Hard Choice for a Comfortable Death: Sedation

[groovedaddy]

In almost every room people were sleeping, but not like babies. This was not the carefree sleep that would restore them to rise and shine for another day. It was the sleep before — and sometimes until — death.

In some of the rooms in the hospice unit at Franklin Hospital, in Valley Stream on Long Island, the patients were sleeping because their organs were shutting down, the natural process of death by disease. But at least one patient had been rendered unconscious by strong drugs.

The patient, Leo Oltzik, an 88-year-old man with dementia, congestive heart failure and kidney problems, was brought from home by his wife and son, who were distressed to see him agitated, jumping out of bed and ripping off his clothes. Now he was sleeping soundly with his mouth wide open.

“Obviously, he’s much different than he was when he came in,” Dr. Edward Halbridge, the hospice medical director, told Mr. Oltzik’s wife. “He’s calm, he’s quiet.”

Mr. Oltzik’s life would end not with a bang, but with the drip, drip, drip of an IV drug that put him into a slumber from which he would never awaken. That drug, lorazepam, is a strong sedative. Mr. Oltzik was also receiving morphine, to kill pain. This combination can slow breathing and heart rate, and may make it impossible for the patient to eat or drink. In so doing, it can hasten death.

http://www.nytimes.com/2009/12/27/health/27sedation.html?th&emc=th

[kestrel91316]

1. "Hard" choice?? It's a fricking KINDNESS.

[bluescribbler]

6. Yes, it is a kindness, but it is still a hard choice

I know. I had to make that choice for my wife a month ago. I'll never forget the look on her face when they loaded her into the ambulance for the trip to the hospice home. I had never seen such sorrow. She knew that she would never be coming home again. It was the hardest decision I ever had to make, even though I knew it was the right thing to do. I would make the same decision again if faced with a similar situation, but it still was hard.

[hedgehog]

8. I'm so sorry you had to make that choice. Blessings on you for

thinking of her rather than yourself.

[no_hypocrisy]

2. Exact situation with my mother.

Stage IV cancer of the lung. Friday and Saturday she and I were having clear discussions, discussing hospice and options. Sunday, she was "asleep" and our father warned me and my sibs "not to wake her" which I thought was a strange choice of words. We thought she had lapsed into a coma and died. I later wondered if she was given a narcotic "off the record" to hasten her demise in order to prevent her the horror of inhaling and nothing "happened".

This article is both a comfort to me and also peeling off a painful scab. I remember it like yesterday.

[Warpy]

3. Non demented patients suffering unbelievable pain

from horrible things like pancreatic cancer often turn down drugs just before death. It seems our brains release all the stored endorphins and enkephalins and we ride out on a tide of happy hormones.

However, for frightened and agitated patients, heavy sedation is the kindest thing we can do for them as they near the end.

It's not a hard choice for anyone who has seen death.

[dmallind]

4. I guess this will have to do until we become civilized enough to accept voluntary euthanasia. NT

[dkf]

5. Please let there be sanity by the time I get to this stage.

[bemildred]

7. Hard choice my ass.

There is no benefit in keeping terminal patients who are agitated or in pain that way.

[hedgehog]

9. I think these words about forcing water and nutrition on a patient

are important:

"food and water may only prolong agony by feeding the fatal disease. "

Not to trivialize anyone's pain by the comparison, but I've had six cats and two dogs pass quietly without assistance. One dog died suddenly, probably from a clot thrown by a tumor that would soon have made itself known by making him miserable. The others faded away from an illness or just general old age. They didn't want to eat or drink the last few days, just sleep quietly in a safe corner.