For this first hospice blog entry I will recount a most unusual, yet gratifying case.
A friend asked me to visit her ”dying father.” During a visit to this man’s home a month ago, I found a thin, 86-year-old gentleman who in the previous 6 months had experienced about a 35-pound weight loss. He was suffering from some dementia. He had the usual memory loss, cognition decline, non-sensical speech and poor appetite.
To my astonishment there was a grotesque, painful, bleeding right ear mass. He was cupping it in his hand. He had partially covered it with a paper towel, which was spotted red with blood. The protruding tumor was huge, the size of a baseball. I was looking at a neglected skin cancer, a type usually easily treatable unless it grows unchecked as this one had.
What was unusual was that he had abruptly stopped talking several months ago. Not a word for 3 months. He also hadn’t left his house in several years, and he wouldn’t allow his family members to touch him. The days of this former World War II serviceman consisted sadly of pacing and re-pacing his small bedroom. He consumed nothing but five Dr. Peppers a day and small amounts of Grandy’s mashed potatoes. He did not bathe and rarely changed his clothes.
A few days prior to my visit he had started talking again while furiously pointing at his ear. He was obviously requesting pain relief.
He hardly allowed me examine the bleeding cancer. He refused my attempts to bandage. He rebuffed any of my efforts to help by shouting to his family members that I was going to hurt him. It was clear he was also suffering from untreated schizophrenia. This disease would prevent me and my hospice team from treating his weight loss and cancer pain. Before anything else, we would have to control his paranoia.
We spent the next several weeks medicating him with anti-psychotics and narcotics. We poured the elixirs into his Dr. Peppers, which he drank without suspicion. Over four weeks the medications began to have their effect. He became more cooperative and was in less pain.
Three days ago he allowed us to admit him to the hospital. Yesterday the surgeon removed the mass. Since he is still losing weight and is malnourished we will take him home on hospice. I plan to keep his progress documented.
