There I was in ICU rounds (the Palliative Care Team attends ICU rounds) shaking my head as usual. One of my nurse practioner students told me she disliked going to ICU rounds because it was like a “Nursing Home.” She was saddened to see so many geriatric patients, in the ICU, mostly with a poor overall prognosis. The words “Trach and Peg,” ran through my mind for hours after rounds because so many patients were being “Trached and Pegged.” Those words brought so many negative emotions and feelings; sadness, fear, isolation, pain and suffering to name a few. The words and images burned into my mind, that for the rest of the day it was like a song that haunted me…”Trach and Peg, Trach and Peg.” The words bothered me to the point that I had to write the following:
“Trach and PEG”
“Trach and PEG”
Those words sound horrible in my ears.
Unknowing to families an artificial prison for months or years.
The family will never know what to expect.
Bedsores, UTI’s, pneumonias, you name it, continue to occur even without neglect.
Most families doing the best they can,
thinking that this is the best plan.
While I make rounds in the ICU
will the patient suffer through another code blue?
“Trach and PEG”
“Trach and PEG”
Hospice Physician's Blog 
After visiting a family that had a wonderful dying experience at home, I am compelled to write and ask you to educate whoever will listen about dying at home. I have been a home hospice RN for many years and cannot imagine anything different. We just need to educate folks about dying comfortably and peacefully at home or in hospice care.
Thank you Terry. Discussions and referrals to hospice in an appropriate time frame continues to be a challenge. Those of us in the field hope with the increasing popularity of “transitional care” and all the data coming out about palliative care, that patients will be exposed to difficult conversations earlier and therefore possibly be referred to hospice more upstream. We appreciate your hard work and support.
Terry,
Yes, I feel the same passion. I do talk to whoever will listen and I’m on several modes of social media to try and spread the word. Keep up the good work.
Ugh those words are so horrible together when said in a detached manner. Keep blogging we need your voice! I just added you back to the hospice and palliative blogging list on Pallimed as a RESUSCITATED blog: http://www.pallimed.org/2009/09/updated-list-of-hospice-palliative.html
Thanks Christian. I appreciate all the work you’ve done in the field and I wish I could do more. I always want to blog but time is always the issue. I’m transitioning jobs soon and I’m hoping I’ll have a little bit more time to blog as I do enjoy it quite a bit. Again, thanks for the feedback, I’ll try and put up more post I have stored in my “rough draft” folder.
HP
I know what you mean. I switched jobs last year and while I had more time, i spent it more on family than professional development. But what the heck, it is a new year. You’ll see more out of Pallimed this year. I’m also rethinking Palliative Care Grand Rounds to highlight blogs a little more. So give me a good post to talk about and I’ll send some eyeballs! Best to you in 2013!
I’m really enjoying your blog. As a Geriatrician, I’ve had many a head shaking moment like this.
Thank you for the feedback. I wish I had more time to write more entries as I found I really enjoy blogging. I have so many entries in their rough draft form and I just need to get them out. Feedback like yours motivates me to do so. Thanks again for your work as I feel the field of geriatrics is under-staffed and not as appreciated as it should be.
Thank you Dr. Mash, I appreciate your feedback.
Dear hospice physician,
I am a marketing professional doing pro bono work with a local hospice org, helping them “rebrand” themselves to change public perception and compete with the for-profits that have entered the area with big budgets and awareness campaigns. I had a powerful experience (positive) with a (different) hospice when my dad died, so I really want to do what I can for this group, as a way of paying something back to the concept of hospice overall. I just want to tell you that your blog is outstanding. I couldn’t stop reading until I had read every single entry. Please keep it up! And you really should consider putting together a book.
Emily, Thank you for the kind words. I agree about the “for-profit” hospices. I’m sure there are good ones, however my experience has mostly been negative especially with the larger more corporate ones that span several states. I’m glad you had a positive hospice experience with your dad and I admire your pro bono work. We need more people like you raising the awareness of hospice and the benefits. If you ever need any help or there is anything I can do, email me at palliativecaremd@yahoo.com and I’ll email you back with a more personal email and contact information. Again thank you for reading my blog and I plan to blog much more in the future. My account is filled with drafts of entries but I just have to finish them. Maybe one day, when I have more material I’d consider a book.
Warm Regards,
Hospice Physician
Thank you very much for making this content live here. i like to read it and found it really very useful one.
I know the horror of that phrase. When I worked on a Palliative Medicine inpatient service, we called that the “LTACH Shuffle” as it meant that interventions were being done to move the patient to the next “level of care” (which wasn’t really _care_ at all), and that the really hard discussions about Goals of Care were like a can being kicked down the road for “another day”. Yup, Trach-PEG-LTACH, Trach-PEG-LTACH, Trach-PEG-LTACH, kind of like a waltz….
We’ll see what the impact of ACOs are in healthcare. I have hope, as Palliative Medicine seems to be drawn in a little closer this go-round.
Yes, I think with the way more people will be held accountable, we will not necessarily get “more” care, but better quality care.
Wow, this is scaring me. My 51yo husband has Multiple System Atrophy — relatively early stage. I know this is in our future and having no real medical exposure (routine stuff over the years), I have no idea how this unfolds. I will become his caregiver when the time comes. I have much to learn from you.
Connie, thank you for your comment. I’m sorry to hear about your husband’s diagnosis, however, you still have time to have some important conversations. It’s important to discuss what is Quality of Life for him and what are his limits for life prolonging measures. There is no right or wrong answer and it’s important to have this discussion. From my experience, when the person has lost the ability to make their own decisions and no discussions were made prior to this, the burden falls on the next of kin to make very difficult decisions. Most of the time, the default for most decisions are usually more aggressive and life prolonging because the family doesn’t want to feel like they have given up on their loved one or feel like they were the one to end their life.