I have posted on here many times and answered questions every now and then. Dad passed away Oct 7th 2013 from Liver Cancer . He was in a hospice facility for 11 days until he died. The day before he was admitted he was in the hospital and was talking,eating and very clear headed but his ammonia levels were high and he had been very combative, not eating and wouldn't take his meds for 4 days at his nursing home. ( He was in for a Psych Evaluation.) The hospice worker talked to me about admitting him instead of returning to the nursing home. I agreed to this and arrangements were made. He was transferred later that day and was alert and in good spirits. The next morning he was unresponsive and stayed that way until he passed. They gave him morphine and ativan around the clock. He never got any water but they did cleanse his mouth and moisten it with swabs. It seemed like he could hear me the first few days because I would shake his shoulder and say "dad". His eyes seemed to be moving under his eyelids and his mouth would move slightly. I did ask about them lowering his dosages so he could wake up a little. The nurse said he was getting a very small dosage already. I just wonder if the drugs made him unresponsive and if less was used he could have ate and drank and lived longer. I know it was time for him to go but I'm kinda puzzled about his going from complete alertness and straight into unresponsiveness so quick. The nurses did a Great job. I myself don't know how they do it. They treated dad like he was their baby. So gentle and compassionate. I was just wondering if anyone else had the feeling that death felt a little rushed once their loved one was placed in Hospice.
I just had a patient on Saturday and Sunday with terminal lung cancer. I knew death would be within a day or two. Her partner had witnessed parents dying in agony without medications and told me her partner WOULD NOT suffer any pain during her death! I was in constant contact with the patient during my 2 eight hour shifts and quickly medicated her when she told me she had pain. Patients also get very restless during the final hours, (maybe they 'sense' death is coming), so I gave her medication for anxiety also. It's common to have excess throat secretions (death rattle), so I gave her meds to dry that up, to make her more comfortable. Her partner had me call the doctor because she was still slightly agitated. I got an order for more anxiety med and an increase in the pain meds, if needed. I could tell that she had only a few hours left, as she was changing her breathing pattern. You might think that the meds did that, but it happens when there are NO meds given too. I've seen a lot of people die in 37 years and that's just how it is. So, to all of you who STILL think we kill our patients, DON'T sign your loved ones up with hospice and YOU manage their pain, anxiety and secretions yourselves. My patients partner will never forget the agonizing deaths of her parents, (Your situation in reverse).
Doctor does state this. He/she has "freedom" as well,since once in Hospice, his/her services are no longer needed, and the patient and/or the patient's family won't see her/him again, unless they are there to witness the passing of the patient.
I know this from personal experience. Since, the doctor that treated my mom, was not at her bedside when she passed, his nurse practitioner was there instead.
I know we all tend to go through the what ifs. I did when my Dad passed last month... all the if only I did this or that. In reality, nothing would have changed.
One has to remember it is the doctor at the hospital that diagnoses that there isn't anything more medically one can do to help a patient to improve. Thus the doctor will recommend Hospice so that the patient can transition with very little or no pain. Hospice doesn't speed up the passing, just makes it comfortable for the patient.
You might notice a rally with your Mom, the patient will start talking, ask to eat, will be alert.... vast majority of the time this rally only last for a day or two. My Mom and my Dad did the same thing. My Dad was sitting up in his recliner, watching TV, reading the newspaper, trying to eat a bit.... and the next day he was gone :(
Decades ago, some surgeries required the patient to stay for a week in the hospital. Today those very same surgeries are out-patient, meaning less than 24 hour stay in the hospital.
Don't forget, many of our elders will tell us they are fine, that they are in no pain, as they don't want us to worry, yet they are in some type of pain.
Both my parents went through Hospice, medically there wasn't anything more that modern science could do to cure the situation. I was glad both my parents had peaceful deaths, dying in their sleep.
I'm not sure which route to take and I feel for everyone else in this same situation. It's a difficult decision and experience. Also, shame on the people that verbally abuse someone for their questions in this forum. We're all doing the best we can, this should be a safe environment.
Comfortable but comatose. Comatose I said? Yes we have her on drugs for the pain. What pain I said my mother had no pain. Oh well, heavy breathing as she is close to death, it can be hard on them. I received a call a few hours later. Mother was dead.
Oh why won't they just kill the whole thread.
What "bean counter" was involved? It sounds as though your sisters, with whom you don't get along, had PoA for your father. Was your father able to participate in the discussion about hospice? In general, patients themselves need to sign off on the hospice decision.
Doctors need to certify that a patient, untreated for an incurable disease, has a projected life span of 6 months or less. Some folks die soon after entering hospice because they've waited until the very end of an illness to sign on. Others improve on hospice and "graduate"; they become ineligible because they improve.
I'm sorry that you don't accept the fact that your dad had a terminal illness, and that your defense against your grief is to lash out at your sisters and the hospice that cared for him. Unmedicated death from lung cancer is a terrible thing. Perhaps having your dying parents at home was simply not feasible. Please look a little more dispassionately at your dad's end of life desires, and get some help with doing the necessary grief work.
My FIL was admitted to A Hospice, as in the organisation with its own building, though. He had oesophageal cancer, non-operable, and had been discharged from hospital. He was in his late eighties, had had serious heart disease for many years, was diagnosed with MS at about 80, and had already rejected the option of chemotherapy to prolong his life.
Had he been returned home for care, he would have been under pressure 24/7 from family members to reconsider his decision. Two of them found it impossible to accept that he could not endure further treatment; and their constant distress would have given him no peace at all.
I think there are people for whom the seclusion of a good hospice is vital in helping them accept and prepare for their own end. Others will need the security of their own home. The only thing I can't think of is what sort of person would want to be in hospital; and yet until hospice services are more widely available that will continue to be where the majority end up, like it or not.