Archive for Symptoms

A Hospice Chaplain is Quantifiably Wrong

(*Photo by John Rothwell.)

“The nurses do things that can be quantified,” one of our hospice chaplains announced, “which is not like what us chaplains or the social workers do.”

With hospice, a patient is supported by a “team” of doctors, nurses, social workers, chaplains, home health aides, and volunteers.

Was the chaplain, a person and a professional I respect, correct?

What is quantified? It’s a word describing precision, numbers, and comparisons.

A nurse may ask a patient what her or his pain is like on a scale of 1-to-10 or (especially if a patient can no longer talk) to choose from a range of emoji faces depicting happy smiles to grim anguish. Nurses increase or decrease the precise dosages of medications based on experience, information, and established guidelines.

The medical staff in hospice—and this is one of the tough parts of patient care—needs to regularly report how a patient is declining. If a hospice patient demonstrates consistent improvement in their physical health, they certainly still have an illness (and can’t stop the aging process), but they may no longer be eligible for the hospice benefit.

  • Is the patient losing weight?
  • Does he require stronger doses of pain medication?
  • Is she eating less, or only liquids, compared to last week or month?

Yes, nurses quantify, with specifics, to discern a patient’s changes. Read More →

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Wanted: A Hospice Time Cop

I’ve had to literally wade through a crowd that felt more like New York’s Times Square . . .

I’ve had to literally wade through a crowd that felt more like New York’s Times Square . . .

My thoughts today are not only for patients and their caregivers, but also (at least a little) for those who aren’t “hospice appropriate.”

But first, I’ll focus on the dying. Several months ago one of our physicians at a hospice team meeting warned about . . . overstimulating patients.

Sometimes a patient seems oddly agitated and unsettled. Maybe their usual calm demeanor has been replaced by caustic comments or awkward silences. If they usually spend much of their time resting, why are they so wide-awake? Or have other unsettling actions or attitudes been observed?

Is a particular medicine the problem?

Has the dying process accelerated?

Has the pain from their terminal illness abruptly increased?

Those questions (and more) are possible and should be evaluated.

But it could be overstimulation.

Huh? Read More →

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Haldol

I’m not a medical expert.image015

I’m not a medication expert.

I know next to nothing about drugs.

I have never met a pill I wanted to take.

Is that blatant enough about my ignorance so my next thoughts are taken with a grain of salt? Nay, not a mere grain. Instead imagine an overflowing wheelbarrow of Morton’s when-it-rains-it-pours overpriced sodium!

Since I’ve confirmed my lack of qualifications, let me share a few biased opinions about . . . Read More →

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