Archive for Pain

The 35%

Each moment feels like a demolition derby where every car loses.

Each moment in hospice feels like a demolition derby where every car loses.

Of the many hospice statistics that rattle me, 35% is near the top of the list.

Nationally, in all hospices, about 35% of the patients will be served for a week or less. In some cases, much less than a week.

These patients often arrive from a hospital setting, with the family desiring the parent or spouse to die at home. They are frequently cancer patients, and their chemo or radiation treatments were concluded a handful of days before admission. They are old and young. They are male and female. They are alert and comatose. Read More →

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No Methadone! Know Methadone?

methadone0924f500pxIf asked about methadone before working for a hospice, one image would have quickly surfaced for me: people at a clinic, anxiously awaiting their dose.

The image included a rundown neighborhood, a mix of scraggly men and weary women lined along the corner of a building, and protestors with handmade signs (“Keep drugs away from our children!”). And maybe—if depicted by a Hollywood film—a black and white police car might cruise by on the street. Those in the line are lowlifes, misfits, and losers, addicted to a serious drug like heroin and now nursing their vile habits with a prescribed substitute.

What comes to your mind when you think about methadone?

Maybe nothing.

meth_clinic_protest_3_773468102_r644x428But if you do have a thought, it’s probably based on a film, a story on the mean streets of New York with old Al Pacino or young Ryan Gosling as a loner cop. If your thoughts weren’t from a film, then it was in a newspaper article from the last century, a Law & Order rerun, or a hazy recollection when you were lost in the rundown side of chilly Milwaukee or sunburned Miami searching for a college roommate’s address. Regardless of the source of your piecemeal memory, you “know” about methadone: it’s for drug addicts. Sure, people may need a physician’s prescription to get a dose, but it’s not much different than the various illegal drugs that are ruining society.

So when a hospice nurse suggested that methadone was a good choice to manage your pain, you quickly said, “No way.” Or a family member equally quickly said, “No way.” Or, after the nurse invited you to consider methadone for part of your pain treatment and then left for her next patient, you and your spouse chat about the possibility for about 5 seconds and decided, “No way.” Read More →

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Alert and Oriented (Again and Again)

Hospice ADLs:  My Adventures of Daily Learning.92

Who-are-you800x420_thumbIs the patient alert and oriented?

That was the first official “hospice type” question I learned when I was a hospice chaplain.

Are they alert and oriented times 1, times 2, times 3, or times 4?

Ah, it gets more complicated! Here, as I understand it, are the key questions for determining if a patient is alert and oriented:

  1. Who are you?
  2. Where are you?
  3. What time is it?
  4. What just happened?

These are very basic, and very essential questions, to help discern the current mental status of a patient. Ideally, we all “know” these four answers. I am Larry. I am in Fresno, California. It is about 5:30 in the morning (or it’s an early Thursday morning if you’d prefer me to be general). And, finally, not all that much is happening in my (see #1) home (see #2) at this pre-dawn hour (see #3), other than I just heard our kitty Liam (#4) thunder down the hallway, likely headed toward the back of the house to bother my wife. Read More →

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