Tuesday, August 19, 2008

On death & dying...hospice care

On Monday, I had a good introduction on hospice care at a hospice non-profit company. btw, hospice care is paid for by Medicare. They showed me a 50 minute video called "Pioneers of Hospice" which included the people who started hospice care, hence the title.
Then I visited a young cancer patient (40s) who was diagnosed with stage 4 lung cancer. His major complaint was pain which can be 8/10 often times. He was concerned about a new pain in his side and wanted to know what was causing it, but didn't want to hear the answer "it's because of the cancer." Once a patient enters hospice, we do as much as possible to help relieve pain so that quality of life is improved. We'd give morphine, methadone, etc.
Later that afternoon in family clinic, I saw a patient in her early 50s (which I don't normally see since I'm seeing only geriatrics, but the doctor didn't realize it 'til later.). Her chief complaint were these two huge knot at the tops of her shoulder with muscle tightness and tension headache in the back of her head. The precipitating factor: when her son brings up topics like funeral arrangements. We're treating her with a muscle relaxant and trazodone. But the patient's biggest concern was her son, age 27 with history of 2 strokes and now colon cancer. No one else in the family has cancer. All of his siblings are healthy. He's undergoing chemo now, but there isn't much left that can be done medically. Although, the son has accepted that he doesn't have long to live, the patient (mom) really doesn't want to lose him. The patient says that if you looked at him, you would never think he had cancer. He still plays basketball with friends. But he does limp on his right side because of the stroke.
I haven't really dealt with death personally. Both sides of my grandparents have passed away when I was a teenager, but I only knew one set pretty well when I was a young child. I don't remember them much, so I didn't really grieve.

After clinic, I decided today was a good day to stop procrastinating and start the ethics assignment. It was, after all, about "expressing your feelings" about death of a patient in one of the sample cases. btw, I never enjoyed ethics. I didn't mind listening to interesting cases. But as far as putting in input on what I thought, I was usually a complete blank. I'm not even sure if I completed the assignment correctly, but just tried to follow the instructions as best as I could.

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