Category: Palliation

Hospice in Nairobi

February 24th, 2010 · Dr. Brian Byrd · Hospice Agency Operations, Palliation Comments Off

I am in Nairobi, Kenya this week working in prisons with Prison Fellowship Kenya (www.pfm.org).  While here, I met a man who has some experience with Kenyan hospice, and a young lady who told me a story about a her friend.

There is only one hospice in Nairobi, a town of 3.5 million people.  Most patients are AIDS sufferers, and it sounds like the hospice teams are doing a great job treating symptoms.  There is no federal funding for hospice, so patients must pay what they can.  Private donors cover the rest.

I heard about a woman, age 23, who was diagnosed last year with inoperable brain cancer.  She has just a year left, and is starting to lose her short-term memory.  When she finally heard the news about her condition, she told her friend, “Hey, I don’t have to be an architect now!”

I’ll throw in one more comment in about her case.  Apparently, she went mis-diagnosed within the Canada medical system.  She had been seen several times, received a diagnosis of stress, and never returned to the doctor until her pain became excruciating.  Apparently, in their system, it can be difficult to get a physician appointment when you need one.  For many, our system isn’t much better.

These stories make me think of my Savior’s words, “Come to me you who are weary and heavy laden, and I will give rest.”  That is a Savior worth worshiping.

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What about all these medications?

February 7th, 2010 · Dr. Brian Byrd · Dementia, Palliation, Spirituality 4 comments

Some of our patients come to us taking 5 or more medications.  We try to take them off as many as we can.

There are lots of good reasons for stopping medicines.  Many patients, particularly those suffering from dementia, have a hard time swallowing pills.  And studies show that over-medication is a common cause of falls in the elderly population.

In hospice, here in Fort Worth or anywhere, we emphasize palliation.  So we look at each medicine and determine whether or not it is providing symptom control.  If it isn’t, we discontinue it.

Often it is easy to make this determination.  Examples of non-palliative drugs are cholesterol medicines, and iron or calcium supplements.

Sometimes, though, it isn’t easy to determine whether or not a medicine should be pulled.  For example, most people feel that blood pressure medicines are not appropriate in hospice; however, some blood pressure medications also keep the heart rate in check.  Stopping one of those might induce shortness of breath.

The most common medicines we use in hospice are pain relievers.  These are miracle workers for many.  But they don’t come without side-effects, such as constipation and changes in sensorium.  So we have to be careful.

Some of my friends feel that when we take medications, we are not trusting God to heal, or take care of us.  I used to be fairly aggressive in countering that opinion, but I have lightened up in recent years.  For some people, God may ask them not to take treatment.  He may be working on something else within them.

Generally, I feel that science is a gift from our Lord, who created the universe and all its physical laws.  God has allowed humans to study these laws and use them to relieve suffering and treat all kinds of disease.

One of the aspects of Jesus’ healing that strikes me is that he would always engage people in conversation when he healed them.  He could have blinked and healed all sick folks within a five-mile radius of Him.  If his intent was only to heal, He probably would have done that.  But He wanted something more, and that was relationship with us.

My favorite example is the blind man, Bart, I believe was his name.  After some townspeople led Bart to Jesus, Jesus asked him, “What do you want me to do for you?”  I’m sure Jesus knew that this guy was blind and that he wanted Jesus to restore his sight.  But He wanted the Bart to tell him.  I think He wanted closeness and relationship with Bart, just as He wants with each of us.

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