Monday, March 08, 2010

glorified drug pusher...

... For some odd reason I understood hospice care to be providing comfort for the dying, caring for their needs and seeing to it that their last days were dignified. However; physicians seem to think "comfort and dignity" means forcibly keeping the patient incoherently sedated and constantly unconscious.

I had one patient beg me not to give them any more morphine. As the effects of the medication began to wear off, this person became cognitive and talkative with their visitors and family. We sat and played scrabble, laughed and exchanged stories about my son and their grand-children. I was careful not to over exert the patient, asking periodically if they were experiencing any pain. Again, they refused the morphine saying the discomfort was nothing compared to the helpless vegetative state they had been under.

When my shift ended I was scolded for my "undignified" behavior and reminded that the patients do not know what is in their best interest and that most were mentally incapable of making decisions regarding their care.

Yes, I do suppose it is hard to make decisions when you are being pumped full of pain killers and anti-psychotics 24/7.

Dear readers, I beg you. Please remember the dying in your prayers this Lent.

Carlo Maratta, The Happy Death of St. Joseph.


Mary Liz said...

Thank you for treating your patients with true dignity.
My family, especially my mother, is still hurting years after the fact from the way my grandfather was treated by hospice workers. He never ever complained of pain before going into the hospital (and then hospice), or after he was admitted, yet for some mysterious reason the staff insisted on constantly pumping him full of morphine and the like. In many ways they took him from us before God did. They didn't listen to him or us.
Keep up your good work! Thank you.

HEATHER said...

Good for you!! There's a big difference in keeping someone comfortable and keeping them comatose. That is just wrong. Sounds like the people in charge just want to make their jobs easier.

Just another mad Catholic said...

Somebody once told me that they were worried that so many dying Catholics were choosing to be doped up in thier final days, said that it prevented them from making a good last confession.

Old Bob said...

Good for you, and thank you!

Debbie said...

Enlightening post!

The Crescat said...

I think of that all the time, Jack. We are robbing the dying of their last goodbyes, oppurtunities to ask for foregivenss and make confessions. All for the sake of some lazy physician's conveniences. SOmetimes the family is just as bad. Everyone is thinking about themselves, no one is actually asking what the dying person wants. It infuriates me!

Christie said...

I have had four loved ones die under the auspices of hospice care. One of my loved ones had the loving care and concern that hospice is known for. He was under the "elderly" care section of our hospice and therefore a different set of rules. He was at peace and it was a loving, gentle end.

The other three were cancer patients. It was excruciating. The "pain management" consisted of monitoring our loved ones for any signs of consciousness and drugging them the instant they showed any signs of arousal. I can't tell you the horror I felt while watching the feeble struggle of my aunt as the drugs were administered. The (well-meaning I'm certain or at least I'm hoping) nurse explained, "See how she's asking for the drugs?"

It's awful. Awful. It's like a dirty secret that no one wants to talk about. Thank you for this post.

Dymphna said...

On the other hand you there's John Zmirmak who complains in his latest essay that his dying mother never got enough morphine.

Agnes B Bullock said...

My godmother is currently in hospice and unfortunately has to be medicated so that she can bear the pain. She receives morphine every two hours or so. She is unable to speak, read, etc because of this. She does recognize her visitors, and she is ready to go. She receives the Eucharist almost daily. Her hospice doctors and her lpns and cna's are wonderful, as are her nurses. (She does not have a private nurse, and has to pay 6 grand a month for her care as her insurance and Medicare don't cover anything at this stage) We were warned that at the end she would most likely be in a coma like state for 23 hours a day. She is receiving wonderful care, but her pain is terrible- what are the doctors supposed to do? The morphine only blunts the edge of the pain anyway.

My Aunt Regina is a wonderful woman, and gave everything she had to her nieces and nephews. She took us for our first McDonald's, let us have chocolate milkshakes for breakfast at IHOP, knitted innumerable sweaters and vests for us, made our First Communion dresses, and later made afghans for us as adults. She was a constant presence in my life and, as when my Dad died last year, will be sorely missed.

Would you want her suffering to be increased because of the policies at the hospice where you are being trained?

The Crescat said...

Agnes, I feel for your suffering. I really do.

Please let me point out that this particular patient constantly refuses the morphine.

Christina said...

This also happened to my grandmother, although she also expressed a wish to not be completely drugged. She would manage her pain and would only take a small dose or another lesser pain med if it became too much to handle. My mother is a strong woman and kept them from giving her mother-in-law the high doses of morphine they wanted to give her.

However, my mother couldn't be there all the time. One day she had to relinquish her duty and the other caretakers decided to give her so much morphine that she went into a coma and died 24 hours later. Euthanasia is an active practice and it's a fact it's administered AGAINST the wishes of the dying.

nazareth priest said...

Bless you!
And prayers from here every day for the dying.
They need to be comfortable but not "out of it".
And yes, thank God you are there for your patients.

eulogos said...

Some people dying of cancer have terrible pain and really need a lot of morphine.
However others do not.
And the ability to deal with pain varies, and people's choices of pain vs consciousness will vary.
Hospice is supposed to know this. When you wrote up your notes, I hope you documented that you repeatedly asked the patient if she were in pain and if she wanted medication.
I am afraid that some people think that hospice means "snowing" the patients or "easing them out."
Hospice can only be paid for for six months as patients are supposed to be within six months of death to receive hospice care. I would not be surprised if treatment were in some cases designed to achieve the maximum number of months in hospice but no more.
There is also this. If the patient is awake, the patient is aware that he or she is dying. The caregiver then is aware that he or she is in the presence of someone who is aware that he or she is dying. This is uncomfortable for the caregiver-whether nurse or family member. So the patient is medicated so the caregiver doesn't have to deal with the discomfort of not knowing what to say to someone who knows he is dying.

I suspect that is the most important reason why this happens. Hospice nurses should be people who can face dying people. But if most of their patients are drugged to oblivion, you may wind up with hospice nurses who are self selected as people who really don't want to deal with conscious patients at all.

Susan Peterson

Just another mad Catholic said...

One of my best friends is a law student, I am a marketing student, so as you can imagine we both think that the other's profession charges exorbitant fees for doing next to nothing, when I am on my death bed I want to be fully cogent, I want Neal to be there so we can still make those jokes, so we can joke about each others' abysmal luck with the girls, so we can joke about the time when we had to attend Mass in an 'ecumneical centre' on campus.

I was reading Appendix A of LOTR today and what struck me is that Aragorn faces death not with fear as his numerion ancestors did but with peace, and how even in the bitterness of losing a loved one we can taste the sweetness of the Ressurection, Mourn yes, but with Joy and make plenty of jokes on your deathbed, gather your friends and family and enjoy those last sweet moments fully alert and for goodness sake don't go until they've written in their diaries to have plenty of Mass's offered for the repose of your soul, especially if one of your sons is a priest.

thus endeth the lesson

nazareth priest said...

just another mad Catholic: I want lots of Irish whiskey, the rosary, and plenty of good cheer when I pass to the "other side"(in addition to the Last Sacraments and Apostolic Pardon...good God, I'll need that!)....probably not such a monastic wish, nevertheless:<)!

Dominic Mary said...

Two rules for Hospice Care :
1. The Patient decides how much analgesia s/he wants.
2. If in doubt, Rule 1 applies.

- in other words, if the Patient says 'no', that means 'no' (to quote a phrase).

I'm sure no-one would want your aunt to have a moment of pain that she doesn't want; all that was being said is that it should be her choice, not someone else's.

Equally, she might prefer a bit of pain and a good confession to dying without pain and unshriven.

My late wife had analgesia at the very end; but by then she'd had all the Rites of Holy Church, because we'd had six weeks of consciousness to prepare for it - and I'd agree, eulogos, that a lot of people seem to find it very hard to cope with the fact that the person they're talking to knows they're dying . . . I personally find it inspiring, especially when the person has made his/her peace with God, and come to terms with eternity.

The important thing is for us all to pray for the dying - daily, if possible - and to remember the lesson that making a good death is worth some discomfort; particularly when it comes to our own !

margaret said...

Thank you.

Will you remember my father, Bill, in your prayers if you pray for unbelievers? He died in a hospice and I, a nurse, realised that they literally put him to sleep when he got really difficult and it was too late. He said he was ready to die (in his own mind) but still they doped him up and sent him on his way and it is a cause of much pain to me. I too believed in the hospice system (never worked in one) but now I'm not so sure.

Blessings on you for the way you cared for this particular patient. You are a good nurse.

Agnes B Bullock said...

My Aunt Regina has been shriven and has already been under hospice care for over a year, first at home and then entering the hospice itself in January of this year. She has lived longer than her idiot doctors who told us she had leukemia in October of 2008. She does not, but what is killing her was misdiagnosed as asthma in NY over 15 years ago and wasn't correctly diagnosed until she moved to SC and it was too late to correct it. She is a faithful Catholic and she struggles every day with her pain. I "spoke" with her today on the phone and she tried so hard to answer- it just kills me. We visited her last month, thankfully, and the waiting is the hard part. She has made her peace, has been shriven and received Last Rites. Her pain is unbearable at times and this hospice is making her comfortable, not sending her packing before her time. Her LPNs and CNAs dote on her, as if she were a private nursing patient and you can see that she hates to ask for any help.AS far as I am concerned, she is setting a world record for hospice care and spending my inheritance!!! I wish that I could shoulder some of her pain for her.

Just another mad Catholic said...

Nazareth priest

GOOD IDEA! although I'm going disagree with you about the irish whisky and insist instead that my friends and relatives smuggle copius amounts of Johnnie Walker Blue and Plymouth Gin into my room.

G said...

I've been a nurse since 1977. I currently work in an urban ER. This is precisely why so many physicians (at least around here) do not refer to hospice until the last possible minute. I.e., most hospice pts locally die within 2 weeks of referral. Patients & families will ask us not to refer them to hospice out of fear of just this kind of experience. Sad to say its getting much more common than it was 30 years ago.

ashley said...

God bless you for your ministry.

truthfinder said...

God bless you, Kat! I'd want you to be my caregiver when my time comes. (And, yes, I'd find Irish whiskey preferable to morphine.)