I guess one of the opinions that I formed while....

[Roland]

watching my mother in hospice (in patient) was that length of life should be included as a core value in their mission statement. That is to say that in addition to attempting to palliate suffering, that every thing reasonably possible should be done to facilitate the maximum possible lifespan of the patient (unless the patient expresses an express desire to the contrary). Some of these interventions in my mom's case could have included:

1. Use of IV fluids and or parentenial feeding until the underlying reason for emesis (in her case it appears there might have been a partial fecal impaction that didn't show up on the CT scan at the hospital) could be identified.

2. Use of radiation to treat her primary lung tumor. This is often effective in relieving the spinal cord compression from which she suffered (she was on dexamethasone for this and appetite stimulation).

3. Bathing along with range of motion exercises. While in hospice she received only one bath despite my requesting them daily. Since I stayed with her virtually all the time day and night I know that they were not offered.

4. Less aggressive escalation of pain medications. In her case she was placed on escalating doses of morphine delivered via a pump/IV site. Only two weeks before admission she was fully ambulatory (she even drove herself to a retirement campground in the eastern part of the state).

When I was a young adolescent I suffered from acute type A lymphocytic leukemia. I was given virturally no chance of survival given the treatment options available in 1983, and the advanced state of my disease. I remember "relishing" the pain because I felt it was my only connection to life. What I hated more than anything was the loss of "self" that came with the administration of narcotics to control my pain. For some reason I didn't die. At that time there were few hospices so I was treated at a children's hospital. However, had I been admitted and treated in the same manner as my mother I question if I would still be alive today at the ripe old age of thirty four. I realize that every patient and disease is different, but feel that length of life and maintenence of "conciousness" in an inextrable component of life quality.

[Hellllllo Nurse, BSN, RN]

I worked inpt hospice for 4 years. We did have pts on palliative radiation, and we did palliative blood transfusions. We also had pts on PT and ROM, not to extend life, but to maintain as much function as possible and for comfort.

Our pts received daily baths.

For pts who required increasingly large doses of meds for pain control, sometimes Ritalin was given to help counteract the mentally dulling effects of the pain meds.

We never had anyone on TPN. However, many pts were on IV fluids. Often it was not appropriate for them and increased their suffering. However, it was frequntly difficult to convince docs and family members of this.

I am sorry that you feel your mother's hospice care was not what it should have been.

Wishing you peace and comfort.