Psychotherapy at the End of Life

Abstract

As a nurse working at the community living center of the local Veterans Administration hospital and a doctor working in geriatrics and extended care at the same facility, we are both concerned with helping veterans adjust at life’s end. The veterans admitted to our unit are designated to receive either palliative care or end-of-life care. Chronic medical illnesses are prominently featured in these patients, and their medication lists tend to be extensive. There are 20 beds, occupied largely by men. These veterans typically served the military in World War II, but a few who are younger saw combat in Korea or Vietnam. The medical team consists of an internist-director, a nursing staff, a physical therapist, a recreational therapist, a dietician, a pharmacist, and several social workers. The burden of psychotherapy rests largely in the hands of interested nurses and 1 psychiatrist. For each patient admitted, there is the task of adjusting to this new stage of life.1 For many patients, this is their final stage, and their death paves the way for a new admission to occupy the bed. Some residents, however, are dramatically affected by the receipt of 3 square meals, good medical care, and considerable activity and attention, leading to a lengthy stay, recovery, and discharge.2 Some veterans attract the psychological involvement of both a nurse and a psychiatrist, each often working independently. The length of psychotherapeutic treatment tends to be unpredictable. Mr A merited attention from us both, and the treatment was lengthier than either of us could have anticipated.