Monday, September 06, 2004

The Peace that Passes all...

Great comments from Sparky and Beppe on the last post. Your words were really encouraging. Thanks.

The social worker called me the Friday before Charlie died. She asked if I would be willing to make a joint visit with she and the RN. “Of course.” I said. "Just let me grab a burger and head out that way.” She wanted us to be there because the RN said that Charlie was in what we call, “terminal agitation.” That means that he was confused and moving around everywhere not being able to rest. The medical people who do “Palliative Care,” know that there are several problems with terminal agitation. One is that it takes some one to watch a patient 24/7 to make sure that they don’t get hurt and usually that person is the patient care giver (the husband, wife, adult child, etc.) In the hospital or nursing home, the patient is usually tied down to prevent injury but with hospice care, families are reluctance to do that. Another problem is that the agitation prevents the patient from dying a quiet, peaceful death. So, the patient is disturbed, the care giver is disturbed and the process becomes painful and suffering is increased.

Charlie was in terminal agitation and he was able to get out of bed so I knew that it must have been pretty wild around the house for he and Beverly. I dreaded it because I’d gotten attached to Charlie and I knew that this was going to be hard for me. I didn’t want to see him in the last stages of his disease. I got there before the rest of the team and Beverly and Charlie’s daughter, Cathy were literally herding Charlie out of the way of harm. He would get into bed, then get up and go to the bathroom but he’d head the wrong way. He had O2, so the tube would get tangled and someone would have to guide him around the obstacles to keep him safe. Then he’d sit in his chair, forgetting that he wanted to go to the bathroom.

Charlie was skin and bones. He was a skeleton and I was sick at heart when I saw him. Finally, after trying to get his attention, Beverly said, “Look, Charlie. Ken’s here, why don’t you go sit with him.” Charlie suddenly saw me and came across the room like a drunken man and I caught him as he nearly fell into my lap. He sat on the sofa next to me and I rubbed his back. God- he was all bones! Charlie sat there for the longest time and I took full advantage of the time by talking quietly to him to try to ease his agitation.

Soon after the social worker arrived, Beverly and Cathy got him to lie down for a while. By the time the RN arrived, Charlie was sound asleep. We gathered in the living room and our team RN explored the options with our support. The family was relieved when they heard what we could do for Charlie. The RN tried to talk to Charlie about it but she couldn’t ‘rouse him. There was so much relief in the home that in time, the social worker and I were able to leave. The RN worked late into the evening getting doctors on the phone and lining up the pharmacy to get her the medicationthat Charlie needed to control the agitation. Charlie died two days later about as peacefully as anybody could with his disease.


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