Advocating for Anna
Sweet Anna fell out of her wheelchair and broke her hip reaching for her pillow that fell on the floor. She developed a horrible infection after surgery that spread through out her body. She was in horrible pain and was not expected to live through the week. Her son didn’t want us to use anything stronger than Tylenol, he was adamant about it.
I stared at my pen for moment while I was thinking about the implications of the ink I was ready to lay down on a hospice order at the skilled nursing facility. My pen has significant power; I have to be very careful with it. It is rarely my intention to sedate anybody; I typically start pain medicine at a low dose and then titrate the dose up until pain relief has been reached. Sometimes the amount of pain medicine it takes to dull the pain can cause drowsiness. Occasionally the amount of medicine needed can put someone into a deep sleep.
This is difficult for some families to accept. Some families would rather have their loved one live their final days in pain and awake verses pain free and possibly sedated. I am a strong advocate for my patients who can’t speak for themselves; I do everything in my power to educate families about comfort care. In this case, I firmly suggested to the son that I break his hip and offer him only Tylenol.
Anna died pain free and peacefully.