Hospice Care. —
A reader asked me what hospice means. To understand hospice, I need to discuss its purpose.
Hospice care is very specific to a terminal patient. It involves palliative or ‘comfort care’ for life-limiting illness rather than curative treatments. It involves professional medical care, advanced pain and symptom management, and emotional, spiritual and practical support based on the patient’s wishes and family’s needs. In Canada, the terms ‘palliative care’ and ‘hospice care’ are often used interchangeably. The word ‘hospice’ is sometimes used to refer to a home-like place where people spend the last days or weeks of life.
Anonymous asked: do you think the science of keeping people alive (treating, managing and curing conditions that would have previously lead to early death) is progressing at such a rate that it is harming society? do you think we, as the human race, have truly accepted death as a possibility when faced with disease? do you think it is easier to talk about death as a medical professional than it will be to face it when it comes to us? do you think you'll strive for treatment until the very end?
In the case of vaccinations and infectious diseases, we have done such an effective job over the last fifty years at eradicating disease that society has forgotten how much blood was shed over what is now a preventable illness. Sadly, it seems that vaccination rates are starting to lapse and poor antibiotic stewardship is leading to infections completely resistant to our antimicrobial agents. On this front, I feel that we have in some ways failed to do our due diligence as a culture and as a society. That is a whole topic unto itself.
Now that I am rotating through palliative medicine, the science and medicine of our care is sometimes overestimated by patients. It is often a mix of misunderstandings, unrealistic expectations, or a disconnect with the health care team.
What I do find to be the greatest barrier to true acceptance of death and the process of dying is society’s aversion of the subject. Often the first time people encounter death is through an affected family member or a friend. It generally comes as a surprise and a shock, and no one is sure how to cope or deal with it. It can be a very superficial experience unless you are directly affected; otherwise, it remains a nebulous and remote concept that is uncomfortable to talk about for most people until it begins to appear among their closest circle. I think if society was more open to talking about death and the process of dying, it can make everyone better informed and better equipped to support and come to grips with this kind of news.
Having said that, accepting our own mortality and impending death is difficult and will most likely continue to be a challenge for patients and health care providers alike.
Like many subjects, what treatments I pursue in my medical care depends on the context. At a young age with a reversible process, I would definitely consider all treatments. But if I am elderly with a terminal disease where the risks of therapy are greater than the benefits, then perhaps a more conservative, comfortable approach is more appropriate.
Where did he even get that font?!
Sometimes, a poorly legible note is only made worse when it is scanned into the computer. Detail is lost, the writing is faded, and what may have been semi-legible is completely incomprehensible. Welcome to first world medical problems.
When I was waiting for test results I tried to make up a description in my mind of the consequences of a bad outcome; for myself and then for my wife and my children. For myself it maybe is not too bad - straight to the grave - which is where we all go; even if we think it is too early whenever it comes to that. It is awful, it is difficult to get used to that thought - if you ever are able to…it would be worst for my wife…she is the one who has to take the blow.
When I heard of going to the cancer clinic, I began shivering all over my body. As soon as I opened the door here I felt the smell of the house of death. I can still feel this smell. The word cancer is loaded with fear, I think, and I know some persons who have died of cancer. A tumor is a tumor; uncontrolled cell division, something growing and attacking inner organs.
I react severely to the cytotoxic drugs. I feel so sick, and although I get other drugs to subdue the vomiting, the sick feeling is there, rocking my body all the way. I feel as if I am being run over by a steamroller - my whole body is reacting.
I remember when I woke up from the operation the surgeon told me they had found “islands of outgrowths” in the peritoneum, which was negative news. Something strange happened to me; all anaesthetics and all drugs disappeared from my body, my brain become crystal- clear and I thought: “How can I tell this to my wife? — An excerpt from Expressive Metaphors in Cancer Narratives by Carola Skott, PhD RN.
Anonymous asked: What's your opinion of the use of electric stimulation in the treatment of hemiplegic limbs post CVA?
While I appreciate your question, I cannot provide you with an answer. This question falls into the category of medical advice that I have emphasized on my ask box will not be answered. There are ethical and professional reasons why that statement is there. As a student, I am not allowed or have the expertise to give you an educated response to a medical question.
After finally answering all the questions sitting in my inbox, I am once again open for questions in time for the winter break. Please also be considerate of myself and others. I will try to answer your questions as soon as I can but there may be a delay in my response depending on how many questions I have received. Thanks again for your patience and understanding.
Tom of the Medical State of Mind
Please do everything. I do not want to die. I am not ready. — A patient in terminal condition reaffirms her wish for full therapy instead of comfort measures only.