Al

One of the beautiful things about volunteering for two years is that you have many opportunities to meet other interesting people who are traveling and giving of their time. These past two weeks, I was very fortunate to follow a married couple from the U.S. that has been traveling since January touring the world and volunteering in various hospice settings. Their perspective is truly unique. The husband, Pat, is a general practice doctor who works a bit in hospice and the wife, Deb, is a clinical nurse specialist in a psychiatric clinic. Not only do they have experience in hospice in the U.S. , they have experienced hospice in a handful of third world countries. This past week they brought the wealth of their experiences to hospice in Chimbote, Peru. It was very heartwarming to see the staff respond to their advice.

One patient, in particular, captured the essence of their mission. Al (name changed) was dying of a disease, pulmonary fibrosis. It is a disease that causes a lot of discomfort. As the lungs lose their elasticity, it becomes painful to breath. The patient has a hard time catching a deep breath and can experience a similar sensation to that of drowning. Al had definitely been a challenge for the staff in hospice. He was psychologically dependent on oxygen. Much of what he did seemed to be for show. He and his family were anxious and constantly demanding attention. Unwilling to leave his bed, and with no call-lights around in hospice, he would wrap on the side of his bed with a spoon. The clanging would bring the staff throughout the day and his requests were always tied into his anxiety… help with the bed pan, request for meds for nausea or pain or a need to increase the oxygen.

Pat put him on morphine. Morphine is available in hospice but it is reluctantly prescribed here. Many fear addiction or loss of respiratory drive. Pat was able to educate the hospice doctor and the patients family about the benefits of morphine, especially acting directly on the lungs and aiding Al, the patient, in comfort.

Palliative care, care that emphasizes comfort rather than finding a cure, is a corner stone for hospice in the U.S. but is still a relatively young concept in Chimbote. Families and even the staff put a lot of effort into sustaining life, even when someone is actively dying from an incurable disease. Al illustrated this point as well. With the morphine on board, Al’s respirations returned to normal. The morphine did not depress his respiratory drive. He was able to verbalize he was comfortable and anxiety free. His requests became infrequent and he began to sleep more. You could tell he was starting to let go.

Whenever a question would arise from the staff concerning Al’s care, Pat would continually defer to the patient. He assured the patient we were doing everything we could but with his disease, he would, at some point, inevitably decline. The pulse oximeter, a device that monitors oxygen saturation in the blood was only at 54% for Al. Not a huge surprise with pulmonary fibrosis. The staff wanted to change to a non-rebreather mask that can deliver a higher concentration of oxygen but the patient preferred the nasal cannula which allowed him to talk and eat with greater ease. Pat simply asked him , “what do you prefer?” The patient kept the nasal cannula.

The patient also was sleeping through some of his meals, and the staff wanted to decrease the morphine to make him eat again. Pat’s question again went back to the patient, “are you hungry?” “No”, Al responded. The staff needed to learn to let go as well. Many patients in hospice become like family and this can be difficult.

Pat estimated Al probably only had about three days left. The most important thing for Al was that he was comfortable, pain free and anxiety free. The staff finally understood this and Al’s family was called and notified to prepare for his death. Instead of spending his last days in fear, Al realized he was going to be ok.

I am grateful for Pat and Deb’s presence in hospice. I couldn’t help but think of the Buddhist saying, “When the student is ready, the teacher appears.” Their visit could not have come to hospice in Chimbote at a better time. If you wish to read more about Pat & Deb’s travel adventures please check out their blog at www.lalleywalkabout2011.blogspot.com