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Dr Michael Barbato – Palliative Care

MICHAEL BARBATO has been in medical practice for more than 40 years and has been a palliative care physician for over 20 years.

During this time he has directed several palliative care services within NSW and the ACT and has held the positions of Medical Director at the Sacred Heart Hospice, Darlinghurst, NSW and the Palliative Care Unit at St Joseph’s Hospital, Auburn, NSW and was Director of Palliative Care for the ACT Canberra.

He retired in late 2008 and now runs courses on Death and Dying for professional and community groups and continues hands on palliative care with locum work in remote parts of Australia. He has a long-standing interest in unusual experiences around the time of death.

Dr Michael Barbato -  Palliative Care Specialist - Michael-Barbato.

Dr Michael Barbato – Palliative Care Specialist – Photo Adam Knott -The Australian

“Michael’s book ‘Caring for the Living and Dying’ is without doubt the best book I have come across so far in terms of in depth practical support for people wanting to die at home and their carers. We just used it in support of my good friend, who came home to die. At every step it was as if Michael was literally there with us guiding us in everything we would need. Make sure to have it on your shelf because when you need it you will want it instantly accessible.” Trypheyna

MICHAEL’s WEBSITE

Caring for the Living and Dying cover

Love and Fear – Article by Dr Michael Barbato

When asked how he created such beautiful sculptures from blocks of marble, Michelangelo replied, “The beauty is already there, all I do is remove the excesses.”

Just as Michelangelo’s chisel exposed the hidden beauty of the stone, dying too can bring forth unexpected treasures, not only for those who are dying, but also for the family and friends who care for them.

For most, this comparison may seem far fetched and unbelievable. What good, you may ask, can come from something as painful as the loss of someone you love? It has been said the pain of dying or losing someone you love is the hardest thing any of us will have to bear, and the experience will tear a person apart in ways no one could ever imagine. Indeed, many of my patients and their family have said to me, “I never imagined it would be like this.” Yet, after 40 years of medical practice I never cease to be amazed by the courage people exhibit as they confront their own death and the changes that can occur.

Two emotions, love and fear dominate the life of those whose death is imminent. These emotions are inextricably linked – the thought of being separated from those we love is often the greatest fear, but that same love also sustains us as death approaches. Being torn between two extremes is a dominant theme at this time of life and it is not unusual for the dying person to struggle with any number of conflicting emotions. Apart from love and fear, other conflicts include hope and disappointment, letting go and reaching out, autonomy and dependence, sadness and joy, peace and despair, anger and contentment and so the list goes on. All contribute to the chaos and paralysing uncertainty that can accompany death. These conflicts are not unique to the dying – they are part of everyday life. The emotional tugs and resulting tensions are, however, dramatically increased when someone is dying, and it is not uncommon for them or their carers to say, ‘they are being stretched to breaking point’.

With time and the right environment it is possible for love to subsume and all but replace fear. This transformation is a gift for it often leads to a state of equanimity and extraordinary peace – no longer does the dying person feel pulled and torn by the many opposing conflicts – they arrive at a point where dualities exist, but no longer dominate their life. Love becomes the healing balm that soothes and allows all concerned to navigate the surreal transition from life to death. It facilitates the difficult task of letting go – for the dying person to submit graciously to the unknown and for family and friends to let go of the fear that makes the dying person’s journey more difficult.

When we let go of fear we shed much of the excess that Michelangelo spoke of, and the fear of dying is replaced by the joy of living another day. We also discover the beauty of seeing the world and the people we know as if for the first time – according to one author, the birds seem to sing louder and sweeter as death nears. Whether it is in life or death, confronting our fears is scary but necessary; it brings out the best in all of us – such is the courage I alluded to earlier…”

 

“Dying, more than any other life event, presents us with the opportunity to grow, to change, to love, to appreciate and ultimately to experience the meaning of our existence. Our death is the completion of our life’s mission. The setting sun may have lost much of its early brightness but this has unexpected rewards for it can, often for the first time, be clearly seen. It seems paradoxical, but truth and the mystery of ‘Who am I?’ are revealed in the final moments of our life.”

– excerpt from “Reflections Of A Setting Sun”

Caring for the living and the dying

CARING FOR THE LIVING AND THE DYING explores the extraordinary experience of caring for a loved-one who is dying, detailing the physical, mental and emotional issues associated with everyday and long-term care. Through his own personal and professional experience Michael Barbato explores death and dying in a sensitive and insightful way and offers practical suggestions on many of the issues carers are likely to confront.

This is the updated second edition of Caring For The Palliative Care Patient originally published by McGraw-Hill.

Contents

Acknowledgments

Preface to the second edition

Prologue

Introduction (Download Sample PDF)

2 Palliative care

3 Living with pain

4 Symptoms other than pain

5 Day-to-day care

6 States of consciousness

7 What happens around the time of death?

8 Care of a child

9 Care of the elderly

10 Motor neuron disease

11 The inner journey

12 Your journey after caring is complete

13 Practical matters

14 Steve’s story

15 Epilogue to the second edition

Appendix/Bibliography

“There is an enormous body of knowledge and literature about death. Of the many messages that come through, none stands out more than the words of Scott Peck: ‘When we shy away from death, the ever changing nature of things, we inevitably shy away from life.’ This reinforces the strong, close relationship between life and death, a relationship that has always existed but is increasingly neglected or denied in a world that attempts to redefine life at the expense of death. There can be no life without death or death without life – together they complete the cycle of life. Not surprisingly, then, preparing for death teaches us about life and helps us to lead a more fulfilling life. Laying claim to the fact that we will all one day die is what makes life as valuable as any treasure, and death the treasure chest that contains it.

Dying is one of the most important times in a person’s life. Preparing for it means leading a full and good life, as best we can. To reflect on this life as it draws to an end is what brings completion. To relive all that has been beautiful or painful, to talk about relationships that have been replenishing and those that need healing, to face our beasts, to speak of the people we love and to remember the wondrous things that have filled our life. The most peaceful people I have seen die were those who, like Steve, had time to do all these things. Their life cycle was complete and, to quote Goethe, ‘like all things ripe, were ready to die’.

If we can accept death as part of life, not just as the end to life, living and dying become inseparable. Rather than a shadow that hovers over life, death becomes the light that illuminates life.”

– excerpt from “Caring for the living and the dying”

 

http://www.caringforthedying.iinet.net.au/caring.html

 

Reflections of a Setting Sun

‘Reflections of a Setting Sun’ explores the mystery of death and the many extraordinary experiences that occur at the interface between life and death.

Michael Barbato probes these little known and frequently misunderstood events, highlights their healing potential and explores possible causes. The book is imbued with case studies, many of which come from the author’s 20 years of experience as a palliative care doctor. Reflections of a Setting Sun sheds new light on the experience of dying, calls for a more holistic approach to the care of the dying and emphasises the important role family play in delivering this care.

Features include

  • Deathbed visions, near-death and out-of-body experiences
  • Dreams, intuition and after-death communication
  • The nature of coma and unconsciousness
  • Medical and holistic models of care
  • How to create a healing environment
  • The dying person’s search for meaning

Chapters

Acknowledgements

Introduction (Download Sample PDF)

  1. The nature and variety of deathbed visions
  2. The near-death experience
  3. The cause of near-to-death experiences
  4. Mysteries around death
  5. As the sun sets
  6. The final and greatest mystery

Epilogue

Bibliography

Index

“Dying, more than any other life event, presents us with the opportunity to grow, to change, to love, to appreciate and ultimately to experience the meaning of our existence. Our death is the completion of our life’s mission. The setting sun may have lost much of its early brightness but this has unexpected rewards for it can, often for the first time, be clearly seen. It seems paradoxical, but truth and the mystery of ‘Who am I?’ are revealed in the final moments of our life.”

– excerpt from “Reflections Of A Setting Sun”

The book also highlights the importance and relevance of the

dying process. I wish it to be seen not as a series of medical events

spiralling, as if out of control, unto death, but as a profound human

experience that envelops all: the person dying, family, friends and

those who deliver care. Labelling death as a failure of treatment not

only ignores this experience but also adds to human suffering. The

late Bede Griffiths, a Catholic monk who established an ashram

in India and wrote widely on Eastern religion, said, ‘The cause of

suffering is that an individual does not see their place in the pattern

of the whole and is therefore in conflict with it’ (Griffiths 1980,

p.51). Reflections of a Setting Sun does not deny or glorify death but acknowledges its importance in the overall scheme of life.

 

http://www.caringforthedying.iinet.net.au/reflections.html

 

Barbato talks about caring for the dying as a lost art. He says the medical model is excellent in providing comfort but much more can be done through a holistic approach and healing environments that lessen the sense of helplessness. “Death is not the conclusion to a series of medical events but a profound human experience. As someone approaches death their emotional and spiritual needs are as great if not greater than those of their bodies,” he says. Deathbed visions and what he calls near-to-death experiences are to him “extraordinary gifts waiting to be shared”.

Barbato’s fascination began 25 years ago as a ¬specialist physician in Armidale, NSW, where he encountered a young man called Ian who was dying of acute leukemia. Ian was admitted to hospital after an unsuccessful bone marrow treatment and very soon lapsed into a coma. “He was expected to die within 24 hours,” Barbato says. Ian’s sister was travelling home from overseas and not expected to arrive for several days. To the amazement of family and medical staff Ian held on, opening his eyes the instant before she walked through the door before dying with a smile on his face several hours later.

Raised as a Catholic, Barbato no longer has any religious affiliation beyond a yearning for spiritual nourishment. Given his relish for symbols and metaphor it’s unsurprising he acknowledges destiny tugging him towards palliative care.

What happens during the days and nights before the dying take their last breath? How do patients endure the loneliness, the white-knuckled fear of the unknown, the psychological trauma of letting go? Nurses, doctors, chaplains and those who care for the dying brim with mysterious coincidences, patient premonitions, visions, auras or, as Helen Walker, the director of Melbourne’s Cabrini palliative care unit, puts it, “the amazing energy” often felt in the room as a person dies.

These phenomena are different to the “near-death” sensations of bright lights and tunnels reported by those who recover from trauma or cardiac arrest. There is fierce debate between sceptics, who dismiss them as hallucinations, drug-induced imagery or the effect of oxygen deprivation, and researchers, including medical professionals, who are intrigued by new evidence of their prevalence and significance. It is a field rich with controversy, but those who dwell close to the dying embrace the inexplicable as part of a day’s work. “A week doesn’t go by without these things happening,” says Barbato, 68. “We’ve all seen it,” Walker concurs. “It’s an extraordinary thing.”

When Barbato first began writing about these phenomena in the late ’90s he was regarded as “very fringe”. Now he tours the country addressing conferences of doctors, nurses and palliative care staff. “People who once thought I’d lost my marbles are now prepared to listen.” Later this year he’ll head a research project in Port Kembla to measure levels of awareness in the unconscious brain and the effect of opiates such as morphine. But he disputes that these experiences are the by-product of drugs. His book Reflections of a Setting Sun recalls a dying patient who reported hallucinations of spiders and strange creatures among apparitions of his dead brother. “At the time he was on a moderate dose of morphine… Once the morphine was substituted with another pain reliever, the spider hallucinations disappeared but the visions of his brother continued up until the time of his death.”

Interviews with family members and the ¬primary carers involved in more than 200 deaths in India and the eastern European republic of Moldova confirmed deathbed visions in 30 per cent of cases. The sight of a deceased relative standing or sitting in the room is the most common apparition reported by the dying, typically the patient’s mother.

Conversations are held with visitors who appear almost as escorts. Usually the presence of these “invisible companions” is the only disturbance in the patient’s visual field. Some visits are a once-only affair before death while others drop in regularly over a period of days. Use of opiates does not appear to have influenced reports of these encounters in both groundbreaking studies, which were published this year in the rigorously peer-reviewed Omega Journal of Death and Dying.

 

Awe and mystery warms the world of death whisperers. Practitioners in hospitals and hospices describe a sense of privilege that inspires them as they minister to a person at the end of life. Michael Barbato is right when he says: “There’s a real art to this.”

Articles related to Dr Barbato

The death whisperers

Kate Legge – The Australian – May 21 2011

Die your own death

Lauren Hermon · about 2 years ago

Palliative care physician, Dr Michael Barbato, believes a “good death” doesn’t exist.

“The words ‘good’ and ‘death’ just don’t seem to go together well for me. Death is painful; it’s sad,” Dr Barbato says.

“While there are some gifts around death, rather than using the term ‘good death’, we should be looking at allowing these people to die their own deaths,” he adds.

Dr Barbato, who has been a palliative care physician for more than 20 years, was one of three panellists to address delegates at Palliative Care Victoria’s biennial conference in Melbourne late last week.

“Anything that has the word death in a sentence frightens people off. Death, morphine and palliative care is a trio nobody wants to hear… and it’s a very difficult barrier to break down,” he says.

“The general community don’t want to address death. It may not be that they’re afraid of death; it’s just they don’t want to be there when it happens,” he says.

While Dr Barbato and others working in palliative care “work and talk about death”, he admits it can still be a “really remote” subject to professionals.

“This is when we have to look inside because we may have the skills and qualities to help others, and we need to know when to offer these skills and qualities.

“My interest in quality palliative care really comes down to how we can deliver palliative care to an individual who is dying and to their family. We need to try to understand who this person is, their experiences and what’s important to them; and we need to try to tune into that.”

Dr Barbato says “humility, vulnerability, honesty and empathy” are words which become important in providing palliative care to a patient nearing the end of life.

“I find it not only a challenge, but extremely rewarding. Recognising the type of death the patient wants, and giving them choice and control becomes imperative,” he says.

He encourages palliative care professionals to “get on patients’ wavelengths”.

“There are no words for people to use to describe what it’s like to die and the question is: where are we in this? Do we have a trained enough ear to recognise the significance of the words our patients are using and understand what they want at the end of their life?” Dr Barbato asks.

Opening up to delegates about the death he would choose when his time comes, Dr Barbato says it’s simple.

“I’d like to know the professionals that are present, but I don’t want them hovering over my bedside.

“I want physical comfort, precious normality. I want to be in bed with my pillow and I want all of the things that make my life worthwhile in the one room, including my family and close friends.”

Joining Dr Barbato on the panel was Sue Hanson, national manager of Little Company of Mary Health Care, who says a good death doesn’t necessarily need to be complicated by medical jargon or people in ‘white coats’.

“The ability to be present for someone is all in the human capacity; let’s not imagine this to be a specialist skill.

“This is something that each of us as a human being has the capacity to do; to be present for another human being who is suffering,” Ms Hanson says.