Fun-filled Funereal Facts

The "E-Kit"


My hospice, like many others, supplies all patients/caregivers with an Emergency Kit, or "E-kit". Ideally, the E-kit is meant to be stored in a common place in all households (for us, in the fridge) so that, if needed, it can be easily found. Also, ideally, caregivers should not open the kit and use its contents unless instructed to do so by a nurse.

These are the contents of our E-kit:

• A small bottle of liquid morphine (Roxanol) for fast relief from pain. The liquid form of oxycodone (Oxyfast) is substituted in the event of a morphine allergy.
• Promethazine (Phenergan) tablets for nausea/vomiting.
• Prochlorperazine (Compazine) suppositories for nausea/vomiting. These are used if the patient is unable to swallow or "keep a pill down" due to severe nausea.
• Acetominophine (Tylenol) suppositories for fever control.
• Lorazapam (Ativan) tablets for anxiety/agitation.
• Atropine eye drops. Although an ophthalmic solution, these drops are placed under the tongue (sublingually) to help control excessive secretions... in other words, the dreaded "death rattle".

Unfortunately, my hospice is less than perfect when it comes to educating our clients about the E-kit. All too often the package is opened by the caregiver and the contents are scattered about the house. There's also the, thankfully rare, caregiver that is happily putting atropine drops into the patient's eyes thinking that they are for the purpose of relieving itchy, dry eyes!

The E-kit is an invaluable tool for the caregiver to have on hand. However, it can be rendered useless or become even dangerous without education about its use and purpose. I've informed caregivers about the E-kit many times... it's literally no more than a five minute exercise. So why are we failing at this? I've brought my concerns to the attention of the hospice director. Soon, hopefully, there will never again be a 2 AM phone call that goes something like this...

Caregiver: "Dad is in so much pain and his nerves are just making it worse. I just can't seem to help him!"

Me: "Okay, I want you to go to the fridge and take out your e-kit."

Caregiver: "What's that?"

Palliative Care Grand Rounds

The next PCGR will be held at Thaddeus Pope's Medical Futility Blog. Please send your submissions and/or suggestions to tmpope (at) widener (dot) com. by noon Tuesday, May 5th. Palliative Care Grand Rounds will be published on Wednesday, May 6th.

Thank you for hosting, Mr. Pope!

Anatomy Lesson With Dr. Steve Brule

All right everyone! Gather up the kiddies and forcibly sit them in front of your laptop. It's time for an anatomy lesson with Dr. Steve Brule. YAY!!



And now you know where teeth come from.

Doctors in the Poor House

by Insurance Guru

I was reading some letters to the Editor in a recent AARP magazine. Hey, it's my Dad's. Really! The letters were discussing "Disappearing Doctors" and laid the blame at the feet of Medicare reimbursement and byzantine insurance rules. Boy, that makes me cranky. Yes, I know about rising malpractice insurance, increased office costs, lower reimbursements, rules, regulations, paper work, etc, etc, etc...

What I don't understand is why these letter writers believe their profession should be immune to the life the rest of us are facing. I'm an average Jane out here in the world trying to get by. I face rising insurance rates, stagnant paychecks, increased costs, rules, regulations and paper work. I'm still trying to get it all together for the tax man.

Being in the Insurance Industry, I get daily e-mails telling me how to "Increase My Medical Office Accounts Receivables!" or "Avoid OIG Billing Audits!" or "Best Billing Practices for Diabetic Patients!". The subjects and e-mails are endless. There is an entire industry out there that is devoted to "show me the money" for physicians. Add to that the American Medical Association which has a yearly 18 million dollar budget to lobby Capitol Hill. That's just one group, there's another for Chiropractors, Hospitals and on and on.

I guess a lot of physicians aren't just like me. I drive a 2004 Ford, live in a small house, my kids go to public schools and we shop at Wal-mart and Target with coupons. In order to further economize, I got rid of the cable movie channels, magazine subscriptions and weekday newspaper. I take care of my own yard, house repairs and dog grooming. My 401K plan now literally means 401 dollars. I haven't checked yet, but I don't think there's a lobbyist out there on my behalf.

Physicians are highly trained and a valued part of our communities, but it can't be just about the cash and status. If it is, than maybe we are better off without the physicians that have chosen to leave. I want my doctor to want to help me and is willing to work as hard as the rest of us to pay the bills by doing the best we can with what we have.

In Defiance of Death...How Far Will We Go?

I was very inspired by Jessica Knapp's post, Cryonics. In this piece, Jessica points us to a fascinating episode of This American Life that deals with the screw-ups and very shaky ethics of cryonics enthusiast, Bob Nelson. It is, indeed, a "must listen"!

Having little faith in the success of cryonics, I couldn't help but think about the Futurama episode, Put Your Head on My Shoulder. Which, in turn, started me on a search regarding the subject of head transplants and grafts. I didn't have to look far... and what I found was not the least bit funny...

1950's Vladimir Demikhov's dog grafting (Warning: not easy to watch)



Kentaro Mori's blog, Forgetomori, covered the topic very well in his April 12th post, A Head (or body) Transplant for Stephen Hawking. His article includes an excellent seven-part documentary about neurosurgeon Robert White. Dr. White, famous (and infamous) for his extensive, successful experimentation with monkeys, sincerely believes that we are now ready for the first human, total body transplant and would love it if Dr. Hawking would be the first in line for the procedure.

Here's a clip, from 1970, of Dr. White at work...




I must remind you, that anyone out there that feels that this is the next great thing for quadriplegics... well, you're wrong. With current technology, the spinal cord remains "unconnectable". In my opinion, Stephen Hawking, with all of his state-of-the-art "tech support" and superb medical care, should remain just as he is.

Not much help for Captain Pike, either.

There are no words to sufficiently describe my amazement and horror upon discovering the magnitude of the human will to defy death and infirmity. Just how far will we go?

Happy National Healthcare Decisions Day!

Thursday, April 16th is National Healthcare Decisions Day. So as mature, rational adults, sit yourselves down and get your end-of-life act together. You know how much it pisses me off when no one knows what funeral home to call!

My Aching Knee

by Insurance Guru

The planets aligned, the Angels sang and my knee surgery happened! All those things seriously had to happen first. I have never had to work so hard to get 30 minutes of surgery.

Two years ago, I had the same exact procedure done to the other knee. A couple of X-rays, an MRI, an ortho appointment, a couple of phone calls and boom... done deal. Then it was a couple of post-op days on pain pills, a post-op visit a few weeks later and on with my life.

This time around it has taken me 7 months of calls, visits, calls and more calls to get this done. Even when the paperwork was going where it was supposed to, I still needed a pre-op physical, labs, CXR, & EKG... that equals four more appointments. I just had a physical last August (with lab and CXR). Another pre-op visit to make sure my crutches were sized and another visit to discuss the surgery. It's a flap of knee cartiledge people... not a liver transplant. I wasn't even under general anesthesia.

24 hours before the surgery, my surgeon's office called to say my PCP had not faxed over all the pre-op paperwork and they needed it in the next 45 minutes or we would need to reschedule. Perfect.

I drive to my PCP's office and tell them I will hand carry the paperwork to the surgeon. I was informed in very haughty tones that they were taking care of it and would fax them over. In haughty-to-infinity tones I told them I wasn't leaving until this was resolved. It became a bit of a shouting match once they informed me my EKG results weren't there, I merely pointed out that they couldn't have been working on it if they just now realized that.

Well, the surgery happened, I think the knee is fixed. Although, for a simple bit of cartilage removal, I have a leg that is black and blue from the knee down. Were there some helper gorillas in there? Was I leg wrestling in my sleep? I dunno, but my lesson in all of this is beware the office staff.

Your Moment of Awwwww...

L.E.D. Sheep





Panda Impostor

Enema Addict Meets Enema Enabler

Image via Wikipedia

(Warning: Unless you are a hard-core, hands-on, health professional, you may not want to read this while eating your lunch.)

I was having one of those "theme nights". The patients were providing a veritable potpourri of gastro-intestinal delights. Nausea and vomiting, intractable diarrhea and constipation...

Now constipation is rarely considered an occasion for an emergency home visit, but in this case I was compelled to go. Willard was insisting on getting an enema now and his caregivers at the assisted living facility were not allowed to administer enemas (lucky shits...my apologies, I couldn't resist). It was either take care of the situation or Willard would be making a trip to the hospital. I had to set aside my suspicion that the patient was stereotypically "bowel obsessed" and accept that he was truly in distress.

After purchasing a couple Fleet, disposable enemas at a nearby Walgreen's I made my way on over to Willard's poorly lit, tiny apartment in the assisted living...

You can get a twin-pak of these for less than 3 bucks! Who knew?

Well, the results from the procedure were truly disappointing. My puppy has produced far more impressive turdage. However, Willard was happy and that's all I needed to know. I helped him with the post-enema clean-up and went into his bathroom to wash my hands and leave the spare Fleet enema there for future emergencies. That's when I first took a good look at my surroundings...

The bathroom shelves and cupboards were filled with disposable enemas! When I returned to the living area, I then noticed that every shelf and bookcase in the room was bursting with boxes of enemas. Oh my God! Willard is enema dependent and I'm an enema enabler! Fine, Willard... I'm taking my extra Fleet enema home with me. That'll show you!

Two days later, Willard called "911" for "intolerable constipation". Poor fellow...

PCGR: Scene 1, Take 3

Palliative Care Grand Rounds is up at Jessica Knapp's site, The Good Death. Please take some time to peruse all the great blog posts for this month.

Great job, Jessica!