The Pleasures of Cheesecake, A Vacation from Death and Dying at Home
JULY 29, 2009 TAGS:
Dear Judy,
My father is dying of a prostate cancer, which has metastasized faster than any member of his allegedly brilliant and ridiculously expensive medical team ever predicted or imagined. His favorite doctor recently indicated he might die in a matter of months, maybe a year. He also has a problem with his sugar levels. So it's all a big mess, and the whole family is completely depressed.
Him too about half the time.
Another big problem: Last week my father asked me to buy him his favorite kind of cheesecake from a favorite baker. I did so. He eats a small piece every day, and it seems to improve his mood for a few precious minutes.
My mother is furious with me, though -- and with my father. She told me I was behaving irresponsibly by ignoring his secondary condition; she has begged him not to eat the cake. He either ignores her, or laughs, saying he has nothing to lose.
I personally agree with my father. But now that he's basically polished off the cake, my mother has flat-out forbidden me to re-visit the bakery shop for another. OK, Judy, which one of my parents should I disobey?
Carol in Beverly Hills
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Dear Carol,
Normally, I'm all for giving the terminally ill exactly what they want. In the hospice where I volunteer, families have been known to bring in packs of cigarettes for patients with Stage 4 lung cancer, and nobody on staff fusses about that, as long as the smoking takes place out of doors on the patio. On the other hand, patients can drink alcohol only if the hospice has received a doctor's order saying it's OK.
So even license has to be bordered by common sense. In this instance, I'd suggest a talk with one of your father's doctors (or perhaps a doctor you might respect more than the ones your father selected) before heading back to the bakery. A thumbs-up will ease not only your mother's objections -- I think it will ease your conscience as well.
Thank you for writing,
Judy
--
Dear Judy,
At the risk of sounding completely selfish, I can't stand it any more. Everyone around me seems to be dying, and I just don't want to deal with it (or them) any more.
In case you think I'm exaggerating or just crazy, it's pretty much literally true: My mother-in-law who has Alzheimer’s has a year or two to live, we're told. A really cherished roommate from my college years is likely to die within months. And a former boss whom I respect and to whom I owe a lot is also seriously ill with stomach cancer. He's only 48.
Judy, I can't stand the smells and sight of sickness any more. I've had it. I see my mother-in-law pretty regularly, and I'm there for my good friend, as well as my former boss. But frankly, I'd like to run away -- and never come back. I'm totally exhausted, depressed, and near physical collapse.
But how can I avoid these visits? It seems cruel to stop any of them now, while these people are so needy. At the same time, how can I save myself? I'm so exhausted, I can barely move. Please help. I'm really desperate.
Amy
Dear Amy,
Take a deep breath. Now. In fact, take several. Then close your eyes and empty your mind for a few minutes. After that, start thinking -- not about death or dying or illness -- but about who can help you out here.
Perhaps, for example, your husband, and other relatives, might tend to his own ailing mother in the months ahead, freeing you up for other activities. Maybe you might contact some old friends from your college years to visit your sick former roommate. Then try e-mailing a few people who know and like your ex-boss; I'm sure he will benefit from their visits.
In other words, right now you're of limited use to anyone. And you're not being kind to yourself. You need a vacation from death.
So make your plans -- and take it.
Thank you for writing,
Judy
--
Dear Judy,
My mother, who has a very aggressive kind of breast cancer (second recurrence and it has spread to her bones) is thinking about the future. So am I.
If this is really the end for her, she says, she would prefer to die at home. But her question -- and mine for you -- is: Can she stay in her home and receive adequate care, by which I mean effective pain medication?
Also, does a hospice determine the type and quantity of pain medication a patient receives? Or is that done through a doctor?
Kyle
Dear Kyle,
Yes, your mother can remain in her home and receive pain medication.
If she is under hospice care -- most hospice care takes place in a patient's home -- it will be the hospice medical staff who will prescribe the type of medication as well as the dosage. In fact, pain control is something in which hospices excel, and they are especially adept at tailoring it to the needs of the individual. Since the cancer has spread to her bones, in your mother's case, my assumption is the pain may get especially severe, and she will need effective medication. How much medication your mother will receive may fluctuate depending on her condition and how she responds.
If she is not under hospice care, a doctor can prescribe pain medication. But frankly, that wouldn’t be my first phone call.
Doctors are occasionally skittish about prescribing really effective (read: extremely strong) pain medication; the old absurd myth about creating addiction sometimes prevails. Yes, even when the patient is obviously and rapidly dying.
Hospice nurses are more skilled in this area. Lorazepam, which is in the Valium family, morphine and the super-potent analgesic narcotic Delaudid (which starts to work within 15 minutes) are often prescribed – and have proven effective in deadening pain.
My advice? Ask for help from a hospice. Not only will the pain control be more effective, but Medicare will pay for most of the expenses incurred.
Thank you for writing,
Judy
My father is dying of a prostate cancer, which has metastasized faster than any member of his allegedly brilliant and ridiculously expensive medical team ever predicted or imagined. His favorite doctor recently indicated he might die in a matter of months, maybe a year. He also has a problem with his sugar levels. So it's all a big mess, and the whole family is completely depressed.
Him too about half the time.
Another big problem: Last week my father asked me to buy him his favorite kind of cheesecake from a favorite baker. I did so. He eats a small piece every day, and it seems to improve his mood for a few precious minutes.
My mother is furious with me, though -- and with my father. She told me I was behaving irresponsibly by ignoring his secondary condition; she has begged him not to eat the cake. He either ignores her, or laughs, saying he has nothing to lose.
I personally agree with my father. But now that he's basically polished off the cake, my mother has flat-out forbidden me to re-visit the bakery shop for another. OK, Judy, which one of my parents should I disobey?
Carol in Beverly Hills
Dear Carol,Normally, I'm all for giving the terminally ill exactly what they want. In the hospice where I volunteer, families have been known to bring in packs of cigarettes for patients with Stage 4 lung cancer, and nobody on staff fusses about that, as long as the smoking takes place out of doors on the patio. On the other hand, patients can drink alcohol only if the hospice has received a doctor's order saying it's OK.
So even license has to be bordered by common sense. In this instance, I'd suggest a talk with one of your father's doctors (or perhaps a doctor you might respect more than the ones your father selected) before heading back to the bakery. A thumbs-up will ease not only your mother's objections -- I think it will ease your conscience as well.
Thank you for writing,
Judy
--
Dear Judy,
At the risk of sounding completely selfish, I can't stand it any more. Everyone around me seems to be dying, and I just don't want to deal with it (or them) any more.
In case you think I'm exaggerating or just crazy, it's pretty much literally true: My mother-in-law who has Alzheimer’s has a year or two to live, we're told. A really cherished roommate from my college years is likely to die within months. And a former boss whom I respect and to whom I owe a lot is also seriously ill with stomach cancer. He's only 48.
Judy, I can't stand the smells and sight of sickness any more. I've had it. I see my mother-in-law pretty regularly, and I'm there for my good friend, as well as my former boss. But frankly, I'd like to run away -- and never come back. I'm totally exhausted, depressed, and near physical collapse.
But how can I avoid these visits? It seems cruel to stop any of them now, while these people are so needy. At the same time, how can I save myself? I'm so exhausted, I can barely move. Please help. I'm really desperate.
Amy
Dear Amy,
Take a deep breath. Now. In fact, take several. Then close your eyes and empty your mind for a few minutes. After that, start thinking -- not about death or dying or illness -- but about who can help you out here.
Perhaps, for example, your husband, and other relatives, might tend to his own ailing mother in the months ahead, freeing you up for other activities. Maybe you might contact some old friends from your college years to visit your sick former roommate. Then try e-mailing a few people who know and like your ex-boss; I'm sure he will benefit from their visits.
In other words, right now you're of limited use to anyone. And you're not being kind to yourself. You need a vacation from death.
So make your plans -- and take it.
Thank you for writing,
Judy
--
Dear Judy,
My mother, who has a very aggressive kind of breast cancer (second recurrence and it has spread to her bones) is thinking about the future. So am I.
If this is really the end for her, she says, she would prefer to die at home. But her question -- and mine for you -- is: Can she stay in her home and receive adequate care, by which I mean effective pain medication?
Also, does a hospice determine the type and quantity of pain medication a patient receives? Or is that done through a doctor?
Kyle
Dear Kyle,
Yes, your mother can remain in her home and receive pain medication.
If she is under hospice care -- most hospice care takes place in a patient's home -- it will be the hospice medical staff who will prescribe the type of medication as well as the dosage. In fact, pain control is something in which hospices excel, and they are especially adept at tailoring it to the needs of the individual. Since the cancer has spread to her bones, in your mother's case, my assumption is the pain may get especially severe, and she will need effective medication. How much medication your mother will receive may fluctuate depending on her condition and how she responds.
If she is not under hospice care, a doctor can prescribe pain medication. But frankly, that wouldn’t be my first phone call.
Doctors are occasionally skittish about prescribing really effective (read: extremely strong) pain medication; the old absurd myth about creating addiction sometimes prevails. Yes, even when the patient is obviously and rapidly dying.
Hospice nurses are more skilled in this area. Lorazepam, which is in the Valium family, morphine and the super-potent analgesic narcotic Delaudid (which starts to work within 15 minutes) are often prescribed – and have proven effective in deadening pain.
My advice? Ask for help from a hospice. Not only will the pain control be more effective, but Medicare will pay for most of the expenses incurred.
Thank you for writing,
Judy
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COMMENTS (2) TO ADD A COMMENT, PLEASE FIRST SIGN IN OR REGISTER.
Anonymous wrote on August 4, 2009 10:41am
Dear Judy, I would like to clear up one thing you said in response to Kyle's letter above. It may be a small point, but I think it needs some slight clarification. It is indeed true that the medical staff of a hospice are the best qualified to recommend certain medications to control pain and manage symptoms. However, they DO NOT PRESCRIBE MEDICATIONS as you stated in your response. The patient's doctor, whether it be an outside doctor or the Hospice Medical Director, are the only medical professionals that can prescribe medications. The other medical staff can certainly suggest the medications they feel are needed but they cannot prescribe them. As you know from being a hospice volunteer, a patient does not have to give up his or her doctor in order to come onto Hospice care. If a patient does not have a regular doctor, the Medical Director of the Hospice can be chosen as the patient's doctor at that time. Sometimes people do not realize this and think they have to give up their doctor if they come onto Hospice - of course, this is just one of those myths that are still out there about Hospice. As I said, it may be a small point, but I just wanted to make sure Lyle knows that 1) his mother may keep her own doctor or she may choose the Hospice Medical Director and 2) only the doctor will prescribe any medications needed. Thank you, Judy, for your wonderful Q & A pages - you do a wonderful job, always sensitive and perceptive. Betty a Hospice Bereavement Coordinator [Report Comment]
Anonymous wrote on August 4, 2009 10:40am
Sorry if my comments came through twice...I thought I had completely lost my note to you so I tried to write it again - got as close as I could to my original note. Betty [Report Comment]
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