Carl Gandola: Palliative Care

SOAP notes. BATHE people.

SOAP notes. BATHE people.
We know about SOAP notes. But do we BATHE the patient?

Letter of Condolence

Letter of Condolence
The NEJM Sounding Board article is not available for free access online. (Unfortunately only original articles are released after six months, not reviews such as this). So I will bring in paper copies. (N Engl J Med 2001;344:1162-1164). Expressing condolence humanizes a part of our work.

Non-pain symptom management

Common symptoms
How do we best manage dyspnea, nausea, vomiting, constipation, anorexia, fatigue, and insomnia? Common non-pain symptoms seen every day. Here is a clinical quiz put together by Dr. Sydney Morss Dy, modified for the web. (Under construction, but ready for testing).

DNR End of Life Decisions

"Any advice on Do Not Resuscitate?"
Here are some thoughts. You can read specific sample conversations from Drs. Lo, Quill and Tulskey (deals with palliative care, but applies to DNR). Or see the process broken down to helpful steps by Drs. Weissman and VonGunten. Even pocket cards with phrases have been tried.

Let Evening Come

Let the light of late afternoon
shine through chinks in the barn, moving
up the bales as the sun moves down.

Let the cricket take up chafing
as a woman takes up her needles
and her yarn. Let evening come.

Let dew collect on the hoe abandoned
in long grass. Let the stars appear
and the moon disclose her silver horn.

Let the fox go back to its sandy den.
Let the wind die down. Let the shed
go black inside. Let evening come.

To the bottle in the ditch, to the scoop
in the oats, to air in the lung
let evening come.

Let it come, as it will, and don't
be afraid. God does not leave us
comfortless, so let evening come.

"Let Evening Come" by Jane Kenyon from Otherwise: New and Selected Poems (Graywolf Press). Writer's Almanac June 12, 2002.

Visit writersalmanac.com for a daily poem, some history, and dose of human creative endeavors.

(For something completely different, try Dylan Thomas.)

Advance Directives

Advance Directives
Your patient asks some questions about types of advanced directives. You stop and think about the terms. You know that...

A Living Will (which is a set of instructions) and a Durable Power of Attorney for Health Care (which designates a proxy) are...

1. written by the patient
2. authorized by a physician
3. best understood by you, a physician, after you have completed your own
4. not accepted in all states

A. 1,2,3
B. 1,3
C. 2,4
D. 4

Helpful for patients and yourself is a thoughtful guide from the Ohio Hospice and Palliative Care Organization. B is the answer.

Noontime Discussion...Your Rotation
Learn about your palliative care & hospice rotation on Tuesday July 16. Pam McCabe, RN from Hospice of Cincinnati plans also to cover some basic aspects of hospice, such as how to make a referral and the concept of Partners Nurses.

Pam along with Dr. Rebecca Bechold have worked to shape a variety of experiences for you at hospice, including home visits, inpatient work, and exposure to the hospice pharmacy. (Dr. Patel is rotating to Hospice this month, as part of Ambulatory.)