Archive for Pain

(No Way I’m) Using Methadone for Hospice

Methadone should be lumped with the “opioid crisis,” right?

If asked about methadone before working in hospice, one image would have immediately surfaced for me: people lined up at a clinic, anxiously awaiting their dose.

The image included a rundown neighborhood, a mix of scraggly men and weary women angling around a building. There would also be protestors with handmade signs (“Keep drugs away from our children!”). And maybe—if depicted by a Hollywood film—a black and white police cruiser would patrol the street. Those crowding the clinic are lowlifes, bums, and losers, addicted to a terrifying opiate like heroin, but now feeding their vile habits with a “safe,” prescribed substitute.

Grim, eh?

What comes to your mind when you consider methadone?

Maybe nothing.

But if you do have a thought, it probably is based on a movie. It’s 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 a 60 Minutes piece, 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 fragmented 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 or over-prescribed drugs that are currently wrecking far too many lives. Methadone should be lumped with the “opioid crisis,” right? Read More →

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Ascites and Other Less Obvious Ailments

How easy it can be to downplay our emotional or spiritual anguish.

Occasionally, a nurse at the hospice team meeting will give an incomplete report about a patient. The team leader will prompt the nurse to make sure all the basics are covered. Though my medical knowledge is limited (and that’s a generous assessment), I’ve gone to the meetings long enough to ask a few of the predictable questions . . .

  • Does the patient require oxygen? Is it continuous or as needed?
  • Is he bedbound?
  • What is her F.A.S.T. score?

Because of situations with several recent patients, I’ve added another subject to ask if a nurse forgot to include the information in her overview.

  • Any sign of ascites?

Huh? First, let’s get to the simple, safe stuff: ascites is pronounced uh-site-teez. Read More →

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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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