Archive for Caregivers

He Was Angry!

According to the nurse, he was angry.

According to the chaplain, he was angry.

According to the social worker, he was angry.

These three hospice colleagues separately visited the same patient and husband over the course of several days. While each met with the patient for different reasons—from the nurse determining the most appropriate medications for the patient’s needs to the social worker assisting with Medicare forms—they all experienced the wrath of a husband.

His wife had entered hospice care a few days before. Her cancer and Alzheimer’s had combined to wear her, and her husband, down. They dreaded the next midnight run to the emergency room or another lengthy stay in the hospital. Her oncologist had announced chemo or radiation therapies would no longer work. The neurologist, once upbeat about drug trials for her dementia, had exhausted all options as her disease slowly worsened. Many of the doctors and nurses they’d seen in recent weeks had mentioned hospice.

And so, his wife became a hospice patient. Read More →

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Cancer Can Break Bones and Caregivers

Along with the primary diagnosis of cancer, a hospice nurse quickly listed her patient’s other health issues at our team meeting. One of the patient’s concerns was a . . . “pathological fracture.”

To which I thought, “Huh? What?”

I first thought of pathological liar, a phrase I’ve read in novels and seen in films. Actor Jim Carrey’s Liar Liar from 1997 humorously came to mind. There he played a lawyer who frequently and thoughtlessly lied. Lying for Carrey’s character was no different than breathing. But did the familiar “pathological liar” have anything to do with “pathological fracture?”

In the realm of words, there’s a common ground because of “pathology,” or the study of diseases. Lying about everything, though funny for a movie’s plot, will hurt, and can be diagnosed as an illness. Lying can cripple a person and profoundly impact every relationship.

A pathological fracture literally cripples a patient. Read More →

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In Hospice, Don’t Be Ruled by the Rules

During a patient care team meeting, the hospice medical director explained that he’d broken one of his rules.

My distant impression of the doctor—physically distant because of where he and I sit in the meetings and professionally distant since he cares for the patients in their dying while I support grieving families after death—is that rules are critical values for the way he lives his life.

However, the soft-spoken physician felt he had to break a rule. Instead of providing key information about the disease process, and the options for comfort care so the patient could make choices about the next steps, the doctor bluntly told a patient that he must be transferred from his residence to our in-patient hospice home. Now! There, the patient would have a better level of care for his needs. Moving was not his choice; it was the doctor’s demand.

The patient died before the next sunrise. He died with the sole member of his local family at bedside. For weeks, his dying had been lonely, problematic, and anguished. In his last hours, dying became peaceful. The doctor had used good judgment. But the doctor had also wrestled over “breaking” a personal, essential rule: whenever possible, let a patient take the lead in making an informed decision. Read More →

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