hospicedoc

Personally, I don't think it is my place (or anyone else's place for that matter) to say to someone, "I know you have a debilitating disease that makes your life miserable, but I am not comfortable with you committing suicide you’ll just have to suffer.” I think the 29-year-old woman with the glioblastoma out in Oregon has every right to make the decision that she's making. I think it's a compassionate act to help someone in that position. So I guess I'm for it, although to be honest I would have a really really hard time doing it.

What I like best is that I get to spend as much time as I need with my patients. I work with people at one of the most vulnerable times of their lives, and it is truly a privilege to be let into their inner circle. I also spend more time with the families of my patients than probably any other specialty, and help guide them through a very difficult time in their lives. I know it sounds corny, but I believe I make a difference every single day, and that was one of the main reasons I wanted to get into medicine in the first place. I do mostly housecalls since my patients are generally too sick to go to the doctor, and I enjoy being out in the community much more than being stuck in an office all day. Even though I really liked the idea of practicing hospice medicine from the beginning, I wasn't quite ready to stop doing general medicine (focusing on prevention and curing of illness which was the essence of my training) when I first got out of my residency so I did that for about five years before going to hospice full-time. Another con is that there are times when I have patients who I probably would've been good friends with had we met under different circumstances, and I have gotten pretty close to them and it is painful when they die. I've also unfortunately cared for personal friends and friends of family members and that has been difficult as well.

That's a very long story, but to sort of TL/DR it, I started out as a firefighter/paramedic, and when I decided to go back to school I chose nursing since it seemed to fit in with the firefighting/EMS work. I was first exposed to hospice medicine as a nurse, and always felt like it was something that would allow me to get to know my patients better then just an office practice based physician, which was one of my goals. I initially did it on a part-time basis, however after a few years decided to do hospice medicine full-time because it seemed to fit.

I couldn’t have said it better. Not everyone goes on morphine (or some other pain medicine narcotic) right away and a high percentage of my patients come to me already on pain medicine. In my experience, Probably less than half of my patients are on any kind of pain medicine, But if someone is actively dying morphine is a very good drug for the reasons that lastredditname pointed out. Unfortunately there is a misconception that hospice is only for people who are actively dying or wish to be helped along the road quicker and for that reason I think about a third of the patients that are admitted to a hospice program in the US die within 24 hours (I think- please don’t hold me to that).

Edit: I'd also like to add that there is a misconception that morphine is an extremely powerful drug. When we look at all of the narcotics that are available and rank them from weakest to strongest, according to most equianalgesic charts morphine and hydrocodone (vicodin) are the two weakest. Oxycodone, the narcotic in Percocet is 50% stronger. In other words, if I have 10 mg of oxycodone and want to give an equivalent amount of morphine I need to give 15 mg of morphine to achieve the same pain relief. Dilaudid (hydromorphone) is stronger then oxycodone, and Fentanyl is stronger still. For some reason it seems that morphine has a reputation of being something that we use to help someone die, and nothing could be further from the truth. To be honest I might have been under that same impression back in the day.

Renal failure seems like a pretty good way to go. Most patients don’t have any pain or shortness of breath, and a lot of them get euphoric the last few days. Most of these patients are are people who were on dialysis and decided to stop and so they can also eat whenever they want for the last few days and that makes them very happy. For someone whose kidney function is completely gone, they usually have a week to 10 days so they have a chance to say goodbye to people but they don't linger for too long.