Finding the Words...

Sometimes, it seems to be very difficult to say what needs to be said. Sometimes there is an elephant in the middle of the room, and nobody will say so. Sometimes, the words that need to be uttered cause palms to be sweaty, hearts to pound, and voices to crack.

Sometimes, we have to acknowledge things that are hard to acknowledge. We want to talk about light-hearted things and make someone laugh.

And that someone is dying, and desperately wants someone to say that they are willing to talk about it.

I saw such a patient yesterday. He has cancer. None of his physicians will talk about it. Oh sure, they have told him what he has, and that the prognosis is “hopeful”......but nothing else. And then, his oncologist ordered Home Health visits for palliative care.

And he knew I was there to give him palliative care. He just didn't know what that meant.

So we talked about it. We talked about what his physician told him. We talked about his religious beliefs. And then we talked about what all of it meant to him.

Simply put, there are three basic types of care: curative, seeking to find and administer a cure for the ailment; pallliative, not seeking a cure, per se, but seeking treatment to palliate the symptoms associated with the diagnosis; and hospice care, helping the patient live his last months symptom free.

That's right: Hospice is about LIVING, not dying.

It is about finding a little bit of joy in each and every day. It is about saying I Love You to those who need to hear it. It is about mending fences, if needed and possible. It is about getting one's finances and personal business in order. It is about finding serenity and calmness, while coming to terms with what is happening, pathophysiologically speaking.

I have blogged about such patients before, in “The H Word” “Arthur” and again in “Endings”...

So yesterday, I told this patient about the differences between palliative care and hospice. He is still considering chemotherapy and/or radiation, so he is not ready for hospice care. Palliative care, being a bridge of sorts, will provide him some of the things that help in hospice care, such as chaplain visits, if he so chooses.

I shared the plan of care that I had developed with his needs in mind. I asked if he thought it was appropriate, and would meet his needs. He said yes, it was and yes, it would. He asked if we could come see him each week, and that is what we are planning to do.

He had several more questions about his symptoms. I know it was difficult for him to ask me because he couldn't make eye contact while he spoke. I told him what some of his choices would be and I told him that he doesn't have to make decisions right now.

In the end, as I got ready to leave, he had a lot to think about. He needed to discuss the options with his wife, and he needed some rest, too. He thanked me for being forthright with him and answering his questions.

I just hope I found the right words...