Comfort and Fear

How comfortable are you right now? Do you ever ask yourself this question throughout your day? Do you think about your comfort level? Or do you just live with being mildly uncomfortable most days.

Stop and ask yourself right now.

This is a question I always ask my patients, but rarely ask myself. However, at end of life, when your world has shrunken down to just yourself, this becomes the most important thing. Comfort and also fear.

The two things people want the most at end of life are comfort and to not be afraid.

I think it’s also true in life.

The thing that has struck me lately is how much and how often we ignore these two things when we think we have a lot of life yet to live. We just live with them day in and day out. We tend not to think about them directly throughout our day, but they remain in the background, like static from a radio, all day long. We just do not hear it anymore, nor pay attention to it.

But we feel it it. We are not comfortable. We just choose to ignore it.

We mask it with distractions and things we do to sooth our “nerves” such as exercise, watching tv, indulging in a few cocktails, keeping “busy” or other things that “take the edge off.” But rarely do we really think about why we need to do this. Why we are not comfortable. It just becomes a habit to try to mitigate it. It’s just life they tell us! You are just getting old they say! Quit complaining!

We also have different definitions of what comfort is. Are you comfortable, to most patients, implies a level of pain. And it’s all subjective. My level of pain may be tolerated better than others. I may say a 5 on a pain scale, while others may view theirs as a 10 or a 2. So we look for other subtle nuances such as facial expressions, body language and position and ask more questions. And comfort isn’t always about pain. At least physical pain. Sometimes it is fear that is making us uncomfortable.

Fear is another thing we live with but ignore. We may label it as worry, but it basically boils down to being afraid of something.

This causes us to have “anxiety” which is treated generally by medications or mindfulness apps or self-medicating. Currently, in our country, we actually now have an Ativan shortage (Ativan is a benzodiazepine used for anxiety) so definitely there is a lot of fear floating around lately. And guess what fear does? It makes us uncomfortable.

So, the two really go hand in hand and many times creates a vicious cycle.

So, how do we break it.

In hospice care, we have the luxury of using a variety of medications at doses not typically ordered. And we make the patient physically comfortable. On top of that, at end of life, a lot of things that created fear go away. No longer do we care about the news, the yard, the dishes in the sink, our bank account, our job, how much we weigh, or what others think. Also, at end of life, there is more attunement to the things that matter most; people we love, spaces that matter. We also pay attention to our senses; smell, taste, touch, sound, sight. So, flowers, scented creams, soft nightgowns and blankets, lovely music, pictures in frames.Patients like to surround themselves with these things because they become a source of comfort. And when we are truly comfortable, fear abates.

So, check yourself in. Do a comfort and fear assessment. You won’t be able to take the drugs we give, but you don’t need them. Not really.

You do need everything else however. Comfort measures is a treatment plan I highly recommend.

Photo by Evie S. on Unsplash

“The ache for home lives in all of us. The safe place where we can go as we are and not be questioned.” ~ Maya Angelou

“Adventures are all very well in their place, but there’s a lot to be said for regular meals and freedom from pain.” ~ Neil Gaiman

“Never underestimate how much assistance, how much satisfaction, how much comfort, how much soul and transcendence there might be in a well-made taco and a cold bottle of beer.” ~ Tom Robbins