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Edited on Sat Mar-12-05 09:43 PM by Heddi
feeding tube is withdrawn.
Even though she cannot feel pain (in the sense that all sensation--pain AND pleasure, is impossible for her), hospice services not only provide end-of-life services to the patient, but to the family as well.
Hospice nurses are among the most caring, compassionate, and emotionally super-humans I've ever witnessed.
Last quarter, in school, we had to visit a hospice service and meet with the nurses. They spoke in length about the power of denial---most often, we associate denial with an emotion the patient experiences, but it's only been recently that we've realized just how powerful it is (as is the whole stages-of-greiving) on the survivors, relatives, friends, and loved ones of the patient.
Many times, patients fear death not because of their own lack of acceptance of their condition, but because they know their loved-ones haven't come to accept the finality of the disease or disease process of their loved one. THe patient fears that they will cause MORE pain to the family if they were to die, so much so that they endure greater pain and suffering themselves in the hopes of reducing the suffering that their loved-ones are going through. THey feel that if THEY can be 'strong' in the face of adversity, it will give family members a reason to be strong.
One of the nurses talked about a difficult situation she found herself in---she was taking care of a woman with end-stage alzheimers. Her brain function was shutting down more and more on a daily basis to the point that not only had she long forgotten the names of friends and family, but she had forgotten how to talk, how to move, how to swallow. Only basal, low-brain functions like respiratory and cardiovascular functions were taking place, and even then, at a rate that would soon be incompatable with life. Her brain, essentially, had forgotten what its entire function was.
The hospice nurse, at the instruction of the physician, was to start giving increased doses of Morphine Sulphate (MS04) to quell whatever pain this patient was going through. Although she couldn't voluntarily move, she still had occasional muscle spazms that injured herself and another family member. THey were completely random and unintentional, but they felt that allowing her to be in a state where she could injure herself or others to be cruel and unncessary.
But the daughter, who was the 'matriarch' of the family at that point, strongly objected to her mother receiving MS04. Why? She didn't want her mother to be a drug addict. She didn't want her mother to become addicted to the Morphine.
THe nurse explained to her that her mother would probably die within a matter of weeks, at the longest, and that the morphine was to relieve any pain she may be experiencing on a basic, physiological level.
THe daughter then accused the nurses of trying to 'kill' her mother by giving her large doses of morphine--of course, the mother had been on morphine for a number of months (perhaps even a year or more) to combat terminal pain associated with her condition and others, and that while a 'normal' person certainly would OD if given that amount of morphine, the mother had built up a tolerance and was in no danger of OD'ing from the drugs, or from being addicted to the drugs.
THe daughter would not relent, and refused to allow her mother to receive the Morphine as ordered by the physician.
The Hospice nurse said the saddest thing was a few days later---the daughter called the nurse, hysterical---her mother was obviously beginning to die---and, as the body often does, was fighting the process. "Give her something to knock her out!" the daughter demanded. The nurse arrived at the house a short time later and started the morphine drip again as the daughter wished. However, because the morphine had been halted a few days earlier, they couldn't give her the large amounts that they had been giving her, nor the larger bolus that they had intended to give her days earlier. Sadly, the mother died, in obvious distress, without the aid of an opiod analgesic as the physican requested.
Knowing her death was imminent, the Dr's and nurses were acting in the patient's best intentions---to give her a large enough dose of morphine over the short remaining course of her life, so that when death's time did come, she would go peacefully and she would feel no pain and her body would not resist the efforts of the heart to stop pumping, or the lungs from not breathing.
The daughter tried to sue the Dr, the Nurse, and Hospice for forcing her mother to endure a painful death. She lost her case, as she had been the one to sign the release form stating that she refused for her mother to get the increased doseage of morphine days earlier.
It's a sad case all around. I'm sure this daughter loved her mother, or else she wouldn't have had hospice there for all those years. But denial is a VERY powerful emotion. Even seeing the gradual, then rapid decline of her mother due to Alzheimers and associated diseases, she could not accept the fact that her mother was dying, and there was nothing in the world that could save her from that fate. She realized the reality and finality of the situation at a time when it was too late to do anything to curb her mother's suffering.
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I feel empathy for Terri's parents. They are faced with the reality of a daughter who is not, and will never be again the girl that they loved so much. Unfortunately, their greif and anguish was hijacked by people who have ulterior motives, who aren't interested in the parent's emotional investment, but rather the policital statements that can be made about this woman's life and death.
They, like so many others, have seized upon people in their most vunerable state. They realize that Terri's parents aren't in a state where rational thought and logical processes run high. They have manipulated and perverted their greif for their daughter and turned it into a political circus--this isn't about TERRI, and this isn't about HER right to live or die. This is about a POLITICAL ISSUE---the right to life in ALL instances, even if not compatable with life. They could give two shits about her parents or their emotional state, and I have no doubt that if they were to come out tomorrow and say "You know, we've come to realize that she should be allowed to die with dignity" they would drop all relations with them (the family), publically question THEIR love for their daughter, publically question THEIR devotion to their daughter, just as they've done with her husband.
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