Is it time for Hospice?

A couple of months ago I had an end of life conversation with someone regarding their relative who is in their 80’s and terminally ill.  This relative had a recurrence of cancer and now the family was wondering if it was time for hospice.

While almost finished with a round of palliative radiation,  things had taken quite a turn; this person was now resistant to food and fluids, didn’t want to take medications, was very confused, incontinent and weak.  Yes, it’s time.  It was time several months ago (except for the palliative radiation treatments).

As a home hospice RN case manager, I have made initial visits to patients who were actively dying (admitted to hospice the night before after leaving the oncologist’s office), AND who still had an appointment on the books with their oncologist for the following week.  If our healthcare providers cannot initiate candid conversations regarding end of life, it is up to us as family members and our society to normalize those conversations.  These kinds of disservices to patients and families do nothing except promote the myth that hospice is for the last three days of your life, and hospice is going to start “the morphine.”  Well, when I get a new admit that is actively dying and their respirations are 30, you can bet I’m going to start “the morphine” (or oxycodone, or dilaudid…whatever they have available).

Sometimes it is the patients or family members that are waiting for their miracle and they don’t want their provider telling them “I’m sorry, there is nothing more we can do.” They want to try every possible treatment available.  They just want their loved one healed.  Sometimes that healing comes in a different form that what they are wanting.  They want their loved one healed from this pain, nausea, diarrhea, shortness of breath, wounds, weakness, from being poked and prodded, from having to go to hundreds of appointments, from whatever is taking the life out of their loved one.

If we can somehow  get those patients three to six months prior to actively dying, there is so much that hospice can do.  Not just symptom management, but putting the pieces together for the family as to the course of this illness/disease that is occurring and what is coming next.  In hospice, we don’t do anything to shorten or lengthen the natural life.  The education, support and comfort hospice can offer as one nears the end of their natural life can be invaluable.  We need to normalize death as a part of living once again, but we also need more than three days to properly serve the patient and family.

 

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