Archive for Doctors

In Hospice, MAC Isn’t About Comfort Food

Mac & Cheese is comfort food, but sometimes . . .

While discussing a new admission, the hospice medical director reminded the patient’s nurse to get a mac.

The nurse immediately nodded. Complete agreement.

A mac? What did the doctor mean? They couldn’t mean a Macintosh computer from Apple, could they? That didn’t make sense. But thoughts of digital apples made me think about real food . . . did they mean Mac & Cheese? Though not a big fan of that packaged pasta and cheese, it is one of my wife’s favorite comfort foods.

My food wondering continued. What about a “Big Mac?” Could the doctor have been recommending a fast food burger? (When younger, I loved McDonald’s flagship burger. The Big Mac debuted, with fanfare and a high calorie count, around the time I started college. If I could scrape together a few extra quarters, I’d always go for the extra all-beef patty and special sauce!)

But we hospice professionals couldn’t have been talking meal deals . . . right?

Ever ignorant, I asked the doctor, “What is a ‘mac?’” Read More →

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The Best Time to Consider Hospice is ______

When is the right time to ask about hospice?

Isn’t that the hardest of questions? For a potential hospice patient, the “right” or “best” time answer seems like a grim brew of unsettling and unfair choices.

Some would prefer their doctors provide the answer. Though there are exceptions, most doctors have spent scant time in training about “end of life” concerns. The lengthy education for a medical degree doesn’t leave much room in the schedule for learning about the dying and death of patients. Doctors, regardless of her or his specialty, are oriented toward healings, hopes, cures, and the next best option to try. It’s nearly impossible for physicians to view hospice as anything other than “giving up.” Who wants a doctor that will “give up” on you?

There are patients that secretly—or not so secretly—want a family member to make decisions about hospice. Do you truly want the people who blindly love you, who want you to “live forever,” and who frequently don’t understand the medical situation (with its strange terminology and complex treatments) to make your decisions? It’s nearly impossible for many family and friends to view hospice as anything other than a personal version of the “end of the world.” In presidential politics, we laugh about (and are deadly serious about) which candidate we want in the Oval Office in the awful event of nuclear war. Who, in any family, wants to trigger the “apocalypse” for a loved one?

But I will give you an answer. Read More →

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Drugs, Doses, Dread & Delivery Options

pills

Around breakfast time, I usually shake out several pills into the palm of my hand . . .

The nurse arrived and sat beside my mother in the dimly lit hospital room.

One of the first things he said was, “This won’t hurt.”

He lied.

He was there to place a peripherally inserted central catheter (PICC, or “pick”) into Mom’s upper right arm. She’d been offered Dilaudid—a brand name for hydromorphone, a narcotic stronger than morphine—for pain management. The medication would be housed in a CADD pump (Computerized Ambulatory Drug Delivery) connected to her PICC line. The linked pump and the catheter would give a predetermined, regular amount of medication to ease her physical agony. A “button” could be pressed on the CADD pump for additional dosages.

Are your eyes glazing over with all the medicalese?

Mom’s body was riddled with cancer and the two surgeries undertaken to “relieve” discomfort had added complications. As I calmly write this three years after her death, I understand why she said “Yes” to that PICC line: she wanted the wrenching pain to end and she was ready to die.

But the nurse, who seemed rightly weary in the near midnight hour when he entered Mom’s room, first caused more pain.

He swabbed her arm with disinfectant and inserted a needle.

She grimaced.

I held her left hand. Watching her tore my heart apart. Read More →

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