So the family asks me "Is Mom dying?"

[357maggie]

Well, we all are, aren't we? Somebody, anybody, chat with me. I am new to hospice. Been here since Thanksgiving, and am going thru the "I don't know what the hell am I doing" stage. I had a good mentor, who worked with me for three weeks. Now on my own, I feel like I am drowning. I have my first patient that is declining. Lung ca with mets to the brain. Last Wed I saw her for the second time, it was her and her husband's anniversary. She was alert, having trouble finding words, complaining of double vision. History of IBS that was under control, she told me she was having BMs daily, that had been loose for 2 weeks, returning to normal over last 2 days. Got in to the office today to find she has been on crisis care all weekend, for agitation and constipation. Family reports no BM in 10 days. Dtr said "Dad told me the anniversary was important to her. Not so much her birthday next week." They have her zorked on ativan and roxinol. Her abdomen is distended. No urine in the last day. Husband has refused digital exam since start of CC, afraid the disimpaction will be too painful. I got orders to disimpact, give an enema and put in a foley. I was able to explain to the husband that as painful as disimpaction may be, the constipation will cause more, longer lasting pain. In turning her to her side, she peed, so foley was delayed. So the questions that the family is asking me: (I hedged pretty well. "Fake it till you know it" was one of the gems my preceptor stressed) If Mom was not sedated would she: still be dying? be in pain? be eating and drinking? I got more, will see what you have to say to this first. HELP!!

[SoCalRN1970]

"gone from my sight" is a little blue book that comes in the admission packet our familes get when they start hospice....we encourage folks to look through it on admission, and we revisit the book with each visit. It explains the transitioning and dying process.

This book is also carried by me and used a reference all the time.. I don't use it as a replacment tool for my own info, but it does help those who like to have printed info and something to refer too.

What shocks the heck out of me.. is the family members who are afraid to read the book.. almost like their denial is so strong that if they don't read the book it' won't happen.

[RNKITTY04]

These are all questions that will happen over and over. Same questions=different patients. Rattling/Food/Pain/medication, sometimes I feel like a tape recorder.

Lots and lots of denial in hospice and lots of blame, mainly directed towards us(." Your over medicating" must be that 0.25mg of MS04 you gave 8 hours ago) ummm yeah.... NO must be the DISEASE PROCESS.

[jerseyRN]

Hey RNkitty,

Sounds like you're ready for a break.... even though we've been through it all before, it's probably the first time for the family you happen to be seeing that day.

[tencat]

357maggie: Don't you have a nurse you can call if you need quick advice? We have a new nurse new to hospice and fairly new to nursing, and actually I bug her frequently just to make sure she's ok (told her she could tell me to quit hovering if I was being too annoying :) ). Sometimes families and patients have to choose: Do they want the patient to be comfortable, but possibly really sleepy, or awake and in a lot of pain and distress? Most of the time once they've seen the discomfort, they're all for the medications. And the goal is not to 'snow' people, but to make them comfortable, and if they need to be 'snowed' to make them comfortable, then that's ok.

There is a steep learning curve with hospice. Just remember: Morphine and ativan are our friends.....and the 'danger' of overdosing someone is pretty small. I've had patients on ungodly amounts of morphine and fentanyl, etc. who were still in pain and very much awake.

[RNKITTY04]

Hey JerseyRN,

I work Inpatient Hospice, 16 bed freestanding, its way different then going to peoples homes. Its bascially just like Med-surg, but more emotionally gut wrenching. Sorry if I came off as uncaring I was trying to relate with the original poster, but its all good, another lesson learned.

[Doubledee]

As a nurse in LTC for quite a few years, I've dealt with many hospice nurses as we did end of life care for my residents. This experience was very helpful as I took care of my father in his last ten days of life this past summer.

My sisters all had the same reaction when I talked about Roxanol. The were afraid Dad would get addicted or something. Many people just aren't as ready to let go as the patient on hospice. It can be hard to deal with family at times. My sister's head spun like the Exorcist when I told my dad it was ok for him to leave.