In response to a previous column of mine on hospice care, I received the following (edited) e-mail from hospice nurse Laurie Walton of Davie, Florida:
"I am sick and tired of the accusations that hospice facilities kill patients. We are not in the business of euthanasia. We are sick of this kind of rhetoric which instills fear in those who are suffering end-of-life illnesses and are afraid to accept relief from pain because of these accusations. They think that by accepting the care we offer we are hastening death. Odd. We actually discharge some patients for extended prognosis.
"I have been a hospice nurse for 13 plus years. I have not once, not ever, caused a death. I have had to educate patients and families about pain and symptom management, ad nauseam. We follow the World Health Organization pyramid of pain relief which begins with Tylenol, the generic of which is acetaminophen. We follow the guidelines even with that, which are that it cannot exceed 4000 mg (4 grams) in 24 hours because of liver damage. We titrate the Class II pain relief medications carefully, and it should be known that we take into account many factors such as age, size of patient and prior use of pain relieving meds.
"As the body systems fail, the body is less and less able to tolerate fluids. In fact, in the dying process, the cardiovascular system weakens resulting in fluids building in the lungs. It is natural. Adding fluids at this point compounds fluid build-up and results in greater discomfort. What is not natural is to spend dying hours and days hooked up to machines with needles sticking the patient, not to mention cold, impersonal hospital rooms or wards, frequently in ICU, with limited visitation.
"Many of our patients want to be cared for in their own homes, and we can do this. Some hospices, such as ours, can also offer inpatient care in our own facilities if it is preferred or symptoms require it. We can offer inpatient respite care for sick or stressed out caregivers for limited time frames, and we can offer our services to nursing home and retirement home patients.
Full Story: http://www.renewamerica.us/columns/abbott/050619