“The World of the Child Who Has Lost Their Parent” interview with Margaret Allan on June 10th at 10AM, pst

Margaret Allan is a LCSW, Licensed Clinical Social Worker with a PsyD, a clinical doctorate in psychoanalysis. She is affiliated with the Institute of Contemporary Psychoanalysis in Los Angeles and is a member of the National Association for Psychoanalysis in Clinical Social Work. Margaret is a psychotherapist in private practice in Westlake Village, CA and works with Hospice of the Conejo as a facilitator in their Family Services, with individual adolescents and in a grief support group for adolescents that meets on Tuesday evenings at HOSPICE of the Conejo. http://www.thewisesource.org/hospice/

Have a kind and respectful day.

Most people on their death bed will ask, “Did I matter?” Here is a dying ritual to help you with this question.

One of the universal questions that people ask themselves when they are dying is, “Did I matter.” It doesn’t matter what religion you are or if you have no religion, we all hope that our life has made a difference. Whether you are interacting with your loved one or if you are a healthcare professional caring for a patient, this is something that you can help the dying with. Let them know directly how they have made a difference in your life. Tell them if you have learned something from them, if they have made you laugh or if they taught you how to be a better person. The person will have a more peaceful death knowing that their life had a positive effect on this world.

A wonderful ritual you can do with the dying is the rock ceremony. Even if the person is unconscious, you can still do this ritual. Here is how it works. Each person who cares about the dying person gets a rock. Any rock. It can be a special rock they pick out or just a rock from the garden. One by one, each person walks into the bedroom or hospital room of the patient and lays the rock on the person’s chest or lap. As they do this, they should say, “This rock represents what you have taught me, done for me, helped me with… You have made a difference in my life. Thank you.” Or words like that. You will know what to say. Young children can do this ritual as well. They might just say, “I like it when you read to me or take me to get ice cream.” It doesn’t matter how small or big, just that the person matters. As each person places the rock on the patient, the patient can literally feel the weight of their effect on the world. It is a powerful way to say thank you and goodbye. I hope that on the day you die, you will know that you have mattered too.

Have a kind and respectful day.

“How do I know it is time for hospice? – Information for doctors and their patients” with Dr. Christian Sinclair, on May 29th, 2PM pst

Dr. Christian Sinclair, “How do I know it is time for hospice? – Information for doctors and their patients. on May 29th, 2PM pst”

Dr. Christian Sinclair is a palliative care expert and is the co-editor of the Pallimed: A Hospice & Palliative Medicine Blog. http://www.pallimed.org/     Dr. Sinclair is the Associate Medical Director of the Kansas City Hospice and Palliative Care. www.kansascityhospice.org He is also on the Board of Directors of the American Academy of Hospice and Paliative Medicine.   www.aahpm.org

You can also contact Dr. Sinclair on Twitter: @ctsinclair

About Me (Christian Sinclair)

My medical training started at the University of California, San Diego, which I completed in 2000. From there my wife, Kelly, our dog and I went to North Carolina for 4 years for my Internal Medicine residency at Wake Forest. My 4th year was spent doing a palliative medicine fellowship at the Hospice and Palliative Care Center. I now have been working since the summer of 2004 at Kansas City Hospice & Palliative Care as a associate medical director. I was also the fellowship program director for the KC Hospice Palliative Care fellowship from 2006-8. I am a big advocate for palliative medicine fellows, and have been the chair of the AAHPM professionals-in-training special interest group (PIT-SIG). I was elected to the AAHPM Board of Directors in 2009.   www.aahpm.org

Say Thank You To A Nurse Today. May 6th – 12th is National Nurse Week.

May 6th – 12th is National Nurse Week

I want to say thank you, thank you, thank you to all of the nurses. Whether you are a hospital nurse, a home health nurse, an office nurse, a nursing home nurse, a surgical nurse, a hospice nurse or some other type of nurse, thanks for everything you do. And thanks for putting up with the doctors. And thanks for putting up with the patients and their families. We all don’t make it easy for you. But you still show up and take care of us.
I truly appreciate you and hope you will keep being a nurse. We need you. I encourage every one to do something nice for a nurse today. Maybe send a thank you note to the nurse that works at your doctor’s office or drop off a healthy treat. If your loved one is in a care facility, do something nice for the nurses there. Maybe offer to volunteer one day a month and help with meals at the skilled nursing facility. Anything you can do will help. We already have a shortage of nurses so if we want the future to be safe for us, be nice to a nurse today and remember to thank them all year long.

On Monday, May 11th at 2PM PST, blogtalkradio.com/kindethics, I will be interviewing Frances Shani Parker, author of “Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”

On Monday, May 11th at 2PM PST, blogtalkradio.com/kindethics, I will be interviewing Frances Shani Parker, author of “Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”

She is an award-winning writer, consultant, and former school principal, Frances shares insights and experiences about her years of hospice volunteering in Detroit nursing homes. Using stories, poems, and general information, she has written a groundbreaking book that is an inclusive and literal guide for becoming dead the right way. Topics include hospice, caregiving, dementia, death, bereavement, and strategies for improving eldercare and nursing homes. While universal perspectives are presented, the often missing views of people of color and residents in urban nursing homes are examined.

Frances’ background as an educator and her upbringing in New Orleans, LA add interesting layers to her problem solving in nursing homes and to her descriptive storytelling. She uses her writing and public speaking skills to advocate for senior citizens and promote conversations empowering others to have dignified death journeys. Her favorite anonymous quote is “If you think one person can’t make a difference, you haven’t been to bed with a mosquito.” Visit Frances in cyberspace at www.francesshaniparker.com and at her blog titled “Hospice and Nursing Homes Blog.”

She welcomes your questions and calls. You can call in to listen or to ask questions at (347) 945-5152.

Have a kind and respectful day.

Why did they take my son’s body away so soon?

Dear Viki,

My son recently died at home with the help of hospice. They were great but I am still really angry that I didn’t know they would take my son’s body away so quickly. When the funeral people showed up, they took him away before I was done saying goodbye. Shouldn’t they know that isn’t right?

I am so sorry that was your experience. And I am sorry for your loss.

Here is what someone should have told you. When you call the funeral home for them to pick up your loved one, they come out within an hour or so. If you had wanted longer with your son, then you should have delayed calling the funeral home. But of course you didn’t know this and nobody explained it to you. Delaying calling them would have given you a little extra time for you to finish saying your goodbyes. You can’t delay calling them for days, but it is okay for a few extra minutes. (If you are anticipating a death in your family, you should ask the mortuary how long it usually takes to pick up someone who has died.) Once they arrive, they should be respectful and compassionate and give you a few more minutes, but they can’t wait for hours once they arrive.

Have a kind and respectful day.

The Good News And The Bad News About Hospice

The good news is that I was just in Scottsbluff, Nebraska and their hospice program is doing such a great job of providing people with the option of a good death that 46% of their dying patients are dying with the help of hospice. Amazing. Nationwide the average is 33%-38% with some states as low as 14%. I am even more impressed with what is happening in Nebraska since they are covering 9000 square miles. I know local hospices in Los Angeles that are struggling to cover their few hundred square miles. Usually those who live in rural communities are limited by the minimal medical services that are available. Nebraska has found a way to move beyond those limitations and to get people what they need. I congratulate the hospice workers of Nebraska.

The bad news is that not every hospice is the same. I was told about a hospice in another state that was providing terrible care. They weren’t using universal precautions to prevent infections from spreading to other family members, were putting the patient at risk when transferring the disabled patient and were not calling the family back when they called to complain. Like any industry, there are good and bad hospices and good and bad employees. If you are on hospice and you don’t think you are getting the care you need or they are not being respectful and responsive, change hospice providers. The bad hospice I just mentioned tells people that they can’t change their hospice provider for 90 days. That is a lie. You can change any healthcare provider any day. You are never locked in.

There are many types of hospices. There are inpatient hospices which are part of hospitals, inpatient hospices that are in their own building, for profit hospices, not for profit hospices and volunteer hospices. Any of these can provide good, loving care and most do everyday. It is not the type of hospice but the people running it and working in it that makes the difference.

How do I get my loved one on Hospice?

Viki,

How do I get my husband into hospice? He has cancer which has spread everywhere and his pain is not being managed. I have heard about hospice but I don’t know who to call. What can I do?

I am so glad you asked. To get a patient on hospice, a doctor has to make the referral to the local medical hospice. You have to ask your husband’s doctor, and it could be any of his doctors, to call hospice and set it up. Some doctors are not willing to put their patient on hospice because they don’t want to give up trying to save your loved one. So if your husband’s doctor won’t put him on hospice, ask another doctor you know. An ER doctor can also put someone on hospice.

After the doctor calls hospice, the hospice representative will call you later that day or the next morning. A social worker and a nurse will both be coming out to see your husband within 24 hours. They will evaluate what needs your husband has and what your family may need. If your husband qualifies for hospice, you will start receiving visits from other hospice staff, deliveries of medical supplies such as hospital beds, oxygen or bedside commodes. You will also be receiving medications to have available to take care of his pain and other symptoms. And the good news is that none of this will cost you anything.

The nurse will teach you about the new medicines and there is a 24 hour hotline you can call if his symptoms change and you need help. Every patient is different. What your husband will need may be very different that what my Dad needed. The good thing about hospice is that as patient’s health needs change, they can adapt the plan and continue to provide comfort for your loved one.

It may be overwhelming for the first few days as so many caregivers will be coming and going as they make sure your husband is well taken care of. Unfortunately, you do lose some privacy which takes some time to get used to. Don’t worry though, after a while you will get to know the hospice team and they will become your trusted friends. Most people find hospice to be a huge comfort to them as they can know that their loved one won’t be suffering.

Got a question? Ask Viki.

Why Did the Doctor Run Away?

Dear Viki,

“The doctor stopped coming into my grandpa’s hospital room and never came back to check on him. Luckily the nurse was there and helped our family as we didn’t know what to do. Viki, why did my grandpa’s doctor run away when my grandpa was dying?”

Maybe the doctor didn’t really “run”, but to the family, it felt like the doctor ran away and became invisible as the end approached. I don’t think doctors mean to do this, but unfortunately, doctors can be uncomfortable around death.

I know, you’re saying, “How can that be?” Well, it is easy. Those who are drawn to medicine and want to become a doctor are those who want to heal and to save. Nobody becomes a doctor to help people die. But unfortunately patients do die and doctors would rather not be a part of it. Unless they get specialized training, their discomfort with death doesn’t go away. Luckily, the young doctors coming out of medical school are getting better training regarding taking care of the dying.

Thank goodness for the nurses who take such good care of our loved ones as they die. Sometimes the best we can do for our loved ones is to have a good nurse, a good chaplain and a good social worker to make the experience a little better. Over the next few months, I will be discussing the concept of a “good death” in greater detail.

Feel free to contact me with your death and dying questions.

Why Won’t the Patient/Family Sign the DNR?

A couple of things may be going wrong. The first thing that happens is that the patient doesn’t understand the success rate of CPR.

On the television show “ER”, the patient not only survives CPR about 80% of the time but they also wake up with no negative consequences from the resuscitative efforts. We need to educate them that CPR works about 15-20% of the time on healthy people and less than 1% of the time for those with multi-system organ failure or metastatic cancer. We need to tell them that they may wake up in a worse condition than before and we need to tell them when it may only prolong their suffering and dying.

The second thing that goes wrong is that we limit our discussion to CPR. The CPR question should be one of many significant questions we ask during a meaningful end of life conversation. We need to ask them about how and where they would like to die.

Ask them, “How can I respect you and help you as you die?” We need to tell them that they have the choice of having a stranger straddling them doing compressions while their family waits outside the door or a peaceful death surrounded by their loved ones? I have never met a doctor who said they would choose the lonely CPR death, so why would you think your patients would want this?

The other thing most people want is to die at home but 53% die in hospitals and 24% in nursing homes. Please send people back home with hospice support.

One other thing you might try is you may want to begin using the term “AND” or Allow Natural Death when you talk about DNR. It is much easier to talk about what they would be allowing versus what you would be taking away from them. Just changing this language changes the discussion. This language also helps when you are talking to people from other cultures. It is difficult for families to choose to “give up” when what you are really offering is a good death.

No matter what, patients and families need us to talk about these scary and difficult subjects. We have to have courage to walk with them as they journey toward death.

Got a question? Ask Viki.

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