least budgeted for body bags and other burial supplies for on site mass graves. I never saw these details made public so I can only assume that smarter people didn't want to scare the general public. Although these are largely public health and institutional security issues the same should apply to personal preparedness.

Consider a medication issue: while many may be able to manage various acute medical problems it is unlikely that any will be able to manufacture medications required to sustain life for the long haul. Simply put, a lot of us won't last very long in a TEOTWAWKI or even a protracted natural disaster- regardless of preparedness because our we are living due to modern medications. How long would a fragile insulin dependent diabetic live without insulin? When we look at supply lines we find that much of our generic medications come from foreign nations. Major foreign producers already have major quality control issue with medication production. supply shortages will only worsen any product.

Because of restricted budgets many foreign countries already lack access to medications commonly found in America. Those countries may well be the ultimate survivors, in terms of medication need, as many have already developed and adapted in the absence of modern medicine and limited national budgets. A trip to China, India or any Eastern European nation will demonstrate the point. Could it be that modern medicine has actually placed us behind the curve by making us more dependent on technology? Let's consider practical alternatives.

For starters, take a quick self/family inventory. What will happen to you when your medications are gone? Which of your family members requires meds for diabetes, epilepsy, high blood pressure, cancer, chronic pain,mental illness or chronic infections? Who requires dialysis, oxygen or is bed ridden? Start by talking with your medical provider. Ask for help to prioritize your meds. This is commonly done in clinics because of cost concerns so the question should not seem odd. What would happen if you had to reduce your dose or ran out completely? Your provider should be able to give you planning options. Ask about alternatives for cheaper or more readily available medications. Pharmacists are also excellent resources for these questions. What are your options when the local pharmacy closes? Many now order drugs on line from out of country. Medication planning could help to avoid death in a scenario of limited duration, i.e. natural disaster. The same concerns apply to those dependent on medical devices and related equipment: ventilators, pumps, oxygen, braces and wheelchairs. Many avoid this aspect of preparedness planning as the details can be overwhelming. Despite our best efforts, many will die quickly or painfully because of the lack of medications and medical devices. There are options.

If your health is fine then you are good to go, right? Wrong! What about your spouse, child, friend or pet? The ultimate part of preparedness includes an understanding of death and dying. Although faith is obviously a cornerstone to this discussion it is not the entire story. It is not enough to simply put your loved one in a back room until God decides the time. I have been with many people of faith during their dying time. Responses are varied. Often, the relatives of the dying require just as much care.

Aside from your own discussions with your maker, there are some other practical considerations to a death and dying scenario.
  • Develop an understanding of how your religion or belief system values death and dying.
  • Help those in your community who struggle with health problems, aging, chronic disease or sudden loss. Shovel a neighbor's snow or mow a yard. This will frame your mind for understanding community effort as well as just doing the right thing.
  • Volunteer as a nursing home/hospice visitor. Learn to see dying up close. Make yourself available. Listen to the dying person.
  • Help your neighbor when they lose a member. Take a meal to a friend. Help your sick farm/ranch neighbor with their cattle or crops. Get used to exercising your "volunteer" muscle.
  • If your community is culturally diverse then you will need to at least be aware or cultural requirements for dying/death rituals.
  • At the risk of getting yourself committed, consider talking with your family members about death and dying for the purpose of stimulating their own planning. You have to be careful with this one as many professionals see this as a sign of suicidal intent. This discussion definitely takes planning! Some "loving" members will only be interested in getting your guns and gold after your demise so don't be too surprised. Some will consider you just plain crazy. You might just decide to skip this one.
  • Survival community members may have different ideas about cares for the dead and dying. Planning will help to minimize fights and will develop cohesiveness.
  • Reevaluate your bug out plans. Do you have a contingency plan for a relative who suddenly dies or cannot be transported because of injury or illness? Would you leave that person or pet to die alone? Do you need to add supplies to your BOB for that dying person?
  • Even if not eating or drinking, dying folks continue to require oral and other personal hygiene cares. Helping people to die with dignity often includes helping another with bathing, shaving, dressing, toiletry,, and cleaning up after they drool their food.
  • A bed ridden person requires attention to range of motion and turning. A dying person can develop unnecessary pain and bed sores if these cares are avoided.
  • Address acute and chronic pain as best as possible. Current management of cancer and other end of life pain includes appropriate uses of various medications. Future scenarios would limit access to what is now more readily available. Research your options.
  • Stock a bedpan/urinal. Be prepared to change bedding when needed. Learn to change bed linens with someone in the bed.
  • If at all possible, don't let loved ones die alone. Move beyond your personal fear of death.
  • If death is imminent (particularly in a field situation) ask if there are any special requests. It might be a prayer or last rites. Family members are often greatly comforted by simply knowing that a last request, especially a religious request, was granted. Don't be afraid to say a blessing or prayer over a dead body.
  • Communicate your desires (e.g. CPR) to family and friends. Does your aging grandmother expect you to perform CPR and break all of her ribs when she has the Big One? Again, be careful with this one per the preceding discussion least you get locked up. You can do this in a more acceptable manner if you refer to this as "advance directives". Have a written will. It might be as simple as dividing bullets and beans. It will help to avoid bickering will help to keep the family unit together.
  • Be prepared to deal with a dead body in the absence of a funeral home. Other articles have already addressed this. If possible, be sensitive to cultural codes of body management. Is your retreat space planned for this?
  • State laws require that most deaths be either investigated or reported to the appropriate agency. These especially include infants, accidents,and unexpected deaths (medically unattended).Just be aware of your legal obligations under current laws.
  • Include death and dying books in your library. Also include basic nursing texts that cover care of the dying. Medical texts often omit this chapter as most doctors aren't the ones who provide actual bedside care.
  • Research the role of humor in dying and chronic illness. This could be a very useful and established skill for your tool box.This skill is not overlooked in cancer and pain management centers.
  • Don't be afraid to tell family member, on a regular basis, that you love them. Remember 9-11? Any of those people would have given everything to have been able to have said just those words.
  • Read John Donne's Meditation XVII ("No man is an island"). Donne was an English poet and preacher in the 1600s. Death was then rampant and very visible because of the Great Plague. He describes, from a Christian perspective, man's mortality and how the death of one person affects an entire community.We may well find ourselves returning to that scenario.
  • Never assume that a dying person cannot hear. I have witnessed many folks bad mouthing their comatose relative only to see them walking the hospital hallway the following day- and the still dying person remembered every word!
  • Learn to be a good listener.
For some of us, our ultimate value will be appreciated by how we both lived and died. Dying members of any group will threaten to drain limited resources. However, their death, if handled properly, may ultimately strengthen their community.
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