All posts by Marilyn Smith-Stoner

I am a nurse educator and researcher. I've been focused on end of life care for years. My model of end of life care is derived from years of experience in hospice and ICU nursing. My goal is to broaden the sources of evidence used to provide care and to reach other to other clinicians providing end of life care, beyond hospice and palliative care.

Aftermath of San Bernardino Shooting

This is a very personal post, a micro view of the crazy senseless violence that dominated rural Southern California yesterday in what is called the Inland Empire. San Bernardino is one of the largest counties in the United States which borders 2 states. In the city of San Bernardino where the shooting took place, the area borders Loma Linda and Redlands. All areas affected by the shootings.

When I heard there were shooting at the Inland Regional Center the only motivation seemed to me to be a workplace issue. Most people do not know the Regional Center is even there, except if you are in a family with someone with a development disability. Then you are one of the many people who are eternally grateful for the services they provide to your disabled loved one. One service, providing caregivers and respite when you need a break from the intense demands of caring for someone with multiple disabilities. I could imagine there would ever be a political motive (AKA terrorist) angle.

Other possible motives might have been the family member of someone who was denied service or did not get the level of service they had expect….

It is necessary to consider the possible motivations when you are out in it. I was one of the many people out getting medical care during the event. I have a minor problem with a finger that has arthritis. I had found the surgical site had become infected, and I was at my doctor’s office in Fontana (west of the shootings) finding out what the plan was going to be. The plan was to have another surgery that afternoon and I was to go home (through the area of the shooting which had just started) and return back to Fontana (drive back through the shooting area) and have the surgery. I would return home that night.

As I left the building, the fire alarm was going off. No fire was announced. I noticed a line of helicopters in the air. As I entered the freeway, I saw a long line of EMS vehicles headed in the same direction I was going, east.

The radio announcer told the story–mass shooting at the Regional Center, don’t go anywhere around it (except if you have to drive by to get your husband and drive back to the hospital to have surgery; I thought to myself)

What followed over then next few hours was a digital kaleidoscope of images viewed from my smartphone in the surgical waiting room collected from Twitter; users provided links to pertinent audio from police scanners,  YouTube videos, photos from neighbor’s witnessing events and Don on Google maps following the location of shootouts.

Occasionally we looked up at CNN’s coverage of irrelevant “it could be this, it could be that.” Nothing they were discussing seemed even close to what was unfolding on my phone.

As a professional I was plugged into the emergency response system and was receiving regular updates on where resources where needed. Where the most injured were going (2 local trauma centers) and what was happening at the local university where I work, which was eventually closed for the day. My surgery was postponed, which was fine. I could have easily come back the next day. I was glad the staff stayed until all were seen.

It was a unique way to see, hear and read the emergency response system from this very person view. Both as a part of the system and as a patient hoping I could still receive the nonemergent care I needed. The San Bernardino EMS did an outstanding job. The entire drama unfolded on both the North and South sides of Interstate 10 within a few miles of the freeway. No one else was injured in this heavily populated area. Job well done!

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US had Brittney New Zealand Has Lecretia

Watch this moving video about Lecretia’s story and the reasons why he continues to campaign for consensual physician-assisted dying for terminally ill patients: carrying, as he says, “a responsibility to ensure that Lecretia’s personal sacrifice wasn’t for nothing.”

Vicker’s  husband from New Zealand talks about their experience in end of life choice when she was diagnosed with brain cancer, Matt Vickers Continue reading US had Brittney New Zealand Has Lecretia

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Joey is Living While she dies -for all of us to see

We have had many different kinds of death played out in the media in the last few years. One of my all-time favorite singers is gifting us with her unique death journey. Joey of Joey+ Rory, both gifted musicians has just entered hospice and we are invited to participate.

Continue reading Joey is Living While she dies -for all of us to see

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It’s Official – Medical Aid in Dying has come to California

DeathCalifornia became the 5th state to approve Medical Aid in Dying. For more information click here. The  End of Life Options Act was met with intense emotions from supporters and detractors. When the law is fully implemented, terminally ill individuals will have the option to request a prescription from a physician that leads to an immediate and painless death. The guidelines follow those from Oregon that have been in place for 20 years. There are many safeguards against abuse.

This is a mew era for end of life professionals. We have the chance to truly partner with patients and their families to help determine the best option for themselves. No one ever truly gets over the death of a beloved family member of friend, but we can help them get through it. This is a start.

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Medical Aid in Dying

graphic good--bye
Comfort care at end of life

In California we stand on the verge of becoming the 5th state to approve medical aid in dying. Governor Brown has the legislation on his desk and has not indicated if he will sign the legislation into law. Here is what we know about the proposed law:

  • There is passion on both sides of the debate. Some of the biggest names in end of life care are passionately against it. Read Ira Byock’s editorial here
  • Disability rights advocates are against it. Read their position here.
  • Brittany Maynard began the discussion and her husband continues the adovcacy for people who are dying. Read about their story here.
  • What do organizations who are nuetral have to say on the current state of end of life care? Read the scathing judgement of the Institute of Medicine ( an organization of experts who systematically gather data and produce reports that sysnthesize the data into recommendations) Dying in America report here.
  • Listen to the NPR coverage of the research data that shows end of life care is getting worse in the United States despite years of effort to change it to the better. This study was shocking in more ways than I can state.
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My view of death

 

fire forest canada 2006Some years ago Don and I were driving in Canada and saw this image.  I was immediately struck by how it reminded me of what death is.  When I first saw the image the burned out trunks of tress caught me eyes. However, once I looked more deeply into the image I saw the beauty of the growth that the fire made possible. The new purple and white flowers. The new grass surely fed many new animals. It seemed to me that this is the death too. The burning away of the body can be nothing short of the hottest fire.  I live in the fire prone area of California and for the last many years we have been ravaged by fires. But once the body burns away, once the disease takes it’s course, maybe a person and their family, sometimes with our help, can find the beauty that was always present and still there.

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