Archive for Drugs

Morphine: the Best Drug at the Worst Time?

The hospice nurse has strongly suggested using morphine for the patient’s increased pain.

You are the patient, still alert and oriented, able to make your own decisions. What will you say to the nurse?

You have the authority—the durable power of attorney for health care—to make decisions when your loved one is unable to choose. What will you say to the nurse?

Every person and family is different. Some, when faced with the toughest decisions in hospice (like starting morphine for pain management), surprise themselves when they are all in agreement. Other families, who may easily agree on whose house to go to for Thanksgiving, or the right gift for Mom and Dad’s fortieth wedding anniversary, either debate or procrastinate about morphine as an option. And nearly every hospice professional has encountered a chaotic, angry, opinionated—yes, over-the-top dysfunctional—family that seems to go to war when a drug like morphine is a loved one’s suggested next step.

Morphine is an effective, scary, and powerful medication. It often becomes the tipping point for resisting or accepting hospice’s comfort care philosophy. 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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In Hospice: Should You Titrate?

What does titrate mean?

What does titrate mean?

Until working in hospice, and hanging around nurses and doctors, I’d never knowingly heard or used titrate in a sentence.

With no medical or chemistry background, I have darn good excuses for my ignorance.

In a patient care meeting, when a nurse asked a doctor about titrating the new medication for a patient, I’d keep a straight face. I’d maybe give a brief neutral nod, and then hoped there wouldn’t be a snap quiz after the coffee break.

Fortunately, while ignorant of many things, I’m equally curious about nearly everything! I own bunches of dictionaries and thesauruses! I can search the web! I can ask a nurse!

I eventually asked a nurse. Talking to a nice person is far better than aiming the dusty magnifying glass at a page in my Compact Edition of the Oxford English Dictionary. The definitions are printed in fonts so tiny an eagle would struggle to read a sentence.

So a friendly RN told me that many drugs should be titrated whenever introduced or discontinued as part of a patient’s care. In other words, she explained with a kind smile, there should be a gradual increase or decrease in the dosage over a period of time.

Why? Read More →

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