Monday, June 30, 2008

Bad Daughter!! Bad... Bad... Daughter...

0730 hrs. I'm not so crazy about making visits so close to the end of my shift. It kind of makes me crabby. Thankfully, the crabbiness always wears off during the drive to the patient's home. An elderly woman has passed on and her middle-aged daughter opens the door for me. There's a neighbor lady sitting at the kitchen table. She has a nice face.

The patient's hospital bed is in the middle of the large living room. The house feels "good". It's tidy and the decor is from the 1970's. It's an old woman's home and it makes me feel warm and fuzzy.

 I'm no medical examiner, but the deceased looks (and feels) like she's been dead a long time. That's not so unusual. Many caregivers go to bed and find, in the morning, that their loved one has passed on sometime during the night. I take out my cell phone and flip it open. 

"You're not going to take her picture, are you?" the daughter nearly shrieks.

"Oh, no. No no no no no! I'm just looking at the time!" I reply. "I don't wear a watch. I use the time on my cell phone for official time of death."

She looks relieved. The daughter tells me that she must run into work to drop off some papers. She gives me permission to call the funeral home and have them remove the body during her absence. The elderly, neighbor lady will keep me company until the removal team arrives. 

The old lady is easy to talk to. She tells me that health permitting, she would come to the home and check up on the helpless, bed-bound patient. She feels badly that she couldn't come more often. The woman then reveals that the daughter never stayed here with her mother. The daughter would come over briefly, twice a day, before and after work. She then went to her own home in the suburbs. 

I am stunned. "Does she have children? A husband?", I ask, trying to grasp at some explanation for this.


The woman is studying my expression. She's getting an eyeful. I'm thinking about all the time the patient spent alone, in bed. No one to talk to, no hand to hold, no repositioning, no ... pain medication. No anything. Anything! I'm getting dizzy. And very, very crabby.

Fun-filled Funereal Facts

Hospice is not just a building that houses dying people. Hospice is a "philosophy of care". In fact, most hospices cannot afford to have their own ,"stand-alone", inpatient facility. Most hospices contract with local nursing homes, rehabs, hospitals, etc. to house and assist with the care of their inpatients. 

You cannot, upon getting a prognosis of six months or less to live, just move into an inpatient unit and hang out there until you die. Medicare and other insurance providers have guidelines about what constitutes an appropriate inpatient admission. Symptom management, such as uncontrolled pain, is an example of an acceptable inpatient admission.

The vast majority of hospice patients are in their homes. They, and their caregivers, receive the support of nurses, doctors, nursing assistants, social workers and pastoral counselors. It's a beautiful concept. Not perfect...but beautiful.

Saturday, June 28, 2008

Yep...I did it. I killed 'er.

2200 hrs -- A grandmother has died. I enter the home and offer my condolences to the four family members gathered in the living room. One of them responds with a grunt. All four faces are grim... eyes narrowed. No evidence of tears. No sniffling noses. I go, unattended, into the grandmother's room, examine her and make an official pronouncement of time of death. 

Upon reentering the living room, I notice that the family is sitting, four abreast, on the sofa and staring at the television. All with stony faces. All with arms folded over their chests. I notice that they have a Tivo. I'm oddly curious about it. I don't think I've seen one before. I give myself a mental poke in the ribs and begin my usual spiel:

"The first thing I'm going to do is call the coroner's office. I'll just be giving them some basic demographic information about Mrs. (    ). Then I'll call the funeral home and they will take her to the mortuary. No police, emergency services or investigators will come to the house. Do you have any questions?"

Stone, cold silence. Not even crickets. All four faces still pointed at the TV. My gut makes a little jump from a sudden realization. They're all pissed off at ME! Or at least at the philosophy of care that I represent. 

Some families only begrudgingly accept hospices services. They've been informed by medical professionals that their loved one will no longer benefit from aggressive treatment. That there will be no more "getting better" or miraculous recoveries. They're able to intellectually process this information, but there's always something left gnawing at them. Some kind of a "what if". To them, accepting hospice care means giving up. To some people, just letting someone die is as good as killing them.

I sit at their kitchen table. All necessary phone calls and laptop entries have been made. Unless I get another emergency call, I am committed to staying here until the funeral home guys arrive. It's gonna be a looooong wait.