7/2/10

12 on and where's that weekend?

twelve days on is too many in a row for any job.
my job is a particularly draining one and at the end of this run, i am ready for a break.

i havent written much about my job since getting hired, as the blog has really morphed into a place of refuge for me. a place to put up photos of goings-on here in the largest state in the union.
i hope someday it will serve as a great journal for jade who will likely forget all about eagles, moose, bear and vast views.

today i am compelled to write a bit about the phone call that came from a man who's father would die while under the care of my service.

the patient was elderly and frail and died quickly and peacefully.
he was free of pain and anxiety.

his son flew in from away as his father slipped into unconsciousness.
his wife, a medical professional, was kind and honest, recognizing her father in law would not want aggressive, life-prolonging treatment.
his son was abrupt and suspicious upon meeting me.
he demanded to speak with the physician.
after calmly explaining it was the physician who has sent me because of the expertise my service offered, he began to listen.

his sister wondered out loud if i was part of obamacare.

(thanks palin for making my already emotionally draining profession something now viewed with fear and hate. its incredibly helpful to me, my patients and their families.)

despite our rocky start i returned again and again to the room to assure them, to adjust medications and to answer questions. when the sister again tried to bait me with mention of obamacare and death panels i looked her square in the eye and calmly stated; " i will not engage with you" and moved on to address questions about breathing patterns and fever.

this time, i could see the son wince when his sister went after me. i (remarkably) stayed even and calm, knowing i was providing essential information and support to all of them despite hostility and fear.

the patient died peacefully with all three family members present a short while later.

today there was a message from the son on our answering machine in the office.
i was hesitant to call back, but i did.

i was so grateful to receive a heart felt thank you from this son, and more importantly, an acknowledgement that my job must be difficult.
he expressed that guiding families through a process most are unfamiliar with seemed natural for me and it put them at ease. he also said that to face families who are scared and grieving was viewed as grace under considerable pressure.

my professional life is incredibly gratefying.
my time away from it is as well.

heres to a wonderfully long weekend.

this article came out earlier this week.
take some time to read it and let me know what you think.
http://news.yahoo.com/s/ap/20100628/ap_on_he_me/us_med_overtreated_final_days_7

7 comments:

Views from Malmesbury said...

My cousin had cancer; incurable by the time it was diagosed; given a year to live without treatment, which could only prolong life not cure it. She was expected to have a slow deterioration until shortly before the end. She chose not to have treatment on the basis she could be in a hospice near home when she needed it. She was married without children and lucky enough to have a terminal illness insurance, paying out on diagnosis rather than death. Her husband agreed she should use the money as she wished and her employers gave her early retirement. She spent the next year LIVING - a story in itself. Sadly, at the end, there were no places available at the local hospice and she had to go 25 miles away, which made it hard for a lot of people to visit her - but it was her choice not to stay at home. A friend had terminal brain cancer, wife and grown up children. He chose treatment at first as his family could not accept the situation but stopped after two completed treatments showed no improvement. He died at home surrounded by his family. My uncle had stomach cancer in his 70's, wife, children, grandchildren and a just-born great-grandson. He was gone within 6 weeks of diagnosis; the last week in a local hospice surrounded by friends and family as he did not want his wife to live without him in a place he had died. Another friend with brain cancer, this time with wife, and two young children fought desperately for live, investigating treatments, travelling to the US in search of new or unusual cures. In the end he spurned all drugs other than pain-killers and died peacefully at home surrounded by family. They all had something in common, their time was made more bearable and dignified by care from the Marie Curie cancer nurses - they and their family had nothing but praise for the nurses. My 96 year old step-grandmother saw doctors try and leave her sister without water at the end. She made them continue and told me that when her time comes she doesn't want any exceptional measures like re-starting her heart but definitely doesn't want to die through starvation or de-hydration. My point is, and having read the article, understanding the situation and having choices is most important. None of us should be made to feel we have to have treatment over quality of life and doctors shouldn't be pressured into prolonging life because of fear of the consequences if they give other options. And lastly, if you are one of those who brings comfort and ease of mind to those who are dying and their familes - you are a wonderful person in great profession - I know I wouldn't have the strength for it.

Views from Malmesbury said...

Apologies to all concerned, I dind't mean Marie Curie, I meant the Macmillan nurses. For some reason I persist on getting the two names confused - sorry!

alaskagrrrL said...

Kudos for having the grace to give compassionate care to those who needed it, and letting go of the craziness that wanted to hook you into some dead end storyline...this work is the most meaningful and challenging kind, isn't it? No wonder we need a beer and a dance every week or so, eh? Happy 4th to you, Jeff and Jaden!

Views from Malmesbury said...

May I ask, what's 'obamacare'?

Karen Travels said...

I will be honest, in the past, when I heard people say they were not going to fight cancer anymore, I was the typical America with the "WHY WOULD YOU GIVE UP???" attitude. Obviously I know very little about the treatment of cancer, and I thank you for sharing this article because it is a real eye opener. I don't know where my mother's cancer is heading...and she has yet to require any treatment other than staying as healthy as possible (she eats a practically no sodium diet and now takes yoga). It is good to know this information. That eventually the treatment can be worse than the disease. Ick.

p.s. I am glad you have found your place in your profession! YOU ROCK!!

akfnp said...

Thank you Malmesbury for the thoughtful comment. The palliative care movement here is still somewhat in its infancy, and it is indeed about informed choices instead of being led blindly by fear. We Americans are somewhat ignorant when it comes to discussing end-of-life decisions and hang on to life even when futility is staring us in the face. I am grateful to be a part of such meaningful work.
As to your question, in short, President Obama has helped to lead the much needed change in our health care system. (now dubbed Obamacare by its opponents). Our system is BEYOND broken and is bankrupting our country. There is, however, much debate as to whether all Americans are entitled to healthcare at all, which befuddles me. There are millions without it. During his campaign the (IGNORANT) and ill informed Sarah Palin charged that if Obama ushered through health care reform he would bring in "death panels" to discuss such meaningful topics as advanced directives and end-of life care planning, and advise "killing off" the elderly. (God forbid we should actually discuss such choices before we are hooked up to ventilators, brain dead and unable to make them) You on the other side of the pond are light years ahead when it comes to accepting death and allowing death as a natural part of life. We can do a lot of things TO people. There always comes a time when we ought to reflect on what we do FOR them instead.
Cheers!

Views from Malmesbury said...

Thanks for the explanation and I wish you all luck with getting a good system up and running