Unpleasant Conversations...Hospice and Palliative Care


Unpleasant Conversations...Hospice and Palliative Care

I'm sure this has been discussed  on this site before, but it has happened again over in my neck of the woods.

Today was interesting. For starters, I pulled a back muscle in the morning while doing a light workout--in an attempt to be "healthier" and to "take care of myself." Sigh. Also, my Gram's daytime caregiver was sick, but we were lucky enough to get our weekend gal to come in for a few hours....so I could work-out...and...hurt myself. Better luck next time, I suppose.

More importantly, today was the day we met with my Grandma's home health nurse and two nurses from Palliative Care. As I sat there with an ice pack on my back, I watched my grandmother get visibly upset at the idea of Hospice and Do-Not-Resuscitate orders, wishing I could do more to comfort her. She refuses to let Hospice enter the picture, even though it would probably help us all out. To her, Hospice = Imminent Death, no matter how many times it is discussed.

The worst was watching her stare at the nurse as she tried to explain that if any of us tried to use CPR on her, the damage could be fatal. This has been explained to us all before, but it never seems to matter--Gram always says she wants us to try and save her at any cost.

I've always assumed that it would be the EMT's in that position, that it just wouldn't happen, or that she'd be in the 2-3% that would survive the chest compressions. I suppose if I think about it realistically, it doesn't make much sense. Her home health nurse said that she didn't want me to be the one to break her ribs and inadvertently kill her. That goes without saying, but it did give me a moment's pause to really think about what it would feel like to be in that position: trying to save my grandmother while breaking her bones in the process. I can't think of anything more traumatic. I have been present during T.I.A.'s and found that giving her a sternum rub to wake her up was stressful enough. I can't imagine having to do CPR with her in such a fragile state.

After everyone had left, my grandmother said to me that she did not enjoy the company and that she "felt like they were planning my funeral." Knowing her, this could be an honest confession, or it could be a slight jab intended to make us feel guilty for speaking of such things. Regardless, how does one attempt to have these conversations without them sounding morbid and without causing offense?

Palliative agreed to have their Chaplain come out and speak with her, and we've had other ministers over as well, but it doesn't seem like any of them have really worked with her to help her talk about the fact that she is dying. I suppose it's easier to not talk about it since she doesn't have any terminal illness but is instead just in declining health. It's harder to talk directly about something that is sort of elusive.

So how to handle such things? I feel I should defer to those who know best, such as clergy, but the ministers we've had visit with her seem to stick mainly to niceties rather than getting to the meat of the issue. I know it's hard to talk about it, but must we all remain in denial and talk of the D--word only in hushed voices?

What have the rest of you done in situations such as these?

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