Mondays Morbid Missives

• I could walk into any families life at the point of a family members death and be able to give you a pretty accurate picture of that persons spiritual life based on the reaction of their family at the point of his death.



• Two thoughts occurred to me after my last patient expired: 1) What a relief it can be for the family when they are finally gone- I mean a palpable, visible and total relief- a release even. 2) When a big, physically and imposing in demeanor person is sad and really lets go and sobs why does the situation always seem so much more sad?



• I slept for 15 hours straight after that case.



• Apparent deep sleep doesn't necessarily indicate comfort in the terminal patient- in fact the person who appears in a deep sleep may be in agony and sleep an attempt of an overwhelmed brain to give a patient some relief. Look instead at the persons expression: do they look peaceful or is there a pinched or grimaced look? Are their blood pressure and pulse elevated way above normal? Certain conditions are inherently terribly painful and frequently under medicated, a few that come to mind are, bone, stomach, pancreas and liver cancer. Is the person cold and clammy? Are they irritable when awakened? Have they turned their heads away and/or covered their faces?



• A recent patient who seemed to be "sleeping an awful lot' according to family and exhibiting some other symptoms made me think they were agony and not being properly medicated. After some convincing, the family allowed me to treat the patient with morphine. Not only was her overwhelming pain relieved but, due to morphines mechanism of action the breathing trouble she had been experiencing due to her failing heart was relieved and within 24 hours of starting continuous care she was up and about with assistance, eating well and in fact was decertified from continuous care and placed on routine care.



• When I commit to a family to stay with their loved one to the end it's like an uplifting beating. Does that make sense? I feel so good but, so much pressure.



• There are varying qualities of nurses in hospice just like any other nursing (or any profession) but, I really feel all in all hospice nurses are a cut above any other. In this vein this last patient and his family were very lucky (blessed?) to consistently have the best nurses I've ever encountered every day and shift from case managers to the night shift nurse who stepped up for one single night to provide coverage.



• I like to hear,"He would have loved to have known you." regarding patients whom I know I would have liked to meet when they were healthy.



• When providing foods for the family of a dying or dead person and wondering what to send you could do a lot worse than to send desserts and coffee or other caffeinated drinks. Both are very good to help sad folks feel better and inspire conversation and openness.



• Smells are very important to address as a person is dying for several reasons. When a person is emotional smells get locked into the brain and associated with memories and this can be used to advantage. If the dying is clean, comfortable, well presented and with a little of a nice cologne and maybe a scented candle in the room, as those left behind encounter these smells afterward throughout their life they will have good memories of the person who died.



• I use these thoughts when I lay them out here for simple expression, to get things off my chest and maybe teach a little. I hope I'm never seen as fishing for compliments.
• If you have a loved one who even just might be dying related to old age or a normally terminal illness I cannot stress with you enough how much it will help to request a hospice consult. The consult doesn't mean they will necessarily enter hospice services but, you'll be surprised how much the information you can gather may help. A fresh set of eyes and thought processes can help adjust medicines, recommend therapies etc. that will improve their lives no matter what.



• It means a lot when I care for a patient who is local although, I've still yet to care for anyone I've known personally.



• I get requested personally by friends and family of previous patients and of course by nurses I've met in facilities as they lose family members, however I've been requested recently by name through my agency by people whom I've not encountered as far as I know- they've just heard of me. That's both complimentary and a little unnerving.



• A mother and daughter relatives of a lady I recently cared for are going to go to nursing school (I think) together as a result of our interaction, my suggestion, encouragement and education of how they could make it work.



• Two more lives I've ruined.