The Wonder Pills

Hospice is one of the rare times when all the medical professionals involved in caring for a patient are on the same page.

I wonder how this relates to medications.

Prior to hospice care, it’s not unusual for one doctor to prescribe a pill for your cranky prostate and another doctor to make sure you’re taking a blood thinner and a third doctor to suggest an antidepressant. You, the thoughtful patient, will mention the various pills you’re taking to each physician. If a new doctor claims that a new “wonder drug” is worth trying, you will also tell him or her about the other medications. The doctor(s) will assure you that everything is compatible. The nurse(s) are also reassuring when you worry about your growing list of pills, tablet and doses. The pharmacist(s), of course, will add insights.

So many voices! So many pills!

Nowadays, as we grapple with the illnesses that come with the accumulation of birthdays, our medicine cabinets can become chock-full of prescription bottles. We want to feel better. Take that pill. We want to return to what we once felt like. Try this pill. Grace Slick of the long-ago ‘60s rock band Jefferson Airplane, famously sang . . .

One pill makes you larger
And one pill makes you small
And the ones that mother gives you
Don’t do anything at all
Go ask Alice, when she’s ten feet tall…

Even those who disdain the meds and scalpels of modern western medicine will likely have several of those ubiquitous orange—though officially, it’s amber—bottles. The print is small on the labels, the numerical codes are mysterious, and the odd abbreviations can seem like Egyptian hieroglyphics. But each dose helped you! Right! Right?

When someone enters into hospice care, we review a patient’s medications.

Every. Single. One.

There’s the usual financial bottom line reason for this. The hospice benefit only covers the prescriptions pertaining to the primary diagnosis. However, there is also an essential-to-the-patient goal for the review: which prescriptions are truly needed at this stage of life?

Many patients are ecstatic about tossing out the pills. After all, certain medications include nasty side effects (drowsiness, constipation, etc.) even as they heal a condition. Certain meds require complicated regimes (one before meals, two at mid-day, three before bedtime), cost big bucks, or have seemed as beneficial as an air conditioner in the arctic.

Nonetheless, I am intrigued about the reactions other patients or families have when a hospice nurse informs them that particular medications aren’t necessary: they don’t want to give up anything! Whether a physician’s prescription or an over-the-counter drug, they want to keep swallowing their pills. Though there are a number of reasons, one may be the most important . . .

Control.

Yes, maybe patients don’t trust the new hospice “experts” that are suddenly sharing their bedrooms and living rooms. And yes, if a medication feels reassuring, why stop taking it even when what it cured is, well, cured? Equally yes, we humans can be stubborn. Habit and routine also play a role. I’m sure other explanations could be added.

But I’d put control near the top of the list. Whether a drug has healed or irritated, some resist relinquishing control. The hospice staff, along with friends and family members, must pay attention to the patient’s preferences. Whenever patients are able to help make decisions, they should be included in the process leading to the best personal choices.

I wonder if there’s another reason for patients (or their caregivers) to resist any stop-the-pill suggestions. Isn’t it far easier to be angry about hospice “taking away” prescriptions than openly discussing your more troubling issues?

  • What if a patient is afraid of death?
  • What if a family member can’t tell a loved one it’s okay to die?
  • What if an adult child or aging parent has a grudge or regret they still haven’t been able to resolve with their dying loved one (or not so loved one)?
  • What if . . .

Is it safer to fight about unnecessary pills rather than reveal your deepest feelings?

Here’s something I don’t wonder about: hospice offers the opportunity for honesty. Why waste precious time debating about “silly” pills? Even more, please don’t waste any precious time when there’s a chance to heal old wounds or to share unsettling fears.

(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

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