living your best to the end

Pain as a Cause of Agitated Delirium

“Can’t you do something about her pain?” An 85-year-old woman with multiple medical problems, including dementia, coronary artery disease, renal insufficiency, and peripheral vascular disease, was admitted to our hospital with urosepsis. Her hospital course was complicated by the development of dry gangrene of her left foot, Candida sepsis, Clostridium difficile enterocolitis, and multiple deep sacral and trochanteric pressure ulcers. When housestaff asked her son if he wanted us “to do everything,” he always answered yes. She was able to be weaned from the ventilator and was transferred to a medical unit for continued treatment of hospital-acquired C difficile enterocolitis and wound care of her multiple stage 4 ulcers. She underwent 4 surgical debridements under general anesthesia in the operating room over a several-month period but remained persistently febrile despite continuous treatment with broad spectrum antibiotics. The patient was withdrawn, tense, and turned toward the wall in a fetal position, but she screamed and cried out for her mother, moaned in pain, and tried to hit and strike out at the nurses when they performed her twice-daily dressing changes. She refused all efforts to feed her or offers of sips of fluid and received all nourishment and hydration through her feeding tube. She did not respond to the voice or touch of her son or grandsons when they visited. On day 63 of her hospitalization, a palliative care consultation was requested by the nurse manager on the floor because of nursing staff distress about their perception of having to hurt the patient during dressing changes. With the agreement of the attending physician, who had refused to give medication, on...

Music Therapy: Unlocking the soul

Music has charms they say.. (Joe Jackson: ‘Slow Song’) Amy Clements-Cortes For Amy Clements-Cortes, PhD, MusM, MTA, the charm of music is its ability to accomplish a multitude of health and wellness goals.One of Amy’s areas of specialty is end of life music therapy and specifically using music to help clients complete relationships. “When we complete relationships in our lives, there are key sentiments that need to be expressed to help us accomplish these completions. “I Love You,” “I Forgive You,” “Forgive Me,” “Thank You,” and “Goodbye.” Music can unlock emotions and communication where memory loss or the ability to speak has become an issue. For example with dementia, Parkinson’s and Stroke survivors. “Music provides an outlet for expressions of grieving and loss as people come to the end of their lives. Music helps express feelings that are difficult to speak about such as Holocaust experiences.” Working with fellow health-care professionals such as those in speech/language therapy: “I can help augment the work clients are doing in speech therapy by engaging the client in vocalizing vowel sounds to music, so they can hear their own voices.” It’s not just any music that Amy uses: she makes it specific to the situation and the client, asking what music they liked, gently coaching with prompts such ‘what soothes you, what songs did your relative listen to when they were in their 20s?.’ With the populations Amy treats, this isn’t always possible. “It’s a bit of a fishing expedition I’ll research what music was popular in their day, or if they’re from another culture, will consult with musicians from that culture.” Amy...

MedicineX at Stanford U: all the elements of reality tv

Life with several chronic health conditions  For 3 days, I was surrounded by remarkable people whose litany of health issues and coping techniques had all the ingredients of a successful tv series: Courage, drama, humour, pathos, ethos, mystery, adventure, tragedy, fortitude, lateral thinking, creative thinking, tears, fears, bonding, loss, disappointment, triumph over adversity, love, hugs and hiding out as necessary. These stalwarts have diseases affecting every system in the body: Heart, lungs, liver, kidneys, immune, respiratory, digestive, musculoskeletal, amputation, brain. Many are also caring for a loved one with one or more serious health condition. Health care professionals lurked at every corner, and technology of all sorts is in evidence. Perhaps, reading this, you’d expect the series to take place in a retirement home, assisted living or nursing home. Not so. This amazing group was at Stanford University in Palo Alto California. The youngest attendee – Emily in her 20’s, who wrote a poignant blog, Letting people care for you. Not often easy and another lesson learned. MedicineX: Warmed the heart and the spirit It’s a conference designed around and for patients. A conference that aspires to change the way medicine is practiced and the way systems are designed; a conference that changes – for the better – relationships between patients and providers, and that promotes the concept, practice and benefits of patients helping patients. These desperately ill people are brought together by a determination to have control, and take control of their health and their lives and whilst on this journey to support each-other. This was evidenced several times. As an example, when one of the ePatients had...

Dignity Therapy at Life’s End: Thank you Dr Harvey Chochinov

Dignity Conserving Care asks at life’s end: ‘What do I need to know about you as a person to give you the best care possible?’ To give an answer as a person, rather than as a health condition is a focus-changer for providers and for patients alike. As a patient – albeit feeling my healthiest –  I wouldn’t be able to answer that question without some serious soul searching.  However,  thinking about this, when depression dropped its darkness on me, I told my GP of almost three decades: ‘I so hate not feeling energetic or optimistic’. I could do that because she’s come to know me as a person. But at life’s end, will she be there with her specific knowledge of what makes me, me? My family knows me both energetic and optimistic, and fatigued and depressed. But I’ve not told my family it’s one of my worries at life’s end – oxymoron tho this may be – I don’t want to die depressed. I am aiming for a joyful departure. I feel more confident in this, knowing about Dignity Therapy: Thank you to Winnipeg’s Dr Harvey Max Chochinov  – a psychiatrist who has been forever interested in how people cope with and manage chronic debilitating and often terminal illness: Dr Harvey Chochino Dr Harvey Chochinov: “My older sister was born with and lived with Cerebral Palsy, so I was a brother who grew up knowing something about chronic life altering conditions.” Moving forward in his career, studying at Cornell, Chochinov found that in his day to day working largely with cancer patients… “what patients encountered coping with chronic, deteriorating...