Help for Healing

Bitter & Sweet, living daily with grief


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When end-of-life care magnifies the pain

I’m cheating this week. I am going to post an article in the Buffalo News that I wrote and was published yesterday. I love the title the paper came up with. Care is supposed to diminish the pain, such irony. The response to the article has been amazing. I have gotten emails from people telling their own stories, asking for assistance in guiding their journeys with their loved ones. I am especially excited about one from a geriatric doctor who I will be meeting with to discuss how to attempt to make positive changes in the system. I think it’s worth posting it here for those who aren’t local or don’t read the paper. Please feel free to share your own stories and experiences!

“After losing Mom and my husband, writing books about it, and becoming credentialed as an Aging Life Care Manager, I assumed approaching Dad’s death was going to be the best death I had the privilege to be part of. I know that sounds strange, but I had become educated and knew when Dad switched to palliative care, when his time came, he would not suffer. I promised him that.

I had absolutely no idea what I was talking about.

Over the last decade, I became increasingly involved in his care. He had Parkinson’s and we began the journey of educating ourselves the hard way. After treating swallowing issues and bladder disorders for years, we were finally informed they were symptoms of Parkinson’s. Itchy skin. Blood pressure. Is there anything this thing doesn’t touch? It’s a slow progressing disease that makes life miserable but doesn’t have the courtesy of actually killing you. At least not for years and years.

My family and I helped him “get his affairs in order” over time. He slowly made changes financially and legally to put him in a good position. He sold his house and eventually landed in Assisted Living, just down the street. While it seemed crazy expensive, finding out about a VA benefit made it almost affordable. He would have three meals a day, have his apartment cleaned, and his laundry washed.

We made sure his medical papers were ready. We had lots of discussions about his wishes so I could be a good Health Care Proxy if need be. By the time he turned 85, he had lived a good life and was ready for the next and a reunion with his wife.

In July, Dad starting experiencing pain. Spoiler alert: Two of the last three weeks of his life he lived with increasing pain. I knew our medical system was broken, I just didn’t realize how badly. Medicine has become a for-profit business, which usually means money is more important than patient care. No matter how much I advocated, I couldn’t beat the facility or the medical persons they contracted with. It became crystal clear they didn’t understand palliative care or that palliative and hospice were no longer interchangeable. More importantly, they didn’t want to. Professionals should inform patients of treatment options and expected outcomes. The decision to treat (or not) should be the patient’s, not the doctor’s.

I could not get the administrators to see what was happening. The staff would often shudder at what they witnessed but were powerless. His primary would not prescribe enough pain medication and refused to order a catheter in spite of his fall risks. There was blatant refusal to accept his MOLST (Medical Orders for Life Sustaining Treatment). It finally culminated in them blocking Hospice from treating him. Yes, you read that right. Eventually they were cited by the Department of Health for failure to comply or I can’t imagine how bad Dad’s suffering would have gotten.

I later discovered that about four years ago, regulations were drastically changed. Dying is not enough to gain Hospice care. You have to have a terminal illness to qualify. How do I keep heralding the advantages of palliative care if there is no one to help folks when they get to that point? Hospice can’t be happy about this either.

I will never, ever forget the look in Dad’s eyes when he was hurting and I could do nothing for him. The several individuals who refused to do proper research and care for him appropriately should not be practicing. You only get to die once. Why should a decorated Korean War veteran, after working his entire life in an American factory, and was a volunteer firefighter for 60 years, have to suffer at the end of his life? If you can answer that, please tell me. I would do anything to make sense of it.”


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Hanging On

I’ve been doing a lot of reflecting the last couple of weeks as I’ve attempted (with my family) to help Dad navigate the beginning of a different life – the next life. A life without Parkinson’s and all the other malarkey here.

As I write, he is hanging on. He’s been hanging on for several days. He’s given me a lesson in humility as I keep realizing that no matter how much education or experience I have, no amount of prediction is full proof. After my fourth or fifth “this is it” was completely wrong, I stopped trying to guess.

My doctor asked  me today if I was ready for this to happen. I told her that he and I have been talking about this for well over a year. I want this for him, because he has wanted it so much. What I was not prepared for, was how difficult this has been. Dad did all of this “right.” He filled out his forms, got all his ducks in a row and his affairs in order. I told him the beauty of palliative care is that it would be painless when the time came.

Boy was I wrong. I already knew that palliative care that is apart from Hospice is a new concept. I knew that accepting mortality is a tough idea for people to grapple with. I just didn’t anticipate how ginormous the gap actually is. At one point, I had his primary doctor tell me that medicine is not practiced “that way” in America. He truly thinks I have some wacky idea that doesn’t even exist.

The place where he lives is also way out of tune. I approached them back in January and warned them this would be coming. Of course, they ignored that conversation over the last eight months. The result has been devastating.

I pointed out that Dad is only the beginning for them. As this idea catches on, there will be more and more people. Someone finally asked why amazing, compassionate health care is only found at the end of life. Someone finally realized that patients should be driving their own treatment, not medical staff. Now the movement has begun but it is even more difficult than I could have imagined.

That has been the hard part for me. If Dad has to go, I wanted to help him have it on his own terms. A hard-working war veteran should have the right to end his life the way he wants. And he definitely should not have to suffer because of that decision.

We finally have Hospice, but it was the battle of all battles to get it for him. There is no do-over, no second chances with end of life stuff. I just have to hope he knows how hard I fought for him. We eventually succeeded, but he suffered longer than he should have before he got “comfortable.” Damn it to hell!

Please pray for him. He is tired and ready. He seems to have a hard time letting go. I want so much for him to be able to relax into what lies ahead for him. It’s almost over, Dad. You just have to let yourself embrace it. You so deserve the rest and healing that is waiting for you.

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Is It Me???

As I continue the drama of finding Dad the care he needs/wants, I have been astounded at the majority of medical professionals we are dealing with. I say I know these things, but when I am actually interacting in reality with it vs. speaking theoretically, I can’t believe things are as backwards as they are.

While most people wouldn’t say they believe this, in practice they betray they do. I am realizing that even medical peeps hold to the idea that every person wants to live as long as possible. If they don’t, then there is a mental illness (like severe depression) or they are “not of sound mind.”

Dad has literally been badgered repeatedly even though he has been crystal clear and actually has it in writing on every kind of medical and legal form possible.

Are you sure you don’t want an antibiotic?

Do you understand you may die from infection without an antibiotic?

Over and over and over again. This week’s appointment resorted to actual bullying and attempted manipulation. Dad stood his ground and I eventually exploded at them. The doc responded with:

“This is not medical care in America. American medical care does not work like this.”

I know palliative care is relatively new outside of hospice, but I can’t believe he was serious. He is even young. Uneducated, uninformed and therefore treating patients unethically.

Caring for a loved one with a debilitating disease, eventually losing them, etc. is so unbelievably exhausting and heartbreaking. But dealing with this nonsense repeatedly is beyond maddening. I literally shake with anger and frustration. No idea how to fix the mountain of an issue. How can we change facilities when the doctors don’t get it? And how do we change doctors when they are trained to believe death is failure?

Systemic issues aside, I have my father to care for. Please keep him and my exhausted family in your prayers as we attempt to navigate an incredibly complicated set of diagnoses with treatment options that are Catch-22’s at best, in a system that is utterly broken and unsupportive. What a sentence that was.

One moving, profound (to me) bright spot. Frankie turned 16 this week and asked me a ton of questions to try to understand what is happening with his grandfather. He absorbed the horrible information and asked for clarification that indicated that he indeed understands the depth of the problems and their significance.

He asked if Grace, his and my doctor, would be able to help Grandpa. I said that she is an excellent doctor and would respect his wishes but is unable to take on any new clients. He thought for a moment and said, “Mom, why don’t you and I give her up so she has room for him?”

I cried later in my room. I love that kid. He tries to pretend he’s selfish and uncaring because he’s a teenager. He’s not fooling me. He has an amazing heart.

Give yourself some time to think about these issues for yourself.


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I WANNA SCREAM!!

Sigh.

Heavy sigh.

Another heavy sigh.

My poor dad.  Our medical system stinks and he suffers for it. Being on palliative care is supposed to make his life more comfortable. In order for that to happen, you must have a palliative doctor, or one that at least fully understands what it means. I have literally spent weeks trying to find him one. Guess why I couldn’t find one? Because there aren’t any.

Geriatrics continues to be an under-served field of profession. People don’t come out of school wanted to work in geriatrics. Palliative isn’t exactly the same thing, but you can see why they are closely related. In all of western New York, there isn’t a palliative doctor unless you are admitted to Hospice.

Having nothing to lose, I contacted Hospice. After phone interviews with me and my dad, I get the call back. No go. He isn’t qualified. His Parkinson’s has to be much further along. It’s a horrific disease that unfortunately waits a really, really long time before it kills  you. It just makes you suffer, sometimes for decades, with no hope of getting better. It just gets worse and slowly robs you of any control whatsoever. I listened to the nurse tell me what late Parkinson’s will look like down the road. It sickened me. I cried for a long time after I hung up.

He has had a backache and needs a pain pill. How simple is that? I’ve been running in a Catch-22 circle for four business days, hitting my head on the wall. Can’t get a prescription without making an appointment. I know that is SUPPOSED to be about practicing good medicine. My cynical (but unfortunately realistic) self knows it is more about getting more money from the office visit. What do they need to see? He’s an 86-year-old man with Parkinson’s who is on palliative care. He is supposed to be kept comfortable. Give the man a damn script. I can’t get him into a good doctor for another three weeks. So his three days of pain may turn into three weeks. Of course we can see another doctor in one week, but neither Dad or I care for him. He definitely does not have a palliative medical mind. He either goes to a doctor he doesn’t want (and still waits another week) or waits three weeks.

What pushed me over the edge was the Parkinson’s doctor. She could have prescribed something, at least to get him through a couple of weeks until he sees his primary. The answer came back, “I don’t treat backs, just Parkinson’s. He needs to see his primary.” I told the nurse about the week I have had. Can someone out there please be humane and give an old man some relief?

She said it’s not about being humane but there is all this controversy about pain meds now. Blah Blah. I know, but an 86-year-old man with a degenerative disease is not the person they need to worry about. It’s all so ridiculous.

All of this time, energy and emotional turmoil for me, and all the physical and emotional turmoil for him over a pain pill. There is another even more ridiculous saga over getting him physical therapy. I don’t even have the motivation to write about that too.

I’m an Aging Care Manager. I am supposed to help people “navigate our complicated medical system.” I can’t even help my dad. So frustrated.

Feel free to share any stories you might have. And if I am missing some loophole, for God’s sake please tell me ASAP.


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When Sense Goes to Cents

This has got to be one of my most clever titles ever. It references what I consider to be one of the biggest problems our medical system has, the change from service to business. The almighty buck is the bottom line. Thus, common “sense” in practice has gone to worrying about “cents” instead.

If you follow Grey’s Anatomy, last week’s episode got me in a snit. It centered around a surgeon who knew she was having a heart attack but couldn’t get the doctors to listen to her because they were following their “protocol” and discounting the actual patient. Of course she ended up having the heart attack and almost dying because of it and I just sit there with my whole body tensed up knowing this isn’t just drama, it’s what really happens.

Last week I took Dad to his appointment with the cardiologist. The nurse had to check his pacemaker. She and I started chatting. Poor Dad. He must think to himself, “Oh God, here we go again.” I explained to her that Dad had switched to palliative care and that I found myself having to explain what to means to medical professionals, even those that work primarily with the elderly. Palliative does not necessarily mean a person is in the active stages of dying.

She told me that she was having the opposite problem in her family. I asked her to explain what she meant. She said while I was trying to get unnecessary services for Dad decreased, she finds herself fighting for services for her sister. Her story was appalling. I was so grateful she shared it with me because it gave me an entirely different perspective. It’s the same problem of having to fight a giant, broken system, but she was coming from the other side of the fence. It stretched my mind and further ignited my passion to try to change the ridiculous way things are run these days.

Her sister is relatively young, in her fifties. She has a degenerative, incurable disease and is now in as assisted living place where she gets medical care 24/7. At this point, her symptoms are similar to that of a quadriplegic as she has no use of any of her limbs. Like Dad, she has a swallowing issue. She was evaluated (like Dad has been a million times) and it was determined she requires thickened liquids. What often happens at this point, is that dehydration becomes an issue. It’s hard to keep drinking when you are on thickened liquids. Dad made me taste his thickened water at his last rehab stay. It was gross. Dad has decided he’d rather take the risk of choking than live the rest of his life drinking that stuff. I don’t blame him.

This woman is in a different place though. She is much younger than Dad and her brain is sharp. Her body just isn’t cooperating. Her sister noticed on one of her many visits that a little bit of regular water was helping immensely. She could communicate with others and would feel much better for a brief time. Dad’s nurse said that she even showed the medical team what a difference the water made and they agreed it made quite an impact.

Now is when the madness starts. Because she has been medically tagged “thickened liquids,” the staff is unable to give her even a sip of water. They can’t stop a family member from giving her some, but they can’t officially do so. Once she is labeled, there is no room for any exception, even when it is clearly medically indicated.

Upon inquiring further into this insanity, she was told they could indeed give her water if her status was changed to “comfort” care – i.e. palliative care. However, if they did that, she would no longer receive physical therapy or any other services she was currently given. Is it just me or is that ridiculous? It seems particularly cruel to do to a woman who can’t move her own arms to get herself a damn sip of water.

It’s about billing and regulations. I certainly understand the need for regulations, but why should you have to stop using common sense? Is there absolutely no room for even the tiniest piece of individual need? Not if you want insurance to pay for it.

My blood boils when I hear this stuff.  To Dad’s nurse- I don’t know if you are reading this, but if you are, thank you for sharing your story. I have no idea how it will take shape, but I am working to try to effect change for people like you and your sister. It’s an uphill battle with little success, but I’m not going to stop trying. Let’s try and bring compassion back to patient care.

Isn’t that just common sense?


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Back to Basics

When I lecture on death/dying, I often talk about how even with all our modern marvels of medicine, human life always comes back to two basic needs- eating and sleeping. When a person is undergoing treatment, neither eating or sleeping is easy to come by. Palliative/comfort care often restores exactly that- the ability to eat and sleep more easily. That is why research shows that people often live longer with palliative care than they do with curative care (chemo, radiation, etc.).

I’ve been thinking about how recently my eating and sleeping have been not been doing so well. Honestly, not eating well has been a lifelong problem. It has been the exception when I have been able to get a handle on eating properly. I’ve actually been successful, but only for brief periods of time. Every day I wake up and attempt to do so again, but usually by 2:00 pm I’ve sunk again. I have all the education I need, I just don’t have the motivation or willpower to follow through. Or something.

I tried to think of a baby step I could take and I came up with setting up a task in my calendar that comes with an alarm. At 8 am every day, I want to have a protein shake. That will start my day correctly and maybe if it is an actual task that needs to be checked off, I can put my OCD to good use. If I can get that to be habitual, my next goal will be to set a reminder up at 9 pm that says, “No more eating” and eventually decrease the time until 7 pm.

Sleeping is another lifelong battle. Even my baby books talk about the problems I had. I’m sure I had night terrors, they just hadn’t been named yet. I’ve done sleep tests at different ages. I’ve tried all the different medicines there are. But lately, I’ve just gotten in a bad habit of watching Netflix until 1 in the morning. Then I don’t want to (or can’t sometimes) get up when I used to. After waking Frankie for school, I go back to sleep. By mid-afternoon I need a nap in order to get through my activities. Vicious cycle. Once I nap, then I’m up at night again.

My baby step was again to add a daily task set up with an alarm. My goal for the first few days is to go to bed at 11 pm, WITHOUT Netflix or anything else. Even if I just lay there, it will help break the habit. Then I can lower the time by 30 minutes until I get to bed at a more decent time for me.

So simple, but sometimes I just have to hit myself over the head. Your eating and sleeping is off, Darcy so it is effecting everything else. You need to fix it.

Tiny, elementary steps that I feel like I shouldn’t need to still be making at 50 years old, but yet here I am. Small, incremental steps are the only way that I know of though, to make changes that won’t make me want to jump off a cliff.

Sigh.

I love the ‘ol AA slogan: One day at a time. It’s better than not trying at all, right?