Hospice Care and Your Coccyx (er, Derrière)

With apologies to our feathered friends…

The nurse gave her morning report on the condition of a patient, an elderly gentleman with congestive heart failure. She noted concerns about his food intake and breathing, confirmed he’d lost weight in recent weeks, and reminded other hospice staff about his fall on the way to the bathroom before he became a hospice patient.

“Anything else?” the hospice medical director asked.

After a glance at her laptop screen, the nurse responded, “Some skin tears around the coccyx. But it’s mostly under control and healing.”

The doctor nodded. Good job. Next patient.

Ah, the infamous coccyx. It’s one of those peculiar—but common—words in the medicalese of health care that’s linked to physical complications patients may face. It has Greek origins. Though coccyx has but six letters and two syllables, it’s quite a mouthful to pronounce.

Coccyx. Or, as I hear it with my non-medical ears: cock six. Say it fast! The word sounds a tad rude or embarrassing, right?

It’s the tailbone, the tip of the spinal column. In Greek, the word meant cuckoo (kókkyx) since the slightly protruding bone resembled a cuckoo’s beak. Having never seen a cuckoo’s beak, I’ll just have to trust those long-ago, fowl-loving, word-creating Greek geeks.

I suppose, if our polite, professional nurses wanted to, they could express other words for the skin tear’s location. Like the . . .

  • Arse
  • Booty
  • Bumpers
  • Buns
  • Butt
  • Caboose
  • Can
  • Derrière
  • Fanny
  • Hams
  • Haunch
  • Keister
  • Six
  • Trunk
  • Tush

What slang terms am I missing about our buttocks?

There is an abundance of nouns for our posterior’s zip code. I suspect the more slang we sling, the more likely we’re describing culturally embarrassing or personally taboo territory.

Embarrassing or not, the coccyx is one of the body’s pressure points.

When lying on your back, the bone shaped like a cuckoo’s beak presses against the skin. A reddish area becomes a skin tear becomes—in a worst-case scenario—a bedsore. Not good. The nurses focus attention on healing the wound. What seems insignificant, just an “owie” on the bun, may unleash infections and interferes with the comfort of sleep. A bedsore often means a patient can no longer move and both the medical team and family will make sure to help the patient to adjust from one side to another.

We humans are built for motion. Our bodies heal better when active. Nurses know this and remain alert to the status of the skin around the bone shaped like a cuckoo’s beak.

Sometimes, we can’t shift positions on our own.

Sometimes we need help from others.

The coccyx is one of the most likely spots where there can be “bad” pressure on the body. Being a patient in hospice reveals other, less obvious, pressure points.

Some family members don’t want to use certain drugs for pain management. Or don’t want a parent or spouse in hospice because it’s “giving up.” Or don’t want to talk about dying and death. (While there may be a flock of slang words for butts, with hospice, there are those who don’t even want that one word spoken aloud.)

The pressure on every patient is more than physical. That’s why I often wish I could wave a magic wand to convince a reluctant family to have the entire hospice team become part of the care. A nurse will try to manage the physical “pressure points” like the coccyx. But the once simple task of bathing can become a “pressure” that a home health aide can make easier. The opposition between siblings over hospice representing giving up may boil over with an intense “pressure” . . . and a social worker or chaplain might be able move the family to better communication, better understanding.

In hospice, patients and families may think they are going crazy. Crazy with pain, with losing control, with having too many decisions, with caregiving that is exhausting, with strangers from hospice entering their lives. To use more slang, (and with apologies to our feathered friends) everyone may feel like they are going cuckoo!

Though not perfect, the hospice staff will help, seeking to relieve the physical, emotional, and spiritual pressure points that can overwhelm a family when a beloved is dying.

(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

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