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.