How Hospice Helps: One Patient’s Story

by Pauline Cameron, RN, CHPN

Pauline Cameron, RN, CHPN

I worked with a patient who was in his late 30’s and had been diagnosed with an aggressive form of colon cancer. At the time of his referral to hospice, we had been told that his pain was not well-controlled. On my arrival at his home, the patient was lying on the sofa. I explained the 0-10 scale for rating pain and asked him to give me a number; through gritted teeth, he said, “Nine.”  And it was clear what our first priority had to be…

We quickly got his pain down to “6,” at which point he was able to engage in conversation and looked much more relaxed. Over the next several days we visited him twice a day and worked with his MD to adjust the doses of four different drugs, as he actually had multiple kinds of pain – a narcotic, a neuropathic med (for nerve pain), a steroid, and an NSAID (e.g. ibuprofen) for bone pain.

One day I walked in and, as usual, found him lying on the sofa.  I said, “OK, you know the drill – what’s the number today?” He gave me a big smile and, making a circle with his thumb and index finger, said “Zero.”

Yes, that patient died, and that was sad. But before he died he got up from that sofa and took his children to visit Marineland and took them fishing and went to visit his parents once more. He really lived until he died. Excellent pain management gave him back what was left of his life.

Pauline Cameron, RN, CHPN was a Hospicare staff member for many years until her retirement in 2014.




Choosing Hospice Sooner Brings More Comfort at the End of Life

“I wish we’d called you sooner.” This is something we hear often at Hospicare from patients and their loved ones. Once a doctor has certified that a patient has six months or less to live, the patient is eligible to go on hospice, but all too often, our hospice team isn’t called in until the last few days of the patient’s life. Our nurses, social workers, aides and other professionals do all they can to make those last moments as comfortable as possible—but there is so much more they can do if they have more time to get to know the patient and family members.

The longer a Hospicare team works with a patient the more they are able to respond to that person’s unique situation and medical needs. Here are some of the benefits of choosing hospice sooner:

  • As patients and family members work with the Hospicare team, they become more comfortable sharing their end-of-life journey and discussing their care needs. This rapport can help in the building of an optimal care plan based on the patient’s and family’s wishes.
  • Pain and symptoms can be controlled better. Our hospice team members are specially trained in the treatment of pain and discomfort. That includes the mental and emotional distress that can come at the end of life. Pain and symptoms are addressed sooner and crises can be avoided.
  • Stressful hospital visits can be reduced or eliminated.
  • Hospicare team members can help family members understand the end-of-life process. The team social worker, spiritual care coordinator, and bereavement counselor in particular can help family members become more mentally and emotionally prepared for the death of their loved one, which can make the grieving process less overwhelming.

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.

3 Reasons to Choose Hospicare As Soon As You Can

November is National Hospice Month when our nation recognizes the importance of professional, compassionate end-of-life care. Patients are eligible for hospice when a doctor has certified they have six months or less to live, yet, more than a third of Hospicare’s patients in 2015 only signed up for service in the last seven days of life.

Here are three reasons why it’s better to call Hospicare as soon as possible, rather than waiting until the last weeks or days of life. Many patients find that they are better able to live life to the fullest once they are receiving

  1. Many patients find that they are better able to live life to the fullest once they are receiving Hospicare’s services. With the assistance of hospice team members, their pain and symptoms often become more manageable, and they can enjoy interactions with loved ones more. Also caregivers and family members find they are able to spend more quality time with their ill loved one. Hospicare follows a holistic,
  2. Hospicare follows a holistic, team-approach to end-of-life care. The team includes a doctor specializing in hospice and palliative care, a primary nurse, an aide, a social worker, a spiritual care professional, a bereavement expert and trained volunteers. In addition, patients and their family have access to on-call nurses 24 hours a day, 7 days a week. Hospicare offers professional support for caregivers. The support of social workers, spiritual care professionals and bereavement experts can be crucial to family members who are struggling to support their ill loved one and process their own grief. Many have told us how their burden eased once they had the support of the
  3. Hospicare offers professional support for caregivers. The support of social workers, spiritual care professionals and bereavement experts can be crucial to family members who are struggling to support their ill loved one and process their own grief. Many have told us how their burden eased once they had the support of the Hospicare team to help them manage their loved one’s illness.

It’s an Honor to Volunteer at Hospicare

by Cheryl Jewell

I started volunteering at the Nina K. Miller Hospicare Residence in April 2012.I have learned something special from each individual I have encountered.I have been moved by the look in patients’ eyes when I have held their hands and they are unable to speak. I have sat next to others who were unconscious, or who could no longer speak and were unable to open their eyes. I have put my hand on top of their hand and have felt their heartbeat slow down or their hand twitch slightly as they manage to just barely move a muscle. Just bringing a patient a meal or a beverage is  rewarding because they smile or say thank you, and I know they feel loved.

The work I and other volunteers do helps the Hospicare staff as well. Volunteers help make staff members’ jobs easier so they can concentrate on the professional care they are qualified to give, while we can focus on the volunteer work we’re able to do.

Every minute I have volunteered with Hospicare I have learned more about myself and I’ve learned about the patients I have been with.Some patients have told me about their experiences living though World War II or Vietnam. Many have shared cherished memories of all kinds with me.

It is truly an honor to work with Hospicare and to be involved in a patient’s life during their last days.