Finding Ways to Mourn Your Loss

by Jane Baker Segelken, MA, MSW, part of the Social Work team at Hospicare & Palliative Care Services

People who are grieving often hear all kinds of advice about the best way to mourn. All the suggestions we receive may have some semblance of helpfulness, but the fact is there’s no right or wrong way to grieve. What we do and what works for us depends on our personality, our life experiences, the significance of the loss, and many other things.

In his book, The Wild Edge of Sorrow: Rituals of Renewal and the Sacred Work of Grief, Francis Weller encourages mourners to express their grief communally, often through ritual. In a 2015 interview with Tim McKee of The Sun Magazine, Weller said that “Expressing grief has always been a challenge. The main difference between our society and societies in the past is how private we are with it today.”

Weller explains that grief is not meant to be carried as a “solitary burden,” and yet the message many of us receive in our sorrow is “Get over it. Get back to work.” We are not meant to handle grief in isolation, he says in the interview. And yet more often than not the bereaved rarely feel the kindness or compassion or community they need to face their sorrows. He suggests that observances and rituals can help those experiencing loss stay connected to their sorrow.

Formal Rituals and Other Practices

The most obvious rituals involve events such as wakes, funerals, and shiva. For example, traditionally a Catholic wake involves family and friends keeping watch over the body of the deceased, usually in their home. After a Jewish burial, mourners return to the home of the deceased or a close friend/family member to “sit Shiva,” which involves saying prayers and other rituals that encourage facing the fact of the death.

According to funeralbasics.org, funerals, the most universal of rituals, help us acknowledge the reality of the death; give testimony to the life of the deceased; encourage the expression of grief in a way consistent with the culture’s values; provide support to mourners; allow for the embracing of faith and beliefs about life and death; and offers continuity and hope for the living.

Of course, rituals around mourning are not limited in any way to the wake, shiva, or funeral. For some people, the ritual can be as simple as taking a walk, says Rabbi Brian of Religion Outside the Box. For others, a ritual can be cooking the favorite meal of the deceased on the same day each week, creating an altar, leaving something at the gravesite, continuing a monthly activity in honor of the deceased, or engaging in a regular writing exercise. It doesn’t have to be an act performed in a prescribed order; instead, our actions are aimed at tending to our grief.

The author, Weller, explains that “it’s up to us to devise our own rituals … Our rituals must speak to the particular ways we’ve been shaped, or misshaped, by our culture.” Ritual, he adds, “has the capacity to derange us, to shake us out of the old forms. We need that derangement, because the current arrangement isn’t working.” The idea, however, is not to forget the person we’re mourning or the event we’re grieving. The goal is to be present with and express our despair.

One practice that mourners find helpful is writing about a significant loss they experienced. Writing about the person, the loss, and any rituals they did seems to help people make sense of what they experienced. This kind of ritual is best done without censorship, without worry that the writing, spelling, or grammar isn’t perfect, and with the courage to let our emotions spill out. Writing to Ease Grief and Loss, which appeared in the November 15, 2016 Harvard Medical School publication explained “some research suggests that disclosing deep emotions through writing can boost immune function as well as mood and well-being. Conversely, the stress of holding in strong feelings can ratchet up blood pressure and heart rate and increase muscle tension.”

Upcoming Events

During the month of September, Hospicare is hosting two special programs that may be of interest to the bereaved. On the 6, 13, 20, and 27th  from 6-8 p.m. via Zoom, Jane Baker Segelken, MSW, will facilitate Writing Your Loss Story, a four-week writing program that provides therapeutic prompts for the bereaved to use to tell their story. On September 15 from 6-7:30 p.m., Hospicare’s Communications Coordinator, Brenna Fitzgerald, will facilitate an interactive discussion of the book The Wild Edge of Sorrow: Rituals of Renewal and the Sacred Work of Grief by Francis Weller.

See https://www.hospicare.org/event/writing-your-loss-story/2022-09-13/ for more information and to register for the writing program; go to https://www.hospicare.org/event/virtual-book-discussion-the-wild-edge-of-sorrow-by-francis-weller/ to register for the book discussion event. Or call 607-272-0212.

How to Talk to Your Proxy About Your Advanced Care Wishes

By Jane Baker Segelken, MA, MSW, and part of the Social Work team at Hospicare & Palliative Care Services

Jane Segelken, MA, MSW

One thing that’s important to remember when thinking about advanced care planning is that it’s not just about end of life. In reality, it’s about how you’re living now. It’s about making sure everyone is ready to make decisions on your behalf when you’re unable to communicate — even temporarily while you’re recovering from an accident, surgery, or debilitating illness.

Several years ago, 83-year-old Ella fell and severely broke her shoulder. In the hospital and loaded up on pain medication, the usually cognitively sharp Ella was unable to think clearly. She couldn’t understand the surgical options being presented to her and couldn’t communicate which surgery she preferred. Fortunately, she had talked to her legally appointed health care proxy about many different things including how important quality of life was to her. That information, including knowing something about Ella’s hobbies and interests, allowed her agent to advocate for an extensive surgery that allowed Ella to resume all her activities, including driving. Had the proxy not been informed and kept up to date on Ella’s wishes as they evolved, the proxy might have allowed the physicians to perform a lesser surgery that would have severely limited the very active Ella’s independence.

There is no question conversations about our advanced care wishes are hard. Making decisions about future scenarios isn’t easy. It’s scary for us to think about our own misery and it’s daunting for our proxy to consider our suffering. But the talks are totally worth it. In fact, doing so will minimize our distress and give our agent the confidence they are making the right decisions — some of the hardest he or she will ever have to do.

Once you’ve identified the person you want to represent your wishes — someone who can make difficult decisions, can advocate for you, and who knows your values — it’s time to have “The Talk.”

Talking about your advanced care wishes

There is never the perfect moment to begin the conversation. And it may happen over time — in several conversations rather than one. But a good way to start with the person you’ve selected as your agent is to frame it by saying, “I’d like to talk to you about how I want to live.”

  1. Be direct.
  2. Talk about a situation that someone else, such as a friend or relative, has experienced.
  3. Speak about your values — what makes your life worth living?
  4. Discuss what brings you comfort and joy — your interests, likes, and dislikes.
  5. Talk about what health, sickness, and death mean to you.
  6. Talk about pain. Do you want to be able to communicate while being treated for pain even if it means you might still be uncomfortable? Or would you rather be sedated and pain free?
  7. Consider life support treatments and reveal where your views on them come from. Share under what situations you would want to be on life support — such as a device to help you breathe, nutrition and hydration through a tube, CPR, etc. — and when you might want nothing to be done.
  8. Make sure to address your religious beliefs, if any, regarding healthcare decisions.

Part of this discussion should also address care at the end of your life. Things to consider include:

  1. Do you want a religious or spiritual leader to visit with you?
  2. Do you want music, candles, incense, and dim/bright light in the room? Specify the kind of music you like, the candle/incense aroma, and whether the light should be natural or artificial.
  3. Do you want to know when death is approaching so you can tie up loose ends and say goodbye to friends and family?
  4. Where do you want to die (hospital, hospice residence, at home, other)?
  5. Do you want to donate your organs? Are there any limitations?

As time goes by, especially if your health changes, review your advanced care planning wishes. When you’re young, every 10 years is a good benchmark. As you get older you may want to reevaluate even more frequently. Make sure your proxy, family, close friends, and your doctor know of any changes in your preferences.

Resources

The planning you do now will be a gift to your proxy, to those in your life to whom you matter, and to yourself.

Join Dr. Lucia Jander and the Hospicare & Palliative Care Services’ interdisciplinary team on March 15, from 5:30-7 for a webinar, Having the Conversations & Organizing Your Info.  To register email jennifer@crcfl.net or call 607-272-0212.

*Jane Baker Segelken, MA, MSW, is part of the Social Work team at Hospicare & Palliative Care Services.

How Patients’ Wishes Can Guide Medical Decision Making

By Jane Baker Segelken, MA, MSW, and part of the Social Work team at Hospicare & Palliative Care Services

Jane Segelken, MA, MSW

With the new year upon us, one of the kindest favors we can give the important people in our lives is information on the kind of care we wish to receive if we become ill or incapacitated. Letting them know our care plans and wishes in advance is a true act of love. Doing so takes away some of the burden and stress by allowing them to focus on us without the preoccupation of making decisions we haven’t discussed with them.

For anyone over the age of 18, advanced care planning is the process that allows us to make decisions about our future health care. It is a way of providing guidance for decisions that may have to be made when we are unable to make and/or communicate them on our own. The preferences are noted on legally recognized documents; then the choices are communicated to family/friends and health care providers who are appointed to be the decisionmakers.

While we often think about advanced care planning as part of end of life, there are times when you might be unable to make decisions because you are taking medications that make you fuzzy headed or are in severe pain that prevents you from being able to focus. Regardless of whether you are needing someone to assist in an emergency or at the end of life, having someone who knows your wishes almost guarantees you’ll be treated the way you want. Without these legal documents, decisions about your care may be made by healthcare providers who know nothing about your values.

Medical Decisions: Choosing Your Proxy and Talking About Your Wishes

When thinking about who you will have as your proxy, also known as an agent, it’s important to select someone who will honor your wishes. While many people choose a partner/spouse or child, they may not be the best ones to make the difficult decisions. What is key is that the proxy be able to determine the kind of care you receive based on your wishes not theirs. Others who can act on your behalf include a friend, lawyer, or someone in your social or spiritual community. Also, name an alternate proxy. Be sure to ask the people you want to appoint as your agents in advance to ensure they are comfortable with the process.

Make sure you have a deep, detailed, and honest conversation with your appointed agents about how you want to be cared for in a medical emergency or at the end of life. Talk about your thoughts, beliefs, and values so your agent can make the kind of decisions you would if you were able. It’s also important to talk about your decisions with your loved ones and your physicians so they can partner with your proxy. The Five Wishes and My Living Voice programs are two excellent resources to help guide you through the process.

Medical Decisions: The Documents

  • A Health Care Proxy is a legal document that designates the person who will make health care decisions only if you are unable to make them yourself. Because it is difficult to know all the choices that will need to be made, it is important to appoint someone you trust and who knows your core values; make sure he or she hears details about your wishes that go beyond what you have written on the proxy form. Keep the original at home; give copy of the completed document to your appointed agent (proxy), your alternate agent, your primary medical providers, and your attorney if you have one. While some people also prepare a Living Will, it’s important to remember that is not a legal document.
  • A Medical Orders for Life Sustaining Treatment (MOLST) form outlines your wishes for the end of life in the event you cannot make this decision yourself. This form is filled out with and signed by your physician and reviewed at least every 90 days. If you do not have a proxy, the MOLST will guide medical decisions. If you do have a proxy, this document can guide their choices on your behalf.
  • A Do Not Resuscitate Order (DNR) determines what life sustaining measures, if any, you would like if your heart has stopped beating and you are not breathing. While a DNR can stand alone, it is also a part of the more comprehensive MOLST form.

Resources

If you need help connecting to resources, or ideas for how to start this process, please contact Hospicare & Palliative Care Services at 607-272-0212 with any questions or visit their website at hospicare.org.

*This article originally appeared in the Cortland Standard on January 27, 2022, as the first of a 12 column series devoted to topics relating to hospice and Hospicare called “Let’s Talk Hospice”.


UPCOMING ADVANCED CARE PLANNING EVENT

Having the Conversations & Organizing Your Info
March 15, 5:30 – 7:00 pm via Zoom

For help with advanced care planning, attend Having the Conversations & Organizing Your Info, an upcoming webinar with Dr. Lucia Jander and the Hospicare & Palliative Care Services’ interdisciplinary team and hosted by the Cancer Resource Center. For more information about this and other event, visit our event calendar.

Training the Next Generation of Hospice-Minded Doctors

My name is Dr. Lucia Jander. I am the medical director for Hospicare & Palliative Care Services. You may know that Hospicare provides hospice, palliative care, and grief support to people living in Cortland and Tompkins counties, but did you know that we also recently started a new program training medical residents?

Since May of 2021, Hospicare has been working with Dr. Janette Lee of Cayuga Medical Center (CMC) to train a new generation of doctors in the Internal Medicine Residency program. These young doctors are doing their Geriatric Rotation at Hospicare.

Dr. Lucia Jander speaks with Dr. Priyesh Thakurathi, a CMC resident participating in the Geriatric Rotation at Hospicare.

My own professional interest in hospice came from an elective rotation in my residency. There is no formal requirement to have a hospice experience, but clearly it is very helpful for future internists in the community to understand these issues.

Let me explain the difference between hospice and palliative care: Hospice is a subset of palliative care for people who are at the end of life, generally with a 6-month prognosis. Palliative care can be delivered for several years before patients qualify for hospice. It is a special care for people with severe and chronic illnesses and can be given concurrently with curative care. The goal of palliative care is to help with symptom management, allow for open communication, and improve a patient’s quality of life.

During this semester-long rotation, CMC residents spend time in a long-term care facility, perform home hospice visits, come to our hospice residence, and are introduced to working in an interdisciplinary health care team. The goal of the rotation is to develop knowledge, skills, and the interpersonal communication needed to provide effective and compassionate care to patients receiving our services. Residents gain a broader understanding of the difference between hospice and palliative care.

During the Geriatric Rotation, CMC residents learn ways to help patients stay at home, improve their quality of life, and help them understand their illness, which may result in decreased hospitalizations or trips to the emergency room. I think it is important to remind trainees that 99% of patients’ lives are spent outside of the hospital; this may seem an obvious statement, but when residents are in the middle of their training, they are seeing the worst 1% of people’s lives when they are in crisis-medical misery. My hope is that the outpatient geriatric rotation helps CMC resident’s understand what matters most to their geriatric patients and ways to improve their quality of life.

Dr. Priyesh Thakurathi, a CMC resident meets with a patient at the Hospicare residence.

My primary goals are to teach trainees to understand their patients’ priorities (which may be vastly different from the healthcare team’s priorities) and help them recognize how much social factors influence patients’ lives – much more than our medical interventions.

CMC residents become incorporated into the Hospicare team. They join our nurses and social workers on their workday. The more exposure they have to Hospicare, the higher likelihood they will appreciate the help hospice provides for their patients, give prompt referrals for those who will benefit from hospice and palliative services, and stay in the community as primary care practitioners starting next July.

We are very glad to be able to train the next generation of doctors!

A Report of our Work in Cortland and Tompkins Counties

As we turn the final pages of 2020, our thoughts go to all who have struggled with loss. Whether you mourn the death of a beloved friend or family member – or simply the loss of normalcy — this has been a hard year for so many of us.

At Hospicare, we celebrate the nurses, aides, counselors, social workers, and staff who have tended to those whose end-of-life needs and grief did not take a pause for COVID. They donned masks and gloves and gowns, mastered new technologies and techniques to maintain human connections at a distance, and selflessly braved risks to themselves in order to help a person or family in need. 

The good work undertaken by these extraordinary people could not have happened without donor support. Even in less challenging times, nearly one-fifth of Hospicare’s budget is supported with funds given by a generous community—not for frills, but as a means to provide the level of care, dignity, and comfort that has been the hallmark of our agency for over 36 years. 

When you give, you inspire others to give as well, be those gifts of time, talent or treasure. Together, we are creating a community that we can be proud to call home.

To our donors, we say a special thank you. Thanks to our commitment to patient care and our rich community connections, we stretch every donated dollar as far as it can go.  As Helen Keller once said, “Alone we can do so little; together we can do so much.”

On behalf of all the patients and families we serve, and on behalf of Hospicare’s staff who have not let the challenges of 2020 get in the way, we offer our thanks and gratitude. You make a difference, and our online report is how it shows.

Safe and happy holidays to you and yours,
Joe Mareane
Hospicare Interim Executive Director

Hospice Utilization Climbs in Both of the Counties We Serve

Our lives are largely guided by our values, and as an organization, Hospicare is no exception. One of our core values is excellence, which we define, in part, as a commitment to continuous improvement in everything we do. We expect and remain open to change, recognizing that it is inevitable and necessary for all growth. It’s this value that encourages us to take time to assess and reflect on how we’re doing, and it drives us to improve access to and the quality of our services over time.

Whenever we have the chance, we dive deep into data, which can help provide valuable insights, especially when we can compare other similar organizations to our own.

Recently, metrics were shared with us that showed we are growing in a very important area. A newly released Hospice Analytics report of 2016 Medicare data showed that community members who need our hospice services are more successful in finding and accessing them. The measure, which is referred to as “hospice utilization,” is measured by the percentage of Medicare deaths in each county that occurred on hospice services.

The data told an interesting story, and one that we are proud to share with you.  Across our service area, in both Tompkins and Cortland counties, hospice utilization increased between 2015 and 2016.  Tompkins county hospice utilization increased by 3.7% and Cortland county experienced a growth of 3.6%.

While we’re proud of these statistics, and the community relations and outreach work that no doubt contributed to it, we’re more happy that this growth means that more patients and loved ones gained access to our services.

Bottom line: we’re reaching more families in both of the counties we serve.

At the same time, we will not rest on our laurels.  Excelling in the context of hospice utilization in New York State is a great start, but we can always improve. We wouldn’t be embodying our value of excellence without looking to identify where we still have work to do.

One way we could be doing better is by getting involved with patients earlier, which would help introduce families to our services sooner and would increase the quality of life of patients in their final months. Like most New York hospices, our average length of stay is low compared to the national average. And this is where we need your help!

Help us get the word out so our services to reach the people who need them most. Talk to your friends and family about hospice services and the options they have when facing a life-limiting illness. Read more about why it helps to understand palliative care options before you’re sick. Connect with a staff person at Hospicare directly to discuss a patient – family members, friends, neighbors, and even casual acquaintances can make a referral. Additionally, we welcome the opportunity to speak to your group, large or small, about hospice or palliative care services in Tompkins and Cortland county. Email our outreach and communications manager at communcations@hospicare.org or give us a call at 607-272-0212.

Books Help Grieving Children & Teens

by Laura Ward, LMFT

As part of my work with grieving children and teens, I’m always looking for new ways to talk about grief that feel both safe and interesting. One of the ways to accomplish this is by reading books to children that explain death and grief. Some books, especially those for children, focus on telling a short, but relatable story about loss in its various forms and how it feels to experience this loss. These stories build empathy for self and others in an engaging and concrete way.

Children are concrete thinkers who struggle with understanding the abstract and philosophical questions that surround a death. Stories can help them understand death and grief as a normal part of life.

Books such as Lifetimes by Bryan Mellonie and Robert Ingpen, and The Fall of Freddie the Leaf: A Story for All Ages by Leo Buscaglia, explain death as a natural part of life in the same way that birth is a natural part of life. These books can help reduce fear around the topic of death.

Workbooks, or activity books, provide an avenue for children to open up in counseling in a safe and engaging way. They also provide activities which normalize grief and provide tools for coping with the related emotions and experiences. Amy Barret Lindholm and the children of The Dougy Center for Grieving Children authored After a Death: An Activity Book for Children, which I use with children fairly often.

Helping Teens

Teens can have an especially difficult time with grief. They are in the normal developmental phase of pulling away emotionally from the adults in their lives in order to establish their own identity. This can make it difficult for them to confide in the close adults in their lives. In addition, peers are now the main influence whose opinions matter. It can be difficult for teens to “lose face” by confiding in peers and showing the depth of their emotions openly. In addition, puberty increases the intensity of emotions, but without the benefit of a fully functioning frontal lobe to regulate responses.

Journaling is a great way for teens to process feelings and emotions while grieving and a good skill to have for the future.

Chill & Spill: A Place to Put It Down and Work It Out by Steffanie Lorig  provides a fun alternative to journaling that is specific to teens and their experience. The teen can choose to share some of what they have written with the counselor as a means to build connection.

Straight Talk about Death for Teenagers: How to Cope with Losing Someone You Love by Earl A. Grollman provides answers about what teens might expect in their grief, which doesn’t entail taking advice from the various adults in their life. The book is also brief but informative, which is a plus.

Weird is Normal When Teenagers Grieve by Jenny Lee Wheeler is also informative, but is written by a grieving teen. This is especially useful as grieving teens often feel alone and isolated in their grief from their peers. It goes a long way for teens to feel like there are other people their age who have navigated the strong emotions of grief and found a way through.

Each of these books is on our Hospicare Wish List since we like to have a supply available to hand out to families with young children who have lost a loved one or who have a family member receiving hospice services. Part of our work at Hospicare is to help patients’ families prepare for and understand what’s happening with their loved ones. Books like the ones listed here are important tools to help the youngest family members understand what’s happening.

 

Laura Ward is a bereavement counselor at Hospicare. She also organizes our Good Grief program to support grieving children and their parents/guardians.

Join Us for Spring Volunteer Training

Would you like to volunteer with Hospicare? We depend on over 100 volunteer community members to help our agency carry out our work. Our trained volunteers visit patients in their homes or assisted care facilities, offering practical help and companionship. They also assist the agency in other ways, depending on their interests and backgrounds.

What do volunteers get out of volunteering for our agency? Volunteer Kat Patton says her work with Hospicare gives her a chance to learn and grow as she gets to know the patients she helps. “As a volunteer you meet remarkable people who happen to be at the end of their lives,” she says. “There’s a lot of joy and wonderful connections to be made. I meet people who have done amazing things. I didn’t know them back then, but I can still hear about it now and see the twinkle in their eyes when they talk about their experiences.”

Spring volunteer training will be held for three consecutive weeks: March 14, 16, 22, 23, 29 & 30, 5:30 PM-9:00 PM. The trainings will take place at the Nina K. Miller Hospicare Center, 172 East King Road, Ithaca. Attendance at all sessions is required.

Before registering for training, prospective volunteers must submit an application form, available on line and meet with Wendy Yettru, manager of volunteer services for an informal interview.

For further information, check out the volunteers section on our website or email Wendy or call 607-272-0212.

Five Steps for Advance Care Planning

Advance care directives are directions you give to your loved ones and medical professionals outlining your healthcare wishes in the event you are unable to articulate them yourself. If you haven’t yet shared your advance care wishes, follow these five steps to ensure your healthcare choices and desires are communicated to those who will make decisions for you if you are incapacitated.

  1. Learn about the most common forms of advance care directives.
    • A living will gives you the power to designate what types of health care intervention you want or don’t want should you become incapacitated and unable to state your wishes at the time of your healthcare crisis.
    • A Medical Power of Attorney or Health Care Proxy, allows you to designate someone you trust to make health care decisions for you if you become incapacitated.
    • In addition, in New York State, a MOLST, or Medical Orders for Life Sustaining Treatment, complements other advanced directives. It lays out specific medical orders that apply as soon as you consent to the orders and a physician signs the document.
  2. Talk about your health care wishes with your family, friends and doctor. Although you may think that your loved ones and physician know what you would want if you were incapacitated or unable to speak for yourself, that is not necessarily the case. You can ease their minds as well as your own by speaking frankly with them about what types of treatment you would or wouldn’t want. It also helps to give them a general idea of where you fit into the healthcare continuum between those who wish to be allowed to die without medical intervention and those who want every possible medical intervention to be tried all the way until the very end.
  3. Select a person to speak for you in the event you are unable to speak for yourself. This person, called a healthcare proxy, can be a family member or a friend—or someone else you trust understands your wishes and will make decisions in line with them.
  4. Put your choices in writing on the New York State Health Care Proxy and Living Will forms. You can download copies of these forms here.
  5. Make copies of your advance directives and give them to your decision maker and your doctor. Keep the original documents in a safe and accessible place, and tell others where you put them.

Myths and Truths about Pain and Pain Medicine

by Eric Lessinger, MD

As Medical Director of Hospicare & Palliative Care Services, I spent a considerable amount of time addressing issues related to pain and its treatment. Some people have deeply-held beliefs about pain medication which have little or no basis in reality, but which interfere with their willingness to take the drugs that will provide needed relief.

Myth: One person can judge another person’s pain by observation.

Truth: What people say about their pain is the best way to know how much and what kind of pain they have. Some people with severe acute pain and many people with chronic (constant) pain may not show any signs of pain.

Myth: The use of strong medications for pain can lead to addiction.

Truth: Addiction begins as a psychological phenomenon. It is extremely rare for a person to become addicted to narcotics if the medication is being used to treat pain, and the person was not addicted before.

Myth: People taking narcotic medications can’t function well.

Truth: Moderate to severe pain itself often interferes with psychological and physical function. People getting adequate relief of pain through use of narcotic medication commonly think more clearly and function better physically than they did before taking the medication. Side effects of narcotics commonly do include sedation, nausea, and constipation. However, with chronic use, sedation and nausea almost always resolve, leaving only constipation as a side effect which does require ongoing treatment.

Myth: People taking narcotics become dependent and can never stop.

Truth: If the source of the pain is eliminated, a person can safely taper off. On the other hand, with chronic use, it is true that a person’s physical system can become dependent upon narcotics, meaning that abrupt withdrawal of medication can lead to an uncomfortable withdrawal syndrome. This is very different from psychological addiction, and withdrawal syndrome can easily be avoided by tapering off the medication instead of stopping it abruptly.

Myth: Morphine and other narcotics are useful only for treating pain.

Truth: Narcotics are quite effective in treating shortness of breath. As more and more people with chronic lung disease and chronic congestive heart failure reach a terminal phase of their illness, morphine and other narcotics provide welcome relief from episodic shortness of breath, without worsening the underlying condition.

Myth: Morphine is only used when you are dying, and brings death sooner.

Truth: Morphine (and other narcotic or opioid pain relievers, including codeine, oxycodone, hydrocodone, hydromorphone, fentanyl, and methadone) can be used to treat moderate to severe pain from any cause, when less potent pain relievers such as aspirin, ibuprofen, naproxen, and acetaminophen are not adequate. Morphine is often given to relieve pain in patients who are near death, and in such cases it is just as likely to lengthen life (by allowing the patient to relax and live comfortably) as it is to shorten life (by decreasing alertness and thus decreasing intake of fluids). Generally at that very last stage of life, getting comfortable and staying comfortable to the end become the main goals of the patient, and narcotic medications are very useful in helping the patient meet those goals.

If you have questions about pain and symptom management, talk to your physician or call Hospicare & Palliative Services at 607-272-0212.


Dr. Eric Lessinger was the medical director at Hospicare for 12 years until his retirement in 2014.