Saturday, February 7, 2009

Parents, Death, and Hospice

During the course of life, one encounters many obstacles, trials, tribulations. The last year has brought to me a good deal of change, the most notable being the deaths of my parents, just six months apart; the comedian Alan King would understand that mom died first.

The importance of hospice to this story is significant, and readers will find a wealth of perspective on the nature of hospice, and particularly the effects of hospice care upon caregivers.

Helping Mom to Die

The hardest part of hospice was visiting the pharmacy, in full knowledge of my purpose; to by the drugs with which to kill my mother. Morphine sulphate, it is, and they give you lots of it.
Well, that, and the coup-de-gras, Haloperidol.

The last dose came at midnight, May 24, when I was able to get mom to wake one last time, look at me knowingly, recognising that I needed her help, to get her to swallow, ensuring she would have no more pain.

Sure, everybody in the business (and the courts) call it palliative care, as if the name has some kind of magic to it, so that all things are right. They are not right, as I shall demonstrate.

I visited mom in hospital 14 days before her death, at the Kaiser Permanente hospital located in or about Anaheim Hills, California. Characteristic of her wry humor, mom replied to my question about her condition: "Well, I have some good news, and I have some bad news." The good news was that she did not have pneumonia. The bad news is that mom had stage four small cell lung cancer.

Within a few days, arrangements for home-care hospice were complete, and it was time for mom to move from hospital to home. It is at this time that the first prescription of morphine is filled.

Here is where the first blow was struck by Kaiser Permanente.

During mom's hospital stay, she received intravenous morphine. This was due to mom having lost the ability to swallow. When I visited the hospital pharmacy in Anaheim Hills, I was given solid morphine, pills as it were. When I mentioned to the pharmacist that my mother could not swallow, the pharmacist replied that I should use a pill-crusher, dissolve the solid in water, and use an needle-less syringe to administer, and that my mother could swallow the solution.

Fine. I am not a medical practitioner, so perhaps their is some detail that I do not understand, and so I gave it a try. It never worked well, and became a big problem at the end, to use this method to orally administer morphine. No alternative was ever offered.

Morphine was supplemented by lorazepam, used to control anxiety, and at the end, haloperidol (which was supplied in an amount apparently sufficient to kill a herd of buffalo - I gave my mother a minuscule portion from the supply).

So, on a rigid schedule, pills are crushed and dissolved and the liquor is transferred to patient mouth with blunt-nipple syringe. The patient, unable to swallow, simply chokes the liquor down. What could be more pleasant, for patient or caregiver?

A Visit With Dad

During his second hospital stay, about November 17-23, we enjoyed a visit from a physician, and there ensued a discussion of Hospice. Basically, the doctor had come to tell dad that there was very little to be done; that he might like to just go home and smoke a cigarette.

I mentioned to the doctor the experience I'd had with mom, how in the hospital it seemed perfectly proper to use intravenous injection, especially given that mom had great difficulty swallowing, but that when sent home, she was sent with pills of size more suitable to a suppository than an item to be taken by mouth. "Why," I asked, "was mom not sent home with the catheter in place, and me with a supply of injectible morphine? After all, I do have a science education, and can easily measure small (milliliter size) volumes with a syringe. Here is the evasion I obtained:

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