Hospice Blog

  • Word of God
    In Hebrews Chapter 4, looking at a familiar verse: “For the word of God is living and active. Sharper than any double-edged sword, it penetrates even to dividing soul and spirit, joints and marrow; it judges the thoughts and attitudes of the heart.” (vs. 12) The “logos” of God is so many things. It is […]
  • Psalm 23
    Don’t you find it interesting how at times, while reading familiar passages, a word will jump out at you? I have read the 23rd Psalm hundreds of times. My sweet grandmother Roxie even gave me a dollar when I was 10 to memorize it. To say it is familiar is an understatement! Yet, there it […]
  • Barefoot Visit
    I have been told that when treating delirium, you should look for reversible causes first.  In other words, before adding in lots of medication, try to see if a simple solution exists. One such reversible cause for delirium is hypoxia, or not getting enough oxygen to your brain. This can be a very simple thing […]
  • Without Work
    Frankie had worked as a barber in a small town for over 40 years.  It’s important to note that in a small town the barber shop has its own sub culture. Men of all ages, from all walks of life and socioeconomic status, enter on equal footing.  The barber with blades in hand, is ruler […]
  • Hard Things
    Families that take care of dying loved ones in their homes, go through such extraordinary things. We expect illness and dying to affect us physically, but often we don’t anticipate the loss of dignity. It is left to the family members to muddle through the hard things; helping a mother eat, helping a father button his […]
  • Absolution
    Faye had been dealt an over abundance of difficult things. When she was born, she was not wanted by her drug abusing mom, so her grandmother adopted her, but the seeds of being unwanted were planted. Faye got married and had children, then her husband didn’t want her and left. She eventually met her current […]
  • Were We Find Our Worth
    It’s in my nature to want to understand why some people take so long to die. Jenny was a middle aged woman who’s primary cancer had spread to her brain. This is always a big deal, but more so for Jenny who prided herself in being the caretaker of the family.  A wife, mother, and […]
  • A Good Death
    What is a good death anyway? The word in Greek for good is “eu” and the word for death is “thanatos”, so in Greek this becomes “euthanasia”.  But “eu” also means easy – thus, often people think of a good death being synonymous with an easy death.  Of course, in our current culture, that word […]
  • War Baggage
    There have been books and lectures written on veterans and the dying process.  I have witnessed a variety of cases.  The issue has to do with baggage left unprocessed. These are men and women who pushed down their experiences and suddenly on their death bed, the strength to suppress is gone and the issues come catapulting […]
  • Poignant Timing
    I have a slight fascination with the events leading up to the actual timing of someone’s death. Some may call this recall bias, in other words, I simply just remember the one’s that are unique giving me a false sense of the reality relating to the timing of death. This is likely true, but I […]
  • Mother’s Love
    This Valentine’s I am remembering Megan and the incredible love she had for her daughter. When I first met Megan I was extremely skeptical about her ability to care for her newly born daughter Lilly.  Megan, 17 and Todd, her boyfriend, also 17 had just brought Lily home from the hospital for the first time.  They had no home […]
  • Dilemmas with Pain
    I love being able to treat people’s pain without worrying too much about addiction.  This benefit of palliative medicine is certainly important especially in the pain phobic, escapist society we live in.  My patients usually won’t live long enough and/or have such very real pathology (i.e. cancer) that misuse of medications is quite low. This, however, doesn’t account for […]
  • Katie’s Choice
    I’ve seen prolonged dying many times. Usually there is a good explanation, the individual is young or has kids they don’t want to leave.  Sometimes it’s an unresolved conflict or an irrational fear of dying. Regardless of the reason, if a reason, the process becomes extremely tough on the family. One of the tougher ones […]
  • Night Visitor
    Blake’s mom had been sick since he was born. She was diagnosed with lung cancer right as he came into the world. She went through very aggressive therapy and unfortunately began having strokes as well. Each stroke seemed to take part of her person-hood. Her husband and parents would work tirelessly to help her regain […]
  • Admit Failure
    When I walked into Bill’s room all I knew was that he had a type of bone cancer diagnosed 3 years ago. He was in his 70’s and was not at the end of his disease by any means. Just based on his cancer and functional status, he probably had another year or so to […]
  • Suffering
    I think one of the harder things to do is watch someone suffer. I’m not sure if it’s because it causes us to suffer ourselves, or if it just brings up fears of ourselves being in that situation. Recently I had a patient with a complicated cancer. She was at our hospice house for an […]
  • Artificial Flowers
    Walking around work recently I noticed a sudden new addition of plastic flowers in some of the winter lorn gardens. They weren’t hard to miss, bright pink and yellow, they were planted in both pots and soil in this one particular area.  I thought to myself it was a bit uncharacteristic of our neatly manicured […]
  • No explanation
    I had one of those unable to be explained moments at work this week. We had just admitted a little baby. He was born with so many birth defects, that the doctors had told the family there was nothing to be offered.  There were problems with his brain, his eyes, his mouth, his heart, his […]
  • Healing
    When I first met Mr. R, who had just been told that his heart was so weak, that he’d likely die within weeks, and asked him who I could contact for a family meeting, he told me “no one”.  Of his 3 children, he was estranged from them all. I pitied him, he’d clearly chosen […]
  • No one should
    I interacted with an incredible kid recently at the House. Innocent and respectful, he was not intimidated by authority and extremely kind to all he encountered.  I think this interaction sums it up: when meeting him at hospice with his mom, who was dying with cancer, he interrupted my solemn conversation to ask if we had […]
  • Universal
    There’s much debate ongoing in the healthcare-for-all arena these days. I won’t weigh in politically, however, I’d like to share this story: Kathy had a terrible childhood. You’d expect this if you had to watch your mother die of cancer when you were 8 years old. Kathy and her brothers got even more bad news […]
  • Borderline
    If you have borderline personality disorder, please try really hard not to get an aggressive cancer.  The combination of the love/hate, push/pull personality doesn’t do well with the rapid changes that come from say, ovarian cancer or pancreas cancer. I recently took care of a woman in this situation. She’d opted not to pursue chemotherapy for […]
  • Birthdays & Anniversaries
    When anniversaries or birthdays approach someone who is dying, the tension in the room grows. It’s often one of the first things family members tell me, “You know her birthday is this Tuesday, you don’t think she’ll make it till then do you?” or “His son’s birthday is in a week, I hope he can […]
  • Choices
    It was a bittersweet moment. She received her acceptance letter to medical school the same week her pregnancy test read “positive”.  If there hadn’t been 2 previous miscarriages, perhaps there would have been no real decision. But, knowing that motherhood was in her blood, she boldly declined her spot. As the years went by, her […]
  • The Change
    I wonder when things change? At what age do we start using pills for pain? Oh sure, even with little ones we dose out Tylenol occasionally- but that’s usually for fevers and not primarily pain. When I child whimpers from a fall, or even cries out loudly with an “owie” we reach out our arms […]
  • The System
    The “system” always gets flak. But sometimes, like today, it actually does good. Candice is here dying of ovarian cancer.  Her one and only beloved son has been behind bars for much of her illness.  When Candice came to stay with us, and we knew her time was limited, a letter was sent asking permission […]
  • Reminder
    The chaplain was just finishing his prayer for the woman who had died. The family was huddled around the bed. Curled up in bed with her was the woman’s husband, staring at her face and mouth, reminding me of the way a new mother takes in every detail of her newborn from only inches away. […]
  • Confession
    I wish I could always claim altruism when taking care of dying patients. But the truth is, there are times other priorities in my life try to stake a claim in my work. This happened last week at work. I had met with a lovely family to discuss our plan for their loved one who […]
  • Toddlers
    I lead alot of family meetings for my job. This week, I felt like I was mediating a bunch of toddlers at one such meeting. The sad thing is the fighting had little to do with the actual health of my patient. The background: Mr Jones, 60’s, came into the hospital with bad emphysema. The […]
  • Jabba the Hutt
    One of my favorite lecture series all year is the “mystery and awe in medicine” talk. Very informally we sit around telling stories about the things we daily encounter that we can’t explain. It is very common for people to see deceased relatives in the last hours and days of life. Usually a comfort to […]
  • Gum Drops
    Every day she has bowls of candy in her room at the hospice place. There is always one filled with gum drops, but today there was one with pumpkin candies too. She’s not the typical hospice patient, although she came to us 2 months ago appearing to be on death’s door, she clearly is not. […]
  • Fingernails
    You really can’t take the mom out of anyone. I saw an example of this very clearly this week. We have a woman in her 30’s here with cervical cancer. It’s been one of the tougher things for me to come in each day and visit with her about her cancer and about her girls. Ellie […]
  • Bathing
    I’m constantly in awe of the little things hospice does to help families cope. Madame Olga was a true diva. A life long voice teacher, her two daughters’ sole purpose in life was to cater to their mother’s ego.  Madame Olga was well known and spent her life dedicated to her craft. She was still […]
  • Too Much
    Sometimes it’s better not knowing. I stumbled across an article in the paper today. What caught my eye was the picture of the 20ish person. “I know that face” I thought.  As I began to skim, reading about the youthful adventures and work life of this person my brain began to make the connection. A […]
  • Therapeutic Priviledge
    There is a phrase sometimes used in ethical discussions about patient’s rights called “Therapeutic Privilege”.  The connotations aren’t always positive. In fact, when I hear the word this is what I think of “I (the doctor or family) know more than you, therefore I have the privilege of deciding what you should know or not […]
  • Guppy Breathing
    There’s a type of breathing when people die called agonal respiration.  The best way to describe this is a deep, regular breathing that often involves movement of the jaw and shoulders.  The jaw movement is what I almost always notice.  If you think of it, normally when we breathe your jaw doesn’t move at all. This forward thrust of […]
  • Lament
    People express emotions in so many different ways. I’ve met a very fascinating person this week at the house.  He’s in his 80’s and is the husband of one of our patients.  The two of them had been living at home alone, never having had children. She had been getting jaundiced but neither one of […]
  • Who has the say?
    What do you do? She’s in her 20’s.  She’s battled sickle cell disease all her life, with a list of hospital stays that would fill a notebook.  In fact, she even had a baby while in the ICU. That’s right, hooked up to a vent, on blood pressure medicines; they did an emergency c-section last year in the […]
  • A Challenge
    There’s just something about feeding and children that is inseparable.  Or maybe it’s feeding and motherhood? Regardless  I had a case recently that’s been one of my more challenging ones personally. Max was born with a brain condition that didn’t allow him to interact with others.  He was blind and deaf, so as you may […]
  • Visions
    I’m always intrigued at the things people talk about and “see” as they get closer to death. Especially the things that are unexpected.  For instance: There’s a sweet elderly Jewish lady at the “house” with colon cancer.  She’s still very coherent, but isn’t eating much anymore, and can’t get out of bed.  This week when […]
  • Impossible Odds
    Manuel was born 12 weeks early to first time parents of a small town in my state.  The trauma from needing a ventilator with such underdeveloped lungs led to permanent lung damage that required a tracheotomy to be placed.  A ventilator is hooked up to this small hole in his neck at all times.  He […]
  • Tension
    I had a hour long drive to go visit a new home hospice patient.  She lives with her family in a very small town. I passed many farm fields covered with ice and snow to get to the town.  I found her street and recognized her home easily. I had already heard that this little […]
  • Prayer for Compassion
    My impression from my initial visit 2 months ago was the Mr. J had led a very hard life, had been in jail, had been homeless at one point and had extensive alcohol and drug use in the past. He now had metastatic lung cancer to his brain and I was making a follow up visit.  […]
  • More Drama
    I had a dramatic family meeting last night.  My patient, Yvonne, a young 40ish woman with metastatic breast cancer has been in our facility for pain management.  She’s getting ready to transition either back home or to a nursing home for the last weeks/months of her life. She’s had a tough time, her 3 teenage kids […]
  • Ignorance Bliss?
    Something to ponder.  As science advances, one of the things that will occur is the linking of cancers to choices. We know now all about the links of smoking, obesity, etc.  But, what if we’re able to pinpoint all cancer to a specific behavior? So what? Well, think of this.  Is it comforting to be […]
  • Rituals
    I heard a great story today that I’d like to retell: An elderly gentleman with dementia, living at a nursing hom e, started exhibiting some disturbing behavior. Before going to bed at night he’d shuffle up and down through the halls of the nursing home.  This particular place had pictures of all the residents outside […]
  • Story Board
    Finishing up a week at the “house”.  As I sit getting ready to leave for the weekend, I wonder who will still be here Monday.  Each room has such a unique story, with vibrant characters.  Room 1.  80 year old woman dying of heart failure.  Her well dressed husband is hard of hearing, a “talker” […]
  • Dying at Home
    Another one for the books. When I was on call this past weekend I was involved in an extubation of a younger guy; 23 years old and a gun shot wound in the back of his head. He’d been at our hospital for 3 weeks on a breathing machine, waiting to see if he’d become […]
  • Evil
    Tell me if this isn’t just evil. We have a 50ish patient with ALS (Lou Gehrig’s) disease. As his muscle’s have weakened with the disease, he’s been left unable to talk or move.  He’s a brilliant mind trapped in a body that doesn’t work.  His wife, however, is the one with the real problems.  We […]
  • Timing is Everything
    An interesting labor day weekend, as I worked all three days.  Yesterday was one of those, “Can’t believe this is happening” days. I worked in the hospice house and was taking care of a 70ish gentleman who had just been admitted the night before. He had metastatic prostate cancer and had been deteriorating rapidly at […]
  • Prisoner of his Home
    I’ve started home visits this month.  A little different pace than working in the hospital.  I like getting to come into people’s space.  Their homes tell so much about them. A little glimpse that most doctors don’t get into their patient’s lives. One of my encounters yesterday stands out, not because of the appearance of […]
  • Communication
    You never know what direction a palliative care consult may take.  Our team got involved with a 40ish man with a rare condition. He had Berger’s disease, which is a disease of blood vessels that can be very painful.  In fact his fingertips had auto amputated- basically died- leaving just the nail sticking out by […]
  • The Narrative
    Narrative in medicine is a huge part of the human struggle with disease.  Another way to say this is, our stories help us cope. A 70 ish hardworking farmer had a stroke at home and collapsed hitting his head and causing a bleed in his brain. He was rushed to our hospital and placed on […]
  • Chance to Say Goodbye
    We had a very messy family situation on Friday.  A 40 something man with HIV, Hep C causing liver failure and lymphoma in his brain had come into the hospital very sick.  For years he’s told his family that he wouldn’t want to be kept alive on machines.  He was so sick when he arrived […]
  • Visitors
    There are unexplained things that happen near death. Here’s a story from this past week.  A 40ish female had been in hospice dying of lung cancer. I’ve had a chance to talk with her everyday, and watch the slow process of dying.  She made it clear in the beginning that she didn’t believe in God, […]
  • Works VS Faith
    The chaplain that works at the House told me when I started that he can always tell when patients are brought up under a works based or faith based belief system.  I started paying attention to this myself, and noticed the trend. Often when patients think that what happens to them after they breathe their […]
  • The Cruise
    This is not the way you’d like the end to be.  A sweet elderly man with cancer had been living with his wife at home. She managed to arrange for him to be admitted to a rehab facility.  This in itself is silly- because rehabs are for people who have things you rehab from- like […]
  • Unquiet Mind
    I’ve never been so close to an unraveling human brain. A 70ish man had collapsed after having a bleed in his brain. He’d had other complications in the hospital including a seizure and respiratory failure.  We met him when he was already on the breathing machine. Unfortunately, even with no medicines to make him sleepy, […]
  • Prognostication
    There’s a word in palliative medicine we talked about this 1st week of orientation called prognostication. It’s especially important in this field.  Doctor’s make prognoses all the time-  we tell people in clinic when we expect their infection will respond to antibiotic treatment, or when their rash will leave.  We guess when broken bones will […]
  • Eve of Fellowship
    Well, I guess it’s time to be a little more regular at this-  And perfect timing, as I start my new training tomorrow.  That’s right, I am officially done with residency. I survived what most would say are the roughest years of a doctor’s career.  Does it feel good to be done?  Absolutely.  In fact, […]
  • Denial
    In psychology we learn about all of the ways people cope – sublimation, rationalization, reaction formation, etc.  I think the biggest one I see in clinic is denial. I am working with a surgeon this month who does a lot of breast biopsies and mastectomies.  He’d shown me a mammogram earlier of a woman with […]
  • Intro to Palliative Medicine
    This month I am doing something very different, and very rewarding.  Palliative medicine.  Most people get a glassy “What?” look to this term.  Palliative literally means “Relieving or soothing the symptoms of a disease or disorder without effecting a cure”  It is simply end of life care. Friday was my first day on this service […]
  • Personal Tragedy
    I’m now back on the inpatient side for a few weeks.  The stories I encounter are often hard to believe, if not tragic.  One case I can’t get out of my mind is a young man we saw recently.  25 years old and already with 4 very young children. He had been in Iraq for a […]
  • Closure
    Emotionally she was worn down. Just weeks earlier, and very unexpectedly, her father, who lived continents away had died. She made the trek to mourn, but being so far away missed the official funeral ceremonies.  She returned to the states to continue her duties as a resident in my residency program. It was evident she […]
  • Things to do
    I had a bit of a shock yesterday with one of my patients.  He is a 41 year old who had a very swollen left leg.  His upper thigh was tight, red and very painful.  Without my prompting he said he had noticed it was hard to breath the last few days.  The combination of […]
  • “Goodbye, Doc.”
    My colleague told me a great story today from her years of experience. An 80 year old spunky female patient of hers had made a sudden appointment to see her.  When Dr. C entered the room, this kind old lady let her know she had taken 3 different buses to get to her appointment.  “And why have […]
  • Cynicism in the ER
    You get pretty cynical when you work in large ER centers.  Intermixed with the real emergencies, comes a variety of complaints that belong simply with “Ask a Nurse”.  Instead, I am amazed at how long people wait to be seen (often 3-4 hours) to ask about a swollen lip, or a mild case of diarrhea.  It’s 2 in […]
  • Pain Vs. Harm
    There is one thing, I think most of us would agree is tough to deal with- pain.  Although in medicine we say it is the 5th vital sign, it remains largely a mystery.  What makes it so difficult is it’s subjective nature.  Doctors like objective findings; tests, numbers, X-rays.  When we must trust the experience […]
  • Stories
    If I had the time, I would read the stories of my patient’s lives. In the rush of a busy clinic day, it’s easy to forget the pages of events that make them who they are. One gentleman threw out a teaser last week. I just decided to take the time to enter in, and […]
  • Choices
    At 61 the swollen glands under her arm and knot in her breast were concerning.  She somehow ended up at a rheumatologist, who told her he thought she must have metastatic breast cancer. The lump kept growing, despite ignoring it.  Eventually she ended up in our clinic.  Mammograms were ordered confirming her fears – breast […]
  • Elevator Talk
    What type of personality talks to strangers in an elevator?  I take multiple elevator trips daily, and am always shocked when people talk to me.  “Boy this weather! Of course I have to pick up my sister at the airport at 5 tonight, of all days!”  I smile at the woman telling this to me […]
  • Guardianship Nightmare
    When I think back to my genetics class in high school, there is one disease process that still haunts me – Huntington’s Chorea;  A debilitating and progressive genetic disease that strikes in your mid 30’s – and usually causes death in 15 years.  The problem is that most people have had children  by the time […]
  • Uncomfortable Moments
    Sometimes there are uncomfortable moments we must overcome.  For instance… I was scheduled to do a “re” pap for one of my colleague’s patients. This in itself is awkward – who wants to come in a second time for a pap because the 1st doctor didn’t get a good sample ?!  The pressure’s now on […]
  • Dementia
    Have you ever wondered what it really must be like to loose your mind?  To open your eyes and look around, and it all be unfamiliar and new?  I was thinking about that today when we went to see one of our patients with Alzheimer’s. There she sat with her pearls around her neck, and a long […]
  • Secret Ballot
    Families handle dying in such different ways. Our family hasn’t had to deal with end of life decisions, so I can’t say how we’d do it.  Throughout residency, these family meetings deciding the future of the life of a loved one, have been the most fascinating. The intense emotions, the passionate pleas… I wish I could […]
  • Puzzle Solver
    I am back on the hospital side again for work.  This change really only amounts to longer hours and sicker patients.  It is rare in my job to really come across patients with mystery problems. I’d say 90% of the people who come into the hospital or clinic have names for their problems- they have heart […]
  • When we are Dying
    We recently had an Hispanic man on our service. He was 41 and came to the hospital feeling tired and weak, and had a hemoglobin of 4.6.  It’s a number that doesn’t mean much unless you are familiar with hemoglobin numbers. It’s a number for blood.  If the number is below 13 for men, he is […]
  • Thoughts on Death
    I wonder if we ever get used to death. I had a patient in the hospital on hospice…which means they are expected to die – they are ‘in the process’ of dying. From the moment he came in, he was basically unconscious and in no pain. It made me sad that the family wasn’t around much, and […]
  • Pacemaker Deactivation
    When you least expect it, some moral dilemma may strike in the wards. I have been taking care of a young 46-year-old man. He, unfortunately, has a very bad heart.  It only pumps at about 20%. This bad pump function causes fluid to back up into his lungs and legs, making anything strenuous just impossible.  He even […]
  • Doctor Definition
    I have been thinking a bit about the definition of a doctor.  If you look it up in the dictionary under physician you will find “healer”.  This is one of those words that I think we have applied added meaning to.  When I hear healer I think of one who cures, fixes, or rids the body of ailments.  Maybe […]
  • Hospital Ghosts
    The more time I spend in hospitals the more I start encountering the ghosts of patients treated.  I would guess most doctors, nurses, dietitians, etc would say they experience this phenomenon.  The rooms stay the same, but daily and weekly different souls come to inhabit these rooms.  It becomes their home, with me visiting THEIR space, sometimes […]