Tuesday, August 24, 2010

Night Visitor

Blake's mom had been sick since he was born. She was diagnosed with lung cancer right as he came into the world. She went through very aggressive therapy and unfortunately began having strokes as well. Each stroke seemed to take part of her person-hood. Her husband and parents would work tirelessly to help her regain function to undergo more chemo, and then a new stroke would occur.

When I finally met Blake's mom, she had just had her most debilitating stroke. Unable to communicate reliably, her arms and legs were contracted, so that any sips or bites were hand fed to her. She often had a blank stare leaving me to wonder if she was still in there, but the family was determined to keep her living for Blake, her 4 year old son.

She was at our hospice house for many weeks, her husband with her at night, her mom with her in the day.

This particular night Blake had spent time during the day visiting his mom, and was at home with his grandmother. Ready for their nightly routine Blake's grandmother began looking for him, to have him call the hospice house to say goodnight to his Mom.

"Blake" she called, "time to call your mom", repeating this several minutes before Blake finally reappeared. "Blake" she then scolded, "why didn't you coming when I called, you love calling your mom." Blake grinned and told his grandmother "No", leaving her aghast at his indolence.

He then explained, "I don't need to call tonight, because she came to see me, she told me goodnight and that she loves me"

The grandmother was now quite alarmed, calling the hospice house. Her fears realized as she learned her daughter had indeed died just a bit earlier, the husband having not even had time to call yet.

Another unexplainable moment in the world of Hospice and Palliative Care


Wednesday, August 4, 2010

Failed Admission

When I walked into Bill's room all I knew was that he had a type of bone cancer diagnosed 3 years ago. He was in his 70's and was not at the end of his disease by any means. Just based on his cancer and functional status, he probably had another year or so to go.

Arriving at our hospice house, I assumed he must be coming for pain control, since his type of cancer is notorious for pain.

He greeted me cheerfully when I entered, introducing me to his wife and 2 children who were visiting from out of state. I noticed the daughter's hand full of crumpled tissues, eyes still moist from tears. They seemed close, hovering near Bill who seemed surprisingly calm and symptom free to have been rushed into the hospice house.

When I finally came around to the, "and what brings you to the hospice house" question, Bill stated in a matter of fact way, "I am getting weaker now, it's harder to take care of myself and I just don't feel I am contributing any longer to society, so I'm hoping you can give me something to help this go quicker"

These types of statements come up from time to time, so I just did as usual, and addressed it openly, naming his suggestion. "Well, Bill, you know we can support any symptoms you have here, pain or anxiety, etc, but I cannot give you anything to hasten your death, it's illegal actually" At this point normally people say they understand and were just joking...

However, this is when the body language changed in the room. The daughter quipped incredulously, "You can't?" while Bill asked, "Well, where in town can I go for that?" I felt everyone bristle with shock, which confused me that they were this serious.

"I am sorry, but again, there is no where in the United States that a doctor can actually administer a medication to make you die, that is euthanasia and it is illegal" I explained.

Then his son blew me away when he addressed his father, "Well Dad, do you just want to go home then? It seems that the reason we came here, to help you die, they won't do...so want to leave?"

I tried to look as if this conversation was normal, however, realizing that this entire family had come in, even flown in from out of state to have some hollywood moment of saying goodbye while I lethally injected their loved one was startling.

He did leave the house, not just because he wanted, but I couldn't justify him staying - there were no symptoms of pain, anxiety, dyspnea or even emotional pain. He was logically just done and actually didn't require any medication while he was with us transitioning back home.

So my first admission for desired euthanasia, was a failed admission. Thankfully, failed