Today was a first for me. For the first time in my short career I admitted three patients to Hospice. I have admitted dozens of patients to them over the years but never three in one day. The word ‘Hospice’ can evoke different feelings for different people, and today each patient evoked a different feeling for me.
Big Heart
The morning began with rounding in the hospital. This is where the word Hospice evoked a feeling of failure for me. I have been treating a women for almost seven years now. She was one of the first patients I began to see as an intern in residency. Over the years she has had multiple health issues but at this time her COPD had finally won. This patient who we will call Mrs. BH for (Big Heart) has at times put her health to the back burner to take care of her daughter who has down syndrome. Mrs. BH told me today that she was done and just wanted to go home. The problem was that I wasn’t done…I wasn’t ready for her to go home. I wanted to save Mrs BH. I could keep her in the hospital, continue IV medications and even help her breathe if she needed it. However, her soul was done fighting.
As her name states, Mrs. BH’s biggest concern was her daughter. She had me promise to her that I would take care of her and watch over her when Mrs. BH was no longer here on earth. I found myself writing the order for Hospice and thinking Mrs BH must not understand. I am usually a big advocate for hospital at home situations and moving patients to Hospice when they are ready. But for the first time, the patient was ready before the doctor. I went back in the room twice to reconfirm that Mrs BH understood and each time the answer was the same.
Severe Dementia
As I made it to the office a wife of one of patients called to ask us if we could refer her husband who we will call Mr. SD (severe dementia) to Hospice. Mr. SD has recently had several hospitalizations and, like Mrs. BH, did not want to go back. The idea of Hospice was comforting with this patient. Mr. SD would be able to remain at home with his wife as his multiple health issues slowly take his earthly body from him. In my opinion, allowing patients to die with dignity at home is the greatest benefit of home care and Hospice.
Breast Cancer
The final emotion evoked today was that of frustration with our medical community. It was late in the day when Mrs. BC (Breast Cancer) called, with tears in her voice. Mrs. BC had only recently become a patient as she was homebound and needed a physician to see her at home. I did only a few home visits at that point but each time felt sincere gratitude from the family. Mrs BC had been suffering from metastatic breast cancer for several years and was told on the last admission that there was nothing else that could be done.
Mrs. BC was recently admitted to the tertiary care center where it was determined that Hospice was her only option. The reason the patient had called crying is that she felt alone. Whether it was a misunderstanding on the patient’s part or a miscommunication between the discharge planning team, the patient felt that her oncologist, as well as myself, had left her to face this part of her cancer alone. This was very frustrating to me as I was not aware of the patient being discharged, let alone to sent to Hospice. We quickly comforted Mrs. BC, called Hospice to switch attending and set up a home visit to check on her.
Situations like these allow me to gain a better understanding of what patients and their families feel when Hospice becomes involved. As each patient has a different story, a physician’s perspective is ever-changing.
That’s my Hospice from a Primary Care Perspective.
Care to share your thoughts?
{ 3 comments… read them below or add one }
As a Hospice RN Case Manager and now Administrator, please let me give you hospice from my perspective. Hospice in no way is failure on anyone’s behalf. It in no way means you’re giving up on the patient, their family or their care. All it means is that you realize this patient requires more care (be it in the home or the hospital) than the family or yourself as a Primary Physician can provide to them on a personal level. Sometimes it’s not even the physical/medical aspect of care these families need, deserve and are entitled to – it may just be knowing there’s someone there. In my case, someone who cares and who wants to help and sees hospice as a calling – not just a job.
Thank you for your reply. I agree that hospice is not failure but I think it is important to realize that often families and physicians do feel that way.
Wow I must cnoefss you make some very trenchant points.