Friday, October 30, 2009
"Originally, "to palliate" meant "to cover with...a cloak" (Oxford English Dictionary, 1989, vol. 11, p.101). This meaning can be seen in the practice of covering the casket at a funeral with a cloth called a "pall.""
This is nothing new in itself but reading anew where the term "pall" comes from took me back two years. A few days after my great-aunt Teresa died, my grandparents were busy finalizing the funeral arrangements. I was at a track event from one of my youth group girls and I remember it being an unusually chilly Saturday for April. Somehow I had the foresight to turn the volume on my cell phone, as I typically keep it on meeting mode. I was sitting in the bleachers with my co-leader while we waited for the meet to begin. And then my grandma called me and asked if I would like to place the pall at Aunt Teresa's funeral. I was very honored to be asked. We chatted a little longer and then said we'd see each other the next day at the visitation. Until reading the above passage, I hadn't thought about that phone call since it happened. I realized it was the last time my grandma called me. She was diagnosed with stage III multiple myeloma a week after Teresa's funeral and died a month after that. I spent countless hours with her between that phone call and her final moments. But there's something about that phone call that is so precious to me, even though I couldn't tell you what else we talked about or how long the conversation was. She called with a special purpose. She called to thank me for the ways I helped throughout Teresa's time on hospice and the day she died. And she probably ensured that I wasn't driving while I talked on my cell phone- one of her biggest concerns, second only to whether or not I had a sweater or coat to keep me warm in cold temperatures. Ironically I remember little about placing the pall at Teresa's funeral. I might have handed it to the priest and then a few of us placed it on the casket. I do remember feeling odd about playing a part in a Catholic funeral since I and my immediate family are not Catholic. (Imagine how I felt when I and my cousins Clara and Emily carried the elements to the priest at Grandma's funeral! I can assure you we did not partake.) I haven't allowed myself to write much about my Grandma's death but lately I've been flooded with different memories. Maybe that means it's time to write now what I couldn't write then. My grandmother radiated love and I miss her. I am thankful to remember this forgotten moment.
Thursday, October 29, 2009
Wednesday, October 28, 2009
Tuesday, October 27, 2009
"We aren't there yet, but close," she said.
As my blog's title states, I'm a social worker, not a nurse. But even I know from reading that if the patient cried and became extremely anxious when needing to urinate and requested to go to the bathroom repeatedly, it just might indicate a UTI. How on earth could they have missed that? Why would a psychotropic be the first response and why would it come before a psych eval? And why would medical health professionals need to be trained to look for medical issues before resorting to psychotropics? It just doesn't make sense. I look forward to reading Part Two tomorrow and hope that this investigation will lead to change.
Another interesting article concerned the rise in indigent burials, by 30%, in Chicago this past year. Indigents are buried in Homewood Memorial Gardens, if they have not been identified or if family cannot be found or do not have funds (or are unwilling) to pay for burial. Some financial assistance is available. For people who were on or were eligible for public aid, Illinois Department of Human Services reimburses funeral homes or the family after the funeral, allowing $500 for burials and $1,100 for funerals. The Cook County Veterans Assistance Commission buries any honorably discharged indigent veteran, up to $600. Homewood buries indigents at a cost of $235 per body. What is impressive is that they do not just bury these people, they also memorialize them and allow mortuary school students to participate in the process. Consider these words: "We do not know the circumstances in their lives that brought them to this grave," said Kowalski, also an instructor at Worsham College of Mortuary Science. "Many may have died in poverty, others may have simply outlived their families. Our beginnings do not know our ends."
Monday, October 26, 2009
The argument then becomes whether one can assign an age cut off, as seniors are not "one size fits all." Some medical experts believe that if a senior is healthy and would be a good candidate for treatment, then they should take the test.
An important question for seniors to consider is what they would do if cancer is found. If they would not pursue treatment, then there is no need for screening. If however they would want chemo, radiation, or surgery, then they should ask to be tested. Above all, a senior must advocate for their wishes either way.
On a lighter note, I went to visit a patient in a group home this afternoon. The other residents are quite demented. As I visited my patient, one woman looked directly at me and distinctly said: "I don't love you...but I don't hate you." Later she was railing on about how "I am not a vegetarian!"
Wednesday, October 21, 2009
Monday, October 19, 2009
Sunday, October 18, 2009
SOMEWHERE BETWEEN HEAVEN & EARTH
by Cindy Bullens
I curse the night
I watched you slip away
Wouldn't have done no good
To beg you to stay
You were here beside me
But now you're gone
I'm just trying hard
To carry on
But there's no rhythm in the rain
There's no magic in the moon
There's no power in this pain
Til somewhere between Heaven and Earth
I can find you again
Hearts are broken
And dreams are lost
But I made a promise to love
At any cost
Little did I know
The price was so high
In the blink of an eye
There's no rhythm in the rain
There's no wishes in the stars
there's no power in this pain
Til somewhere between Heaven and Earth
I can hold you again
If I could one more time
Feel your hand in mine
Hear your voice call my name
And whisper sweet good night
Then there'd be rhythm in the rain
There'd be magic in the moon
No such thing as love in vain
And somewhere between Heaven and Earth
You'd be with me again
And I could see you again
And I could hold you again, my baby
Somewhere between Heaven and Earth....
I will see you again
In terms of society's view of death: "It's not that I object to my death; I just don't want to be there when it happens." -Woody Allen
We're on the same path as our clients when we're in this line of work. We must face our own losses and face our mortality.
Grief is like phantom limb pain.
The best gift we can give the grieving person is to recognize that we do not know what this experience means to them and to communicate that we are willing to find out and understand.
Your task when you are grieving is not to let go but to find a different way to hold on. Death ends a life but it does not end the relationship.
Monday, October 12, 2009
CMS started collecting data in 2007 and will launch phase 3 on January 1, 2010. Hospice providers will then be required to list visit lengths and number of visits by physicians/nurse practitioners, nurses, social workers, and aides, as well as PT, OT, and ST, and the length of phone calls made by social workers that are related to the terminal illness. It is well worth noting that complete comprehensive documentation by the interdisciplinary group (IDG) members is even more critical now that so many governmental systems are watching hospice providers. Documentation provides evidence of the care provided, verifies the quality and coordination of care, ensures continuity of care, shows compliance with various regulations and organizations, provides substantiation of the sequence of care in the court of law, and provides the basis for service reimbursement. (Ah, yes, it always comes back to money.)
Documentation should tell the patient's story in a legible, complete, and consistent way. The story begins with the initial assessment of the patient's needs, as well as the needs of the family or caregiver. IDG members should consistently and objectively document the patient's and family's/caregiver's status and the state of their environment each contact. There should be 1) a complete description of interventions provided to the patient and family or caregiver, 2) the patient's pain and symptom presentation and interventions and evaluations, 3) communication with the MD, other IDG members, and any nonhospice professionals, and 4) the observed or verbal responses to interventions and care.
Stay away from vague, inconsistent, and contradictory statements about the patient's status or clinical interventions. Avoid using these: "continues slow decline," "remains hospice appropriate," and "needs more care." Make sure the hospice team is seeing the same thing, i.e. the RN documents that the patient is ambulatory while the aide lists the patient as bedbound.
Comparative charting is a best practice method. Comparative charting contrasts the patient's present condition to their prior condition. This also individualizes the patient by looking at their specific trajectory of decline and presenting specific information instead of generalizations. Assessment of the terminal condition should be emphasized and also include any comorbidities that impact the prognosis. There should also be an individualized description of the patient's status as it relates to the terminal diagnosis. Examples can include documenting any limits to daily activities for a patient with CHF or describing the use of oxygen for a patient with COPD.
My organization is currently examining how we document and trying to streamline the process. Social workers and chaplains started using Assessment-Intervention-Plan as a guideline for our clinical notes. It was an adjustment at first to figure out how to structure the clinical note, since I was used to a free form narrative. However, now that I've been doing it for about 2 months, I love it! Each visit, I copy the old note in to the new one and tailor it to the visit I just made. It serves as a refresher for what I've been working on with that patient and helps me keep my plan of care more current. I don't know what Medicare will throw at us next but I think my organization is ready to meet the challenge.
Thursday, October 08, 2009
A 2 minute video in which Bruce shares thoughts from his journal in regards to having cancer:
Tuesday, October 06, 2009
Saturday, October 03, 2009
In any case, here are some of the ways I try to maintain confidentiality:
1. Under my blog title, it states that patient names and identifying information has been changed. This is in accordance with the great and mighty HIPAA.
2. Patient names on this blog are never close to their actual names, which is sometimes a shame because I could never make them up. Sometimes I use TV or Movie characters, random initials, or a random name.
3. I vary ages, sometimes accurate or sometimes a general "in their 70s." It depends on why I'm sharing the story.
4. I usually give an accurate diagnosis unless the diagnosis has no bearing on the story.
5. I struggle with how much to share when it comes to a patient's background or family dynamics. I find those aspects to be so compelling that I want to tell it all but I have become better over the years at picking and choosing what to share. If a patient's story is one of a kind, then I tend to change all the other information.
6. When pictures are included (i.e. Bucket List patient), permission is always requested first.
Like the other social work bloggers, I never share a story that I did not experience myself. I originally thought this blog would be a good outlet for me to process the hospice and bereavement worlds but it has grown in to something more. I am honored that someone would want to read this blog and that my clumsy words might be of use to them. I appreciate all your feedback and insights. If you ever think I am not safeguarding my patients and their families, please let me know! We could all use a good reminder once in awhile.
Any suggestions or pointers for how you protect patient identities while blogging?