Author Archive for Larry Patten

Please Say “Yes!” to a Home Health Aide!

Why would hospice patients say no to a home health aide?

At our weekly hospice team meetings, we review every patient’s current situation. This includes the various staff assigned to a patient’s care. It goes something like this:

What about Juan Lopez?

  • Nurse . . . two to three times a week
  • Social Worker . . . one to two times a month
  • Chaplain . . . phone contact only
  • Home Health Aide . . . declined
  • Volunteer . . . one to two times a month

What about Mary Jones?

  • Nurse . . . one time a week
  • Social Worker . . . two to three times a month
  • Chaplain . . . two to three times a month
  • Home Health Aide . . . declined
  • Volunteer . . . declined

Of course, the above names are fictional. In a typical meeting, the hospice where I work will talk in detail about scores of patients. We discuss the recent deaths and new admissions, along with all of the ongoing patients served in their homes or facilities. Every patient has a choice about which of their “team” provides direct support to them. However, every patient must be seen by a nurse, from as little as several times a month to (though rare) every day. It depends on the needs. Read More →

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DNR and POLST Forms on the 8th Day of the Week

I once talked with my parents about their end-of-life wishes before dessert was served.

When Mom was alive, we talked every Saturday. I miss that. A pre-dawn riser by habit, I could phone her in California for a relaxed early morning chat regardless of where I lived. One year, anticipating Thanksgiving, our weekly ritual included my suggestion that she and Dad talk about a serious topic with their “kids.”

She agreed. At Thanksgiving, they’d let us know their wishes.

I did not anticipate this request would become Mom’s announcement after the second helping of turkey was offered, but prior to choosing between pumpkin or apple pie for dessert. With mashed potatoes cooling on my plate, with my two sisters and our spouses ‘round the table enjoying the Thanksgiving feast, Mom said . . .

“Larry thought we should tell you what we want when we’re dying. Your father and I don’t want to be hooked to machines keeping us alive. Just let us go.”

Those likely weren’t her exact words. But even if my smarter, better-looking sisters disagreed with my memory, that was darn close to what and how Mom announced their wishes.

Every family is different! Happy Thanksgiving, eh? Read More →

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Death Isn’t the Kind of Thin We Want

When cachexic was first spoken to describe a patient during a hospice team meeting, I had no clue what it meant. Nonetheless, as someone who, long-ago and far-away, studied Latin and Greek, I figured the odd word had roots in those languages. Indeed, it does. But I probably would have tossed in extra “Ks” if I’d tried to spell it. And if a nurse demanded I repeat it back to her, I would’ve also failed the pronunciation test.

It’s a clunky, marbles-in-the-mouth type of word for a cruel condition. Here’s what Amber Dance wrote in a still relevant 2012 article for the Los Angeles Times:

“Cachexia (pronounced kuh-KEK-see-uh) is commonly defined as the unintentional loss of 5% or more of a person’s weight within a six-month period. Crucially, it’s muscle that slides off one’s frame, often with fat as well. It’s associated with advanced cancers as well as HIV, heart failure and kidney disease. In layman’s terms, it means “the patient looks awful, they look weak, they’ve lost much of their body mass . . .”

Now I’ll bet it’s easier for you to pronounce the word. Maybe you could even pass a spelling bee. But all things considered, I’d rather never hear the word in a spelling bee or hospice meeting. With those Greek roots wrapped around some of the worst of what can happen to you or a loved one, it won’t surprise anyone to learn it’s similar to pyrexia (an abnormal elevation of body temperature) and dyslexia (a condition of the brain that makes it hard for a person to read, write and spell). Read More →

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