Tuesday, March 27, 2012

Update to End of Life Care

The Prevention Magazine article I referenced in my blog post was Safe Passage.  The doctor featured in the article was Dr. Ira Byock.

Thanks to my sister for getting this information for me.

Friday, March 23, 2012


The resident in the previous post who said "...I'm older than I thought I was", passed away two days later.

Makes me wonder if it's not how old you feel, but how old you think you are that matters.

Monday, March 19, 2012



"What year is this?"

"Two thousand and twelve."


"Twenty twelve."


"Well, goddamnit, I'm older than I thought I was."


"Lookin' sharp," the aide said as he combed Mr. A's hair.

"Lookin' sharp?" Mr. A asked.

"Yes you are," the aide confirmed.

"Hey!" Mr. A called to his wife.  "Come and look at a good lookin' picture of your husband."

Thursday, March 15, 2012

End of Life Care

In Prevention Magazine this month there was a very interesting article about a hospice doctor and what is involved in his end of life care for his patients.  Sadly, I threw the magazine away and I can't find the article online, but if you can get your hands on it, it's a good read.

In any event, one of my residents passed away today and it made me think about the article.  This resident's family chose to finally just let nature take its course.  Unfortunately, in my opinion, they did not put the resident on hospice care.  So, for the last three months or so, we have tried to feed this resident when they didn't want to eat, we have cajoled them into taking medications that they probably no longer needed and we did not make any changes to their pain medication routine that were worth mentioning.  We just continued on as if they were stable or improving instead of making allowances for the changes they were going through.


The thing that really hit home for me was the paragraph where they said that pneumonia is one of the least painful ways to die but, because it's easily treated, we cure the patient.  This then forces them to continue to live in pain and subsequently die in a more painful manner.

Did I mention how many times my late resident was on antibiotics over the course of the last year?  It makes me wonder how much more pain and suffering we caused them by getting them better as opposed to just letting them go.

I realize that this is a very personal choice.  Maybe the resident would have wanted to live for as long as possible.  I have seen more than one resident with a DNR change their mind at the last minute and do whatever they could to stay alive, so it's not out of the question.  Still, I think the resident's Power of Attorney could have made better arrangements for them.  Hospice care with an aggressive pain relief program might have actually extended their life and certainly would have improved the quality of the days they had left.

The list of things I don't understand seems to grow longer by the day.

Saturday, March 3, 2012

If you want to become invisible...

...all you have to do is lose your mind.

Currently, I'm working with a resident who went to the hospital as one person and came back as another.  Before they left, they were sociable, aware, and the village gossip.  If you wanted to know anything about anyone in the facility, staff or resident, this was the person you went to see.  You would routinely find their room occupied by other staff or other residents when you went in to care for them.

One day they found this resident unresponsive and sent them to the ER.  They stayed at the hospital overnight for observation.  And when they came back, something was obviously wrong.

Now the resident thinks their spouse is still alive and is looking all over the facility for them.  They wander the halls asking for help.  They cut holes in their catheter with fingernail clippers.  Any stories they tell you aren't reliable in the least.  Something in their head went "pop" and because they are nearly 100, there's no hope for repairing it without doing further damage.

Sadly, no one really knows how to deal with this.  Instead of gathering in the room for a good gossip, folks are avoiding it like the resident has MRSA.  Somehow, the resident still knows our names, but when they call for us, they don't know what they want, or they ask about their long-dead spouse, or they can't think of the word they need.  When we can't figure out how to help them, they get angry and tell us we don't care.

It's heartbreaking and frustrating.  I've worked with my share of residents with Alzheimer's Disease.  This is nothing like that.  This is like they've had a lobotomy.  It's impossible to find the person they used to be and impossible to relate to who they are now.

I know we need to learn to work with the "new normal".  It's just hard when the change is so sudden.