Kimberly Acquaviva 🏳️‍🌈 Profile picture
Aug 2, 2019 16 tweets 3 min read Read on X
👇🏼Thread

It’s been ~48 hours since Kathy last expressed a desire for ice chips or water.

Once I stopped giving her dexamethasone, her thirst stopped.

1/
She’d been taking the dexamethasone for referred pain (pain in her shoulder and back) caused by the liver metastasis. Stopping the dexamethasone doesn’t appear to have increased her discomfort any.

2/
It’s been about a week since @Kathy_Brandt last asked for food.

I haven’t offered any to her after that.

3/
Hospice and palliative care folks know what I’m about to say but for followers who aren’t #hapc #hpm professionals, I thought it might be helpful info to share.

4/
When someone’s dying, their body stops wanting food and water. This is basically one of the body’s built-in mechanisms to ensure comfort at the end of life.

5/
Think of the human body like a car. When you drive your car a lot, you need to keep putting gas in the tank. If your car is just sitting in the garage, though, topping off the tank every day isn’t helpful - gas spills all over the ground.

6:
When someone is dying, their organs stop sending “gas me up” messages to the brain. Reduced hunger and thirst is the body’s way of saying, “we have plenty of gas to make the trip in front of us.”

7/
This can be hard for family members to deal with. Food and water are the things that keep us alive. Food is one of the ways we show love to one another. It’s one of the ways we nurture people we love.

8:
This is why it’s so important to explain to families — in terms a layperson can understand — that it’s an act of love when they listen to what their loved one’s body is telling them.

9/
Just like gas spills out onto the floor if you try to top off a full tank, feeding and hydrating a dying person who’s no longer hungry or thirsty may cause a cascade of discomfort.

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If the dying person’s body can’t use the food or fluids being put into it, the tank sort of overflows. Fluid can build up making breathing uncomfortable.

11/
The digestive system of a dying person is basically like a diner 2 minutes before closing time. Anything coming in the door at the last minute is unlikely to get great customer service.

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This isn’t the most medically precise explanation of how the human body shuts down near death but it should give you the basic idea.

13/
So if you’re ever with a dying person who stops asking for food or water, pause a moment and remind yourself that their body is doing its best to die peacefully.

Pushing food and water may prevent their body from doing that important job successfully.

14/
If you’re reading this and feeling guilty about pushing food or water with a dying loved one in the past, please don’t.

We all do the best we can with the information we have in the moment we’re living.

/15
Thanks for listening. ♥️

/end thread

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More from @kimacquaviva

Jan 10, 2021
👇🏻Thread

If you’re white, you know someone who empathizes with the mob at the Capitol.

You know someone who *supports* the actions taken by that mob.

1/
You know someone who thinks Trump won the election but it was “stolen” from him.

2/
You know someone who called it a “riot” when Black people took to the streets to protest racism in policing, broke windows, and burned buildings, but...

3/
Read 9 tweets
Jan 9, 2021
👇🏻Thread

If you’re a white person in America, chances are good you know someone who thinks the way this person does.

Maybe you went to high school with them.

Maybe you’re related to them.

Maybe you’re married to them.

1/ Twitter sucks. Which is why I have never used it. And unfortshould be brought up upon anybody breaking the law I find itSeems to me like all the people who spent the last four year
However you happen to know them, they’re in your life. Whether by choice or by chance, these are your people.

2/
Those white people who think like that and are in your life? They’re your people.

I know some, too. They’re MY people.

I don’t want to claim them as mine. Neither do you.

But we have to.

3/
Read 11 tweets
Jan 8, 2021
In the J-term class I'm teaching, the topic of "faking it" came up yesterday. I don't know who needs to hear this today but I thought it was worth sharing.

1/
Some women and non-binary people with vaginas feel pressured to "perform" pleasure for the benefit of a partner. In movies and on TV, sex rarely takes a long time -- it's done quickly and both parties act as though they had an orgasm through penis-in-vagina sex.

2/
In reality, reaching orgasm for people with vaginas is generally more complicated than that. It can be difficult for someone to feel confident enough to say to a penis-having partner that they need more than PIV in order to have an orgasm.

3/
Read 5 tweets
Jan 8, 2021
I've worked as a volunteer at the past three inaugurations: twice with the American Red Cross (Obama 2009, Trump 2017) and once with the Boy Scouts of America (Obama 2013).

1/
I was proud to serve at all three events. Crowds in 2009 and 2013 were massive but I felt safe. Crowds were tiny in 2017 and there was more discord but I still felt safe.

2/
I'm sad to say I won't be volunteering to serve at Biden's inauguration because after this week, I have zero confidence in the ability of the Capitol Police to handle anything other than maybe defending the body wash aisle in CVS.

3/
Read 6 tweets
Jan 8, 2021
Like the author of the piece, I've been on the "patient side of the stethoscope" before -- through hospitalizations with Greyson, my (compulsively early but) late wife, and myself.

1/
I empathize with how frightening it can be when a loved one is in the hospital. I also empathize with how difficult it can be to be a healthcare professional taking care of someone - someone who is usually cared for by a loved one who, at that moment, feels helpless.

2/
The concerns raised by physicians on Twitter about the medical inaccuracies in the article are valid ones.

I feel more conflicted about the comments re: the author "hissing" at a resident who tried to examine her daughter in the middle of the night.

3/
Read 8 tweets
Jan 7, 2021
Thank you to my @UVA, @UVASON, and @uvamedicine colleagues who have been speaking out loudly, clearly, and consistently on Twitter over the past year (and long before that) about the ways in which politics, policy, racism, and health are inextricably intertwined.

1/
For my colleagues at UVA who *haven't* dipped their toe into using Twitter to speak truth to power, here are a few tips for getting started.

1. Decide what kind of world you want to live in.

2/
2. Decide whether you're willing to say hard truths out loud, in public, even if that means the people you work with -- or for -- may not like what you have to say.

3/
Read 10 tweets

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