Work has been especially tough the last couple of weeks or so, because I've had three patients who eventually requested and received hospice care. A very simplistic way of putting it is that hospice care is end of life care.

Sometimes there is an acute event, like a stroke, and sometimes it's a long drawn out illness, like dementia/Alzheimers. Trying to guide a patient and family through this process takes a lot of time, patience, and emotion. It's not an easy process, but a necessary one.

Not everything is wrapped up in 30 or 60 minutes like you see on television. In some cases, this process can take days and even weeks. I constantly have to remind myself to report the facts of the case. For example, "the heart/kidney function is improved or worse verses yesterday," or, "it is a significant stroke affecting motor and/or sensory and/or speech function."

I can't even imagine what my families are going through, because it's not my loved one in that hospital bed. My job is to stay as objective as I can in reporting the medical condition of their family member.

Things can get a little tricky when I'm asked something like, "What if this was your mother or grandmother, what would you do?" Or, "What if I was your mother or grandmother, what would you do?"

When the patient or family open the door for me, I try to be as honest with she/he/them as I can. Even though it may sound like I'm giving up when I recommend something like hospice, if I believe the long term prognosis is poor, they deserve to know that. If there is possibility for recovery from their illness, I'm honest and let them know that as well. Hospice is not appropriate for everybody.

It's even tougher when it's one of your long time patients whom you have seen slowly deteriorate or someone whom you saw last week in your office who had an acute event and no longer the person you remember. In most cases, a rapport was built so that I had an understanding of how heroic/aggressive the patient wanted to be close to the end of life. Obviously, one of the tougher parts of my job.

I do have the satisfaction in that for most of my patients I will do what they want me to do, because we've talked about it. My tribute to them will be to carry out their final health care wishes whatever they may be...

I'm on call today/tonight. You know the drill by now. I'll be back in a day or so to pick up where I left off. Keep on blogging for me. More soon...