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Rapid Responses: Rapid Responses published:
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Beware of Speech Pathologists
- William E. Osmun (19 November 2004)
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The lesson is palliative care
- Maureen McCartney (21 November 2004)
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Biding Adieu ...'dying need not become a medical event'
- Bhalendu S. Vaishnav, Smruti B. Vaishnav ,Addl. Professor, Department of Obstretics and Gynecology, P.S. Medacal College, Karamsad (22 November 2004)
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Good death
- Patrick G Beauchamp (24 November 2004)
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William E. Osmun, Family Physician 22262 Mill Rd, Mount Brydges, ON N0L 1W0
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I have learned to be extremely wary of consulting speech pathologists. They appear to want to put feeding tubes in everybody. Never mind that the only pleasure left to many of these patients is eating. Never mind that they are amazingly frail and are soon to die anyway. My encounters with them have made me go home and tell my children if I ever get to the point I can't eat, NO FEEDING TUBES. I'll take my chances with pneumonia, which before the speech pathologists hit the scene did not seem to happen all that much anyway, and if it did was really the progression of a terminal disease. Competing interests: None declared |
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Maureen McCartney, CCDC EHSSB, 12-22 Linenhall St, Belfast, BT2 8BS
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Ros Levenson's experiences at the end of her mother's life were difficult and unnecessary and I sympathise with her. It is hard enough to lose a mother through firstly dementia and then death, without having to struggle for good care. Yet her story has many parallels with my own mother's emergency admission to hospital with long-standing, and end- stage, dementia, and is probably a common experience in acute hospitals. My mother died, undistressed and 'suddenly' in her excellent nursing home, a month after a brief emergency admission when she was assessed as needing 'nil by mouth', a CT scan of her brain, and rehabilitation. But she wouldn't have been allowed to eat or drink under similar criteria before that last admission, and was long past any hope of benefit from a CT scan. I am sorry we had not discussed a policy of no admission, unless in her clear interests, in the first place. Many healthcare staff, especially in hospitals, do seem to 'find it difficult to care for a patient without doing everything possible to lengthen life', even when lengthening life artificially is futile and prolongs suffering. Fear, misunderstanding of end-stage dementia, lack of training and experience in palliative care, a mistrustful culture, and at times, relatives' unrealistic expectations may be some of the reasons. I suspect that often there is little discussion, either in the team or with relatives, about management options. Time to apply the lessons of palliative care to dementia? Certainly, and nursing homes for the elderly mentally infirm would be the ideal place to start, so that non-essential admission to hospital can be avoided. Competing interests: None declared |
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Bhalendu S. Vaishnav, Addl. Professor, Department of medicine. P.S. Medacal College, Karamsad, INDIA., Smruti B. Vaishnav ,Addl. Professor, Department of Obstretics and Gynecology, P.S. Medacal College, Karamsad
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Sir, This is all we need to remember and put into effective practice. It is a human psychology that everyone comes to accept the inevitable reality of life i.e. death.What is more difficult is to come to terms with the manner in which the illness proceeded and the appropriateness or otherwise of the treatment accorded. In other words, the agony of death is often not about why it occurred, but how it occured. This can only be soothed by THE DIVINE'S LOVE. There cannot be a final protocol about the care of the dying since the psychological frame of the family members is in fluid state. Essentially what one needs to work at is achieving a sense of equillibrium that is most appropriate and dignified for the situation . A doctor can be master of treating life but what is really required at the end of life situations is his HIDDEN PRIESTHOOD to come to the fore and provide the much needed support to the family. From spiritual point of view, a doctor is a priest striving for removal of the falsehood or illness and aiming for more profound expression of the hidden God in his patients. I believe this fine art grows in oneself as he matures in the practice. This aspect has not received the necessary importance in medical education. Competing interests: None declared |
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Patrick G Beauchamp, Retired G.P. Kins Thorn, Hereford HR2 8AL
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What a pity that your mother could not have died quietly at home, looked after by her family with nursing support. All the difficulties you describe could have been avoided and everyone involved spared the anxieties which you describe. Competing interests: None declared |
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