Tuesday, September 19, 2006

Hospice

Work has been especially tough the last couple of weeks or so, because I've had three patients who eventually requested and received hospice care. A very simplistic way of putting it is that hospice care is end of life care.

Sometimes there is an acute event, like a stroke, and sometimes it's a long drawn out illness, like dementia/Alzheimers. Trying to guide a patient and family through this process takes a lot of time, patience, and emotion. It's not an easy process, but a necessary one.

Not everything is wrapped up in 30 or 60 minutes like you see on television. In some cases, this process can take days and even weeks. I constantly have to remind myself to report the facts of the case. For example, "the heart/kidney function is improved or worse verses yesterday," or, "it is a significant stroke affecting motor and/or sensory and/or speech function."

I can't even imagine what my families are going through, because it's not my loved one in that hospital bed. My job is to stay as objective as I can in reporting the medical condition of their family member.

Things can get a little tricky when I'm asked something like, "What if this was your mother or grandmother, what would you do?" Or, "What if I was your mother or grandmother, what would you do?"

When the patient or family open the door for me, I try to be as honest with she/he/them as I can. Even though it may sound like I'm giving up when I recommend something like hospice, if I believe the long term prognosis is poor, they deserve to know that. If there is possibility for recovery from their illness, I'm honest and let them know that as well. Hospice is not appropriate for everybody.

It's even tougher when it's one of your long time patients whom you have seen slowly deteriorate or someone whom you saw last week in your office who had an acute event and no longer the person you remember. In most cases, a rapport was built so that I had an understanding of how heroic/aggressive the patient wanted to be close to the end of life. Obviously, one of the tougher parts of my job.

I do have the satisfaction in that for most of my patients I will do what they want me to do, because we've talked about it. My tribute to them will be to carry out their final health care wishes whatever they may be...

I'm on call today/tonight. You know the drill by now. I'll be back in a day or so to pick up where I left off. Keep on blogging for me. More soon...

13 comments:

ChiefMommy Owl said...

Just standing by the families as you appear to means more than you will ever know. Some doctors just dump the patient in hospice and that's the end of it. This is painful for the family and the patient.

Keep up the good work!
Sara

Moof said...

Beautiful post, Dr. Anon ... and please, don't wear yourself out on call!

See you when you get back!

amka said...

It does take a long time. I remember sitting by the bed of an elderly relative who was on his way to dying, but was currently in the hospital for an acute problem. It was hard, having it take so long. It was even hard seeing the simple acute problem being cured, just prolonging it simply because it was an easy fix, though in the end I learned that the extra two weeks it gave him allowed him better closure to his own life, so it was a good thing.

But the process of death isn't easy.

Sarebear said...

Oh my. As if your job wasn't hard enough.

Virtual hugs, and real wishes and prayers for your families, and for you as well in what you do.

God bless you for your unceasing efforts and care on behalf of your patients. I believe there are many docs who wouldn't do as much.

lil Johnny said...

Don't eat Spinach

ipanema said...

It's heartbreaking when one comes to this point. It must be hard to parties involved.

difficultpt said...

I second what Moof said . . . Take care, Dr. A.

M's said...

Great post!

Jenny said...

I certainly do not covet your position when doctors have to deal with these things. I thought I had it bad when my own son was going through liver disease, then one day it dawned on me that these awesome doctors taking care of my son live with it every single blasted day. At least I get to go home from the hospital at some point and return to "normal" life. You must be an extraordinary person to carry the burdens that you do.
Hospice is awesome. I have had a number of "liver" friends who lean on hospice care towards the end and it has always been such a blessing to them and their families. When my kids get a bit older and more independent I hope to have time to be able to do some volunteer work for hospice care in our area.

Angel Feathers Tickle Me said...

Love to all....

The Curmudgeon said...

I went through hospice with both my parents -- you're right, of course, that the process can take days or weeks -- many weeks -- it's curious how that becomes the status quo.

Just don't stint on the pain meds, doc. That was an issue -- for awhile -- but what's to worry about? Addiction? Not long term, certainly....

WanderingGirl said...

Hi. It's my first time to visit your blog. I'm a traveling PT and I also see patients and their families come to these end of life decisions. What I've tried to tell them that they should do what's in the best interest of their loved one, which is not necessarily the decision that we want for them. And hospice is a wonderful way for a family to choose a quality of death, just as the patient chose their quality of life. It's a gift to be able to offer pain control, nursing care, and family support to people in their homes and let them pass more peacefully.

Wrkinprogress said...

Hospice care is a great blessing for most who, unfortunately, need to use it. My hubby's late wife was assisted by hospice care, though he basically nursed her at home until the very end. They provided palliative care for her, and resources for him to connect with others in his situation. He participated in a grief group for a while, and still has great friends from that group.

Rock on, Doc.