Hospice: Understanding the Unpronounceable

In a hospice meeting, there were a dozen or so huge, clunky words on several patients’ charts that underscored my medical ignorance. But one stood out because it had appeared on a couple of charts and was the longest of all of them:

Thrombocytopenia

Because it’s easy to scour the internet for clues after seeing the strangest of words written on patient summaries or spoken by hospice colleagues, and because my search included the Mayo Clinic’s website, I’m confident that,

Thrombocytopenia is a condition in which you have a low blood platelet count. Platelets (thrombocytes) are colorless blood cells that help blood clot. Platelets stop bleeding by clumping and forming plugs in blood vessel injuries.

Thrombocytopenia often occurs as a result of a separate disorder, such as leukemia or an immune system problem. Or it can be a side effect of taking certain medications. It affects both children and adults.

Knowledge is power. Knowledge leads to better choices and decisions. Knowledge can be the difference between feeling overwhelmed and helpless vs. planning and taking future steps.

Nonetheless, some words intimidate. And not just in the medical/hospice realm. Like many kids in my generation, the film “Mary Poppins” introduced us to the silly and ridiculously long:  Read More →

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A Hospice Chaplain is Quantifiably Wrong

(*Photo by John Rothwell.)

“The nurses do things that can be quantified,” one of our hospice chaplains announced, “which is not like what us chaplains or the social workers do.”

With hospice, a patient is supported by a “team” of doctors, nurses, social workers, chaplains, home health aides, and volunteers.

Was the chaplain, a person and a professional I respect, correct?

What is quantified? It’s a word describing precision, numbers, and comparisons.

A nurse may ask a patient what her or his pain is like on a scale of 1-to-10 or (especially if a patient can no longer talk) to choose from a range of emoji faces depicting happy smiles to grim anguish. Nurses increase or decrease the precise dosages of medications based on experience, information, and established guidelines.

The medical staff in hospice—and this is one of the tough parts of patient care—needs to regularly report how a patient is declining. If a hospice patient demonstrates consistent improvement in their physical health, they certainly still have an illness (and can’t stop the aging process), but they may no longer be eligible for the hospice benefit.

  • Is the patient losing weight?
  • Does he require stronger doses of pain medication?
  • Is she eating less, or only liquids, compared to last week or month?

Yes, nurses quantify, with specifics, to discern a patient’s changes. Read More →

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Social Workers and the Value of Compassion

A compassionate heart…

I smiled.

I shouldn’t have smiled.

Quinn*, one of our social workers, was providing details on a patient’s background and current condition to the rest of the hospice team. The patient, living alone and seventy-something, had numerous health concerns along with her cancer diagnosis.

Our new patient, Quinn suggested, might have undiagnosed mental health issues. She could be easily upset. At times, unexpectedly, she may lash out. It was possible she wouldn’t answer the door and later, when you tried to leave, she might keep talking and talking, making it difficult for staff to leave. Quinn also wondered if the patient would be compliant with medication. (If patients/caregivers forget or refuse the scheduled doses, pain from the disease may spike. Inconsistent dosages make everything for the patient more difficult to manage.)

Why did I smile? Quinn was so, so, so polite when describing this new patient. Read More →

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