Hospice SOBs

Some hospice patients have MOM charted for one of their prescribed medications.

Hey, who wouldn’t want a mother’s love when entering into hospice care? Mom knows best, right? But wait! MOM is one of hospice’s (and health care’s) endless acronyms, an abbreviation for the familiar Milk of Magnesia.

Then there’s SOB, which I’ve written about before . . . but every time I see it as a concern for a patient, I’m still taken aback.

The acronym means Short Of Breath rather than the curse, “You son of a _ _ _ _ _!”

SOB represents many patients greatest fear. A number of illnesses compromise the lungs. Regular, “normal” breathing often becomes a struggle. No one wants to gasp for a next breath. No one wants to pause for long seconds between each word as they slowly attempt to communicate. What person would want to go to bed at night, fearing a lack of air will force them awake? Or, they dread, might mean they’ll never wake?

An acronym linked to SOB is COPD: Chronic Obstructive Pulmonary Disease. According to the Mayo Clinic website, COPD “is a chronic inflammatory lung disease that causes obstructed airflow from the lungs.” That’s a simple and a terrifying definition. On too many occasions, it’s the primary diagnosis for a patient entering hospice and having “six months or less to live.” Bluntly, cigarette smokers rise high on the grim scale for a future with COPD and SOB.

Take a breath. Easy, right?

Take a breath. If you’re in a city, ugly with smog and traffic, the air literally tastes bad. Ah, but how wondrous a deep breath when inhaling clean, crisp air.

Let’s get some air, we say, as we join in a jaunt around the block or on a mountain trail. Let’s air it out, we challenge, as we debate another and seek mutual understanding.

Take a breath.

The so-called average person will breath 16 times per minute “at rest.” Which means 960 breaths an hour. If you arrive at 80 years of age, you will have taken 672,768,000 lifetime breaths.

Keep breathing!

But our breath is limited. Literally limited because the atmosphere around our beautiful, tiny, spinning Earth provides a way for oxygen to be available, though that life-giving oxygen thins the higher you climb. As a young man in good shape, I gasped for breath in the final thousand feet of elevation between the Sierra Nevada’s Trail Crest Pass (the highest trail pass in the United States) and Mt. Whitney’s 14,505-foot summit.

And our breath is literally limited because we are human. There will be a last breath at some point. In a 2012 interview on National Public Radio, Dr. Ira Byock (a physician long involved in hospice care) shared about one of his patients . . .

You know, he didn’t have quit in him and wasn’t about to hear that he was dying. And so he really, you know, fought us, really, to have every treatment possible.

We talked about, you know, how CPR in his circumstance simply would not work. Well, he didn’t want to hear the data. He didn’t want to hear that it really only works when you’re seriously ill on TV and not in real life. As his daughter said, he didn’t have – just doesn’t have quit in him.

And unfortunately, that didn’t make him immortal. It just made his dying harder, try as we might to make it easier for him and for his family. [My italics.]

What will you, o mortal one, do with your hourly 960 breaths?

None of us wants to be SOB, but many of us—and I include myself—abuse the breath we have with the words we use. The acronym SOB isn’t just medicalese. Have you called someone an SOB? Have you been angry with another and screamed at them? Have you hurt another with your insults, sarcasm, belittling, bullying, criticizing, backstabbing and gossiping? Have you held your breath back and not told another about your love, about forgiveness, about your fears, about your dreams?

Writer Frederick Buechner suggested,

Of the Seven Deadly Sins, anger is possibly the most fun. To lick your wounds, to smack your lips over grievances long past, to roll over your tongue the prospect of bitter confrontations still to come, to savor to the last toothsome morsel both the pain you are given and the pain you are giving back—in many ways it is a feast fit for a king. The chief drawback is that what you are wolfing down is yourself. The skeleton at the feast is you.

How easy breathing is, until it isn’t. How abundant oxygen is, until it’s not. How casually we use breath to whisper or shout hurtful things to others, though we’re more likely only hurting ourselves.

Take a breath.

There will be about 15 more in the next 60 or so seconds.

How precious each one is.

Right now.

(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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