posted
On-demand pain medication is a wonderful thing. They hook a little box up to your IV, and you press a button whenever your pain gets too intense. If it’s been x minutes since the last dose, you get morphine (or whatever other drug you’re on). If it hasn’t been x minutes, you don’t. The patient can’t overdose, but also doesn’t need to take the medication if they don’t need it. Great use of technology!
However. When a dying patient gets to the point that they are unable to press the button for themselves, and even more so when they get to the point that they are unable to communicate to a family member that they are in pain, it’s time to switch to an old-fashioned steady-drip delivery system. I had a parishioner last fall who was dying of leukemia, in the last stages, completely unresponsive, and the nurses told his family that to keep him as comfortable as possible they should press his morphine button as soon as the required 20 minutes had elapsed. His daughter slept in the chair by his bed, with a kitchen timer in her lap. All night she would wake up, push the button, set the timer for another 20 minutes, and try to doze off again. Finally a nurse came on duty who agreed that this was ridiculous and she called the doctor to get the prescription changed to a regular drip.
I don’t interfere in parishioners’ medical choices – it’s not my place. But after that incident I do tell families not to be afraid to ask the nurses to switch to a constant dosage when the person can no longer communicate. “On demand” makes no sense when the patient is no longer able to “demand.” And once the drug is being administered regularly every x minutes, there’s no need to have families sitting around with egg timers.
Sorry about the rant. I’ve seen this with every single dying person I’ve visited in one particular hospital, and I just got back from there, where I saw it again. Posts: 9866 | Registered: Apr 2002
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Sounds like that particular hospital has some kind of policy in place that keeps this from being the norm. I know of very few places here that would not automatically go to the drip once the patient is unable to do it themselves.
Perhaps a letter to the hospital administrator is in order if you have witnessed this several times at the same facility. Sometimes that is what it takes to make them aware of how it appears to others, and to make a policy change...
posted
Not completely on topic but in the same vein if you'll pardon the pun. This typifies overreliance on technology to the point of circumventing common sense.
When you spend 5 minutes looking for the remote control to change the tv channel.
Spending 10 minutes looking for a calculator to find out what 15 x 27 divided by 4 equals.
It just seems that many times people don't stop and think about the end they are reaching for and instead concentrate on the means. Common sense folks! Use it.
Posts: 2022 | Registered: Mar 2004
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posted
I could have sworn those devices also had timers set on them, so that something is administered if the button has not been pushed in so many minutes. Or is that just for non critical patients?
Posts: 1170 | Registered: Jan 2003
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posted
Well, in yesterday’s case it turned out to be a non-issue. My cell phone rang just as I was posting this thread and I went back to the hospital. He died about an hour and a half after I got there, and since he was still able to talk a little when I left that afternoon, at most he was unresponsive for three and a half hours before he died. And he hadn’t been in much pain earlier – never used his button anyway.
In the situation from last fall the man had been in a lot of pain and using the morphine button frequently. But as stupid as I think this hospital’s practice is in this area, getting that particular family involved in writing a complaint letter at this point would be a very bad thing (for them).
Sidenote:
quote: more medication => less likely to breathe well, or at all
I know. I’ve been in on lots of discussions about balancing pain relief with the possibility that more medication will shorten the person’s life, and what exactly is the line between comfort care and possible/accidental euthanasia. A few with families that were hoping that the extra morphine would shorten the dying process. Others that wanted the pain relief, but didn’t want to take any chance that their action might hasten death.
But most of the situations I’m involved in are cases where the person is going to die within days (or at most, weeks) no matter what treatment they receive. I can’t imagine having to deal regularly with some of the situations sndrake works on – where the person has the possibility of months or years of life.
Posts: 9866 | Registered: Apr 2002
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