The following
program presents principles
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designed to promote good health
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and is not
intended to take the place
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of personalized
professional care.
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The opinions and
ideas expressed are those
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of the speaker.
Viewers are encouraged
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to draw their own conclusions
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about the information presented.
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David proclaimed
praise God for I'm fearfully
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and wonderfully made,
I'm Dr. James L. Marcum,
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And I wanna welcome
you to wonderfully made.
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Thank you for taking
time out of your hectic
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schedules and busy
weeks to join us today.
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We've a very
interesting topic today
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but one that's
sometimes hard to talk about,
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we're gonna talk
about today's program about
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caring for the terminally ill.
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I'm fortunate to have
Ron Mahlo with me today,
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he's an expert in
this area and he's gonna be
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sharing some of his
insights with us today.
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Welcome Ron
we're glad you're here,
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thank you Jim. Now,
tell me Ron what got
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you interested in
working with hospice.
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Well Jim, I've been in medicine
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for the last 15
years, probably about
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10 years ago I
really didn't know too much
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about hospice,
unfortunately my parents
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became patients and
that was my exposure
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as a rewarding experience.
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Now, for our
listeners that might not
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understand what hospice is?
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Just give us an
overview of what hospice is
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and how does it differ
then other programs like
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Assisted living
and other programs like
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Home health, what's
hospice is all about?
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Well, the main focus
for hospice is we focus
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on comfort and
care, not so much about
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curing something.
That something that once
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the patient has determined that
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they're ready just
for comfort and care then
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we could impact with them.
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Hospice can impact
you at your assisted
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living home, in
your home setting itself
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for perhaps in a
nursing home setting.
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Okay, well that's
exciting and one of the
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things that I
wanna speak to each one
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of our listeners
out there, there is many
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of you here, that
have to deal with some
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of these issues.
You might be coming
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to the end of the
life and I don't look at as
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coming to an
end of the life Ron.
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I look at to
coming on something new
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when we have to sort
of go out or die just
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as well as we began this life.
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So, that's why I
think this is an important
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topic for us to talk about.
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Now, HeartWise Ministries is a
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ministries was
dedicated to bringing
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the truth in
medicine and the truth
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in the scriptures to
many different people.
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Our three words
that sort of talk about
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the theme of the
ministry is truth
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and once you
understand truth you have love
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and then there's healing.
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And looking at
hospice and how hospice works,
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you know hospice
gives a lot of love
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and there's
healing even though a body
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might die there can
be healing that occurs,
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that's correct, do
you agree with that?
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Now I'm sure you
see that many times
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in hospice, many
times. Well, we've collected
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questions from
literally all over the world
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regarding end of life
issues and we're gonna
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talk answer these on air today.
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And first we would
like to start from Doug
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in Tennessee and
Ron, Doug writes,
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as he says, I'm very
concerned about pain,
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my doctor says I've
terminal lung cancer,
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how do you know if a
terminally ill person
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is getting enough
pain medications especially
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if they are not
communicating well.
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Jim, sometimes
that can be difficult
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I mean let's just face
it without communication
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it's tough. I always
talked to my families
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or the caregiver
think about when you took
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care of a baby, how did you know
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if that baby didn't feel well?
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You picked up on
some of the objectives
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and subjective
things that we see,
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maybe grimace,
maybe their breathing
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patterns have
changed, maybe they're just
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restless and uncomfortable,
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those are ways that a
patient can communicate
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if they don't feel
well. Okay, now Rod,
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I've had a lot of
patients that when
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they're dying and
I know they're dying
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they're spiritually
ready but they're still
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uneasy about having pain.
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What are things
that you actually things
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that you do to
help alleviate the
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pain process.
Well, sometimes when
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we need to look at
there's two different
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types of pain,
there is physical pain
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which a lot of
times we can treat with
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medication and be
very successful with it.
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But sometimes
there is that mental pain
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and some of the
mental pain might be an issue
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that they haven't
resolved in the past.
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Something that
they're, they're afraid
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to let it go and
they have a hard time
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communicating that or
perhaps they're waiting
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to see somebody,
it's the pain they wanna
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get resolved
what every issue that
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they're dealing with.
So, one way it sounds like
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you deal with
pain as by helping them
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resolve in mental
issues. Now what are the things
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do you help to do
with physical pains.
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Well, physical pains we
look at medication okay,
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but before medication
let's look at some things
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that we can change.
Perhaps it's comfort,
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perhaps they just
need a hospital bed,
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maybe an air
mattress, things to make them
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more comfortable
of those natures.
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Perhaps it's a
change in the room
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or temperature; after
we've kind of eliminated
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those things then
we can easily change,
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then we look at
different medications.
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There's narcotics;
there's different just
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simple pain medications,
sometimes just plain
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old Tylenol, Ibuprofen
can make a big difference.
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Okay, well let's get
back to Doug's question,
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so I hope Doug that
answered your question
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about how they can
find out even if you know
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if you not communicating well
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if you're having chronic pain,
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I hope this
doesn't ever happen to you.
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On the next
question comes from Rachael
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and she's in Iowa and she states
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if I were to
have a problem needing
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a hospital and I was
in the hospice program,
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will the hospice
program support this?
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I think she's saying if
she's in hospice already
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can she still go to
the hospital and get the
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services that a
hospital might provide.
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Well, she can, the
neat thing about hospice
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is you have
control as the patient
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or as the family,
if you ever wanna stop
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your hospice services
you can stop it anytime.
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But let's say you
need to go to the hospital
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but you don't wanna
stop your hospice services.
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Perhaps you've been at home and
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you're the
patient and you've fallen
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and you're hurting your hip.
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You can go to the emergency room
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and get that
checked and then we can
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if it is broken
then there's some pain
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issues that we
can, we can alleviate
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towards that. If you
were to break your hip
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and you decided that
you want to go forward
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and have curative
treatments for that,
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more than likely at
that time hospice would
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step back, if
you wanna pursue that
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but again remember
at anytime you can reop
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your hospice, okay.
Now, the other thing about
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hospice in the
hospital is let's say
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you're at home,
you're not doing well that
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time of life is coming
or perhaps you're family
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in stressed. It can
be an economical burden
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of a family member taking time
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off from work,
there are programs that
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if hospice is contracted
with the local hospital
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that they can do
some respite careful
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for 5 or 7 days
to make a difference.
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Wow, that's good
well you know in caring,
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in caring for
the terminally ill,
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I mean that's such a
hard topic to talk about
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because everyone
seems to run away
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when some ones,
when you can't cure them.
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But I see you
know when you careful
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the terminally ill
there's more than a physical
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death here. You
know I see a lot of times
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as people are
coming to the end of life
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they're able to heal
in other ways you know
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they'll say listen I
have to get my life ready,
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I have to make
things right in my mind,
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I have to you
know make sure that my
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relationship with God is good.
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So, there's healing
that occurs even though,
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even though the
body might not be healing
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and that's sort of
why I look at this,
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this is such an
important time in life
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and it seems like we
just don't talk enough
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about it. Some of
the best witnesses
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I've ever
experienced for other Christians
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are those that are
sick, those that are seeing
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the end of their
days coming and they wanna
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get the word
out, they've resolved
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their issues, they have
that strong relationship
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with Christ and
they wanna project it.
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You know I was
thinking the other day,
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you know we make
such a big fan fare
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when a baby comes into
this, you know we have a,
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they have baby
showers and lots of presents
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and everyone's happy
and wouldn't it be that
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way if every
situation were someone passed
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or went to sleep in the Lord.
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Wouldn't it be great
if it was a celebration
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like that and
the healing process
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was there. It
would be wonderful,
00:08:06.68\00:08:08.35
this is a life
that's experienced so much,
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I've seen many
changes, what a great time
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to celebrate. Now,
it seems like when in
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families when there's a passing,
00:08:15.94\00:08:17.56
that's
significant amount of stress,
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not only of immediate
family but the caregivers,
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does hospice are
they able to meet some of
00:08:22.88\00:08:25.31
those needs too.
Well through hospice
00:08:25.32\00:08:27.54
they try to
utilize volunteer systems,
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okay perhaps come
in and give that family
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a little bit of break.
The other thing is perhaps
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if you know the
hospice nurses coming
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I encourage families
to take that time maybe
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go to the park,
walk around the block,
00:08:39.33\00:08:41.24
just get out, get a
breathe of fresh air,
00:08:41.25\00:08:43.07
recollect yourself
before you have to go back.
00:08:43.36\00:08:45.57
Okay, well let's move
on to our next question
00:08:45.87\00:08:48.19
here and this comes
from Gina in Virginia
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and Gina I hope
your listening today.
00:08:51.47\00:08:52.90
Gina asks, who
makes up the hospice team,
00:08:53.38\00:08:56.75
I assume a nurse,
chaplain and doctor,
00:08:57.21\00:09:00.53
could you define the
roles of each as I have
00:09:00.87\00:09:03.66
a team caring for my
grandma and there seems
00:09:03.67\00:09:06.39
to be a lot of
overlap. Well, the hospice team
00:09:06.40\00:09:09.43
she's right, okay, there is many
00:09:09.44\00:09:11.77
components to it.
The number one component
00:09:11.78\00:09:13.62
is the caregiver or the family
00:09:13.63\00:09:15.32
okay, maybe it's a good friend,
00:09:15.33\00:09:16.75
those are the key, and
we rely on them heavily.
00:09:16.94\00:09:19.57
The secondly is a
doctor or medical director
00:09:19.58\00:09:23.40
for the hospice
agencies. Now, what's their
00:09:23.41\00:09:25.15
responsibilities?
They'll come out
00:09:25.16\00:09:27.21
and see the
patient; they'll help manage
00:09:27.22\00:09:28.84
the care, they'll kind
of oversee the entire team
00:09:28.85\00:09:31.47
as they go forward.
Personally the hospital,
00:09:31.69\00:09:34.66
hospice director that
I've worked with has been
00:09:35.20\00:09:37.13
very involved with the
patient, enjoys going out
00:09:37.14\00:09:39.57
and having prayer
with them and seeing them,
00:09:39.58\00:09:40.99
very instrumental.
Secondly, you might have
00:09:41.23\00:09:43.85
a nurse practitioner
involved that works with
00:09:43.86\00:09:45.46
the nurse and with
the medical directors.
00:09:45.47\00:09:47.64
You have the
nurses, nurse would come out
00:09:47.65\00:09:49.74
every day, may
be they'll come out
00:09:49.75\00:09:51.33
three times a week.
It just kind of varies
00:09:51.34\00:09:53.08
on the condition of the patient,
00:09:53.09\00:09:54.27
how often that
they wanna be seen.
00:09:54.50\00:09:55.84
Now, will they
come out every day
00:09:56.06\00:09:57.21
if someone needed it to come,
00:09:57.22\00:09:58.66
if they're needed
they'll be there everyday,
00:09:58.67\00:10:00.00
okay. That's the
unique thing about hospices,
00:10:00.01\00:10:01.93
there is a nurse on
call 24 hours a day,
00:10:02.12\00:10:04.44
7 days a week. All
they have to do is pick up
00:10:04.45\00:10:06.77
the phone and a nurse
should be there within
00:10:06.78\00:10:08.66
an hour on top of
that you have nurses aids
00:10:08.67\00:10:11.06
that came out
and help with bathing
00:10:11.07\00:10:12.57
or small household
task around the house.
00:10:12.58\00:10:15.67
Volunteers are involved,
social workers that help
00:10:15.68\00:10:18.18
you work through, if
there's insurance needs,
00:10:18.19\00:10:19.75
perhaps paying your
bills. If there is state
00:10:19.95\00:10:22.20
assistance that
need you to come through,
00:10:22.21\00:10:23.65
everybody is a
unique part of it.
00:10:23.94\00:10:25.62
Okay, so this is
not like treatment
00:10:25.63\00:10:27.88
for the patient, but
sounds like it's treatment
00:10:27.89\00:10:31.29
for the family,
helping them with another many
00:10:31.30\00:10:33.98
issues that they
might not normally you have
00:10:33.99\00:10:35.47
health with. One
of the regulations
00:10:35.48\00:10:37.36
of hospice is that
each hospice agency
00:10:37.37\00:10:40.92
has a team meeting we
would like to call it,
00:10:40.93\00:10:42.84
okay. Maybe they
meet about once a week
00:10:42.85\00:10:44.49
and they discuss
the patients with all
00:10:44.50\00:10:46.15
the team there.
You have dietary input,
00:10:46.16\00:10:48.75
you have
pharmacy input, chaplains,
00:10:48.76\00:10:50.91
social workers,
the nurses involved,
00:10:50.92\00:10:52.52
the doctor,
everybody approaches us from
00:10:52.53\00:10:54.91
a team approach.
Sometimes we invite the
00:10:54.92\00:10:56.65
families to be a part
of it, good, good I'm sure
00:10:56.66\00:10:58.89
they'll like well
Gina I hope that answers
00:10:58.90\00:11:00.64
of your question
and the next questions
00:11:00.65\00:11:03.10
is from Fred, Fred
lives North Carolina
00:11:03.11\00:11:05.23
and he says this is
a very short question.
00:11:05.80\00:11:08.16
If a person cannot
swallow what other route
00:11:08.46\00:11:12.17
can be used to help
with pain and nutrition?
00:11:12.18\00:11:15.73
Very good question,
and we could answer,
00:11:16.61\00:11:18.61
I ask this a lot,
because as the patient
00:11:18.62\00:11:21.05
deteriorates, there's
gonna be issues perhaps
00:11:21.06\00:11:23.35
they can't swallow.
There's different ways
00:11:23.36\00:11:25.58
to give medication and
unfortunate way you know
00:11:25.59\00:11:28.73
we can crush a pill
and place it underneath
00:11:28.74\00:11:30.48
the tongue much like
those with cardiovascular
00:11:30.49\00:11:32.49
disease can take nitroglycerin,
00:11:32.50\00:11:34.36
on some
medication we can do that.
00:11:34.41\00:11:36.00
Now, do you really want
to even give medications
00:11:36.01\00:11:38.12
if you know the person is dying.
00:11:38.13\00:11:39.56
Well, if they need it,
okay again we don't wanna
00:11:39.78\00:11:42.24
over medicate them,
our goal is comfort, okay.
00:11:42.25\00:11:44.98
We don't want it
under, we don't want it over,
00:11:44.99\00:11:47.01
we can give liquid
perhaps they can swallow
00:11:47.40\00:11:49.67
the small amount
of liquid, some drugs
00:11:49.68\00:11:51.77
we can make so
important that just
00:11:51.78\00:11:53.77
a drop on the tongue
alleviates what we need,
00:11:53.78\00:11:56.24
okay. If that's not the route,
00:11:56.25\00:11:57.79
we can also do IV, we can do a
00:11:57.80\00:11:59.85
subcutaneous
injection where a little bit
00:11:59.86\00:12:01.92
of the medicine
goes underneath the skin
00:12:01.93\00:12:03.44
another route is
rectally. Some medications can
00:12:03.84\00:12:07.08
be absorbed that
way, so there's different
00:12:07.09\00:12:09.00
routes that we can
do, another great route
00:12:09.01\00:12:11.03
and this is a, a
booming business starting
00:12:11.04\00:12:13.27
to come forward as topically,
00:12:13.28\00:12:14.56
perhaps a patch or a
cream that can be rubbed
00:12:14.85\00:12:17.07
on the skin
absorbed through the skin
00:12:17.08\00:12:19.02
and alleviate pain that way.
00:12:19.03\00:12:20.38
Now, do they
still this years ago,
00:12:20.39\00:12:21.68
I had a patient
that was terminally ill
00:12:21.69\00:12:24.13
and we use
aerosolized, we aerosolized the
00:12:24.14\00:12:27.28
medicine and
they breathed it in,
00:12:27.29\00:12:28.60
is that still being
done. You know it still is,
00:12:28.86\00:12:31.22
I think a few
years ago it was maybe
00:12:31.23\00:12:33.31
a little bit more popular,
00:12:33.32\00:12:34.29
I think it kind of
waned, it's coming back,
00:12:34.30\00:12:36.08
you can inhale
morphine, Lidocaine or different
00:12:36.26\00:12:38.75
deadening drugs to
help relieve some of
00:12:39.01\00:12:40.80
the pain or
information. And then you always
00:12:40.81\00:12:44.66
hear about people
getting too much pay
00:12:44.67\00:12:46.38
medication and
having someone quit
00:12:46.39\00:12:47.84
breathing, how is
that managed, I mean
00:12:47.85\00:12:50.79
how do you
where there's you know
00:12:50.80\00:12:52.40
you're giving
too much and you know
00:12:52.41\00:12:53.94
and because I
assume that at some point
00:12:53.95\00:12:56.02
the family is
actually making decisions
00:12:56.03\00:12:58.00
on whether to
give medicines right.
00:12:58.01\00:12:59.22
Well, actually the
family makes that decision
00:12:59.48\00:13:01.66
probably more then the nurse,
00:13:01.67\00:13:02.95
okay so how would you
tell the family not to,
00:13:02.96\00:13:04.68
what's nothing,
what's not too much
00:13:05.08\00:13:06.94
as we certainly
don't want anyone
00:13:06.95\00:13:08.03
to have pain. Well,
if the hospice has been
00:13:08.04\00:13:10.12
involved early in the case,
00:13:10.13\00:13:11.76
that family
teaching starts at day one,
00:13:12.06\00:13:14.37
okay and a lot of
times they know the medicine
00:13:14.38\00:13:16.62
better than a lot of people do.
00:13:16.63\00:13:18.04
And so they'll be
familiar with medicine
00:13:18.40\00:13:20.55
and they'll know
things that they look for
00:13:20.85\00:13:23.11
is how faster
are they breathing.
00:13:23.12\00:13:24.99
Are they very shallow breathes?
00:13:25.41\00:13:26.93
Is their level of
consciousness changing,
00:13:27.19\00:13:29.03
are they over medic, or they not
00:13:29.39\00:13:30.57
responding as
well. On the other side
00:13:30.58\00:13:32.78
of the coin is
what if they're not
00:13:32.79\00:13:33.92
given too much,
what do we look for much
00:13:33.93\00:13:35.98
like our first question, right.
00:13:35.99\00:13:37.29
Are they grimacing?
Do they have this look
00:13:37.44\00:13:39.62
on their face of
pain and discomfort,
00:13:39.63\00:13:41.23
are they restless, those
are how they're adjusted.
00:13:41.24\00:13:43.99
Okay, I see well
excellent okay the answer
00:13:44.00\00:13:47.24
of Fred's question
is there's lots of other
00:13:47.25\00:13:49.24
routes the pain
medicine can be giving.
00:13:49.25\00:13:50.87
Now, the next
question is from Max in Kansas,
00:13:51.30\00:13:54.33
Max in Kansas writes
when someone in hospice
00:13:54.34\00:13:58.59
care for
terminally ill passes away
00:13:58.60\00:14:00.66
what happens
after that and he says,
00:14:01.02\00:14:04.02
does a family make arrangements
00:14:04.03\00:14:05.62
with a funeral home or
does hospice still support
00:14:05.63\00:14:09.24
the family and what
happens after someone
00:14:09.25\00:14:12.02
doesn't need the
hospice services anymore.
00:14:12.32\00:14:14.18
Well, each hospice
agency is gonna has
00:14:14.35\00:14:17.41
different protocols
and reactions differently.
00:14:17.42\00:14:19.32
Probably a basic
way of things happening,
00:14:19.74\00:14:21.92
we've supported the
family and let's say,
00:14:22.15\00:14:24.39
I get a call in middle
of night that the patient
00:14:24.40\00:14:26.19
has passed away.
The family is there,
00:14:26.20\00:14:29.32
I talk with the
family, upfront I get an idea
00:14:29.52\00:14:32.29
of what funeral home
would they like to use
00:14:32.30\00:14:34.88
have they already
made arrangements.
00:14:34.89\00:14:36.33
Now, let me stop
you there, do you find
00:14:36.34\00:14:37.39
that hard to talk
about you know which you know
00:14:37.40\00:14:40.27
is that harder? It can be tough,
00:14:40.28\00:14:41.25
you know pick it
out you know whether
00:14:41.42\00:14:43.04
they wanna be I guess
some people are cremated,
00:14:43.05\00:14:44.84
some people care
you know how do you,
00:14:44.85\00:14:46.67
do you sort of let
them make those decisions
00:14:46.68\00:14:48.35
or do you led
them. I let them make the
00:14:48.36\00:14:49.91
decision wholeheartedly.
If I know the patient's
00:14:49.92\00:14:52.37
choice upfront I
try to reiterate that
00:14:52.38\00:14:54.55
with the family,
to make sure that
00:14:54.56\00:14:56.13
they're following
the patient wishes.
00:14:56.14\00:14:57.97
Sometimes a
patient has confided in me
00:14:58.31\00:15:00.39
without telling the
family at those points
00:15:00.58\00:15:03.12
I tried to share
that information and
00:15:03.13\00:15:05.31
make sure that the
family is aware of the
00:15:05.32\00:15:07.72
patient's wishes that was known.
00:15:07.73\00:15:09.23
Funeral
arrangements are normally made
00:15:10.02\00:15:12.05
by the family and a lot of times
00:15:12.06\00:15:14.51
I encourage patients
that if they're able to,
00:15:14.52\00:15:16.52
to go down and
work with their spouse
00:15:16.53\00:15:19.10
and make the
arrangements for their funeral.
00:15:19.11\00:15:20.92
The family does not
need to go through that
00:15:21.75\00:15:23.90
after the passing,
they need time to grieve
00:15:23.91\00:15:26.32
and if it's all said
and done ahead of time
00:15:26.33\00:15:28.11
that way the
patient's wishes are done,
00:15:28.39\00:15:30.36
the family is
respectful for that,
00:15:30.66\00:15:32.57
it's much easier for
everybody to go through
00:15:32.58\00:15:35.92
the grieving process.
Okay, so your patient's
00:15:36.02\00:15:38.88
been in hospice and
you know had a wonderful
00:15:38.89\00:15:41.43
experience all these
issues have been resolved,
00:15:41.44\00:15:43.63
they pass away and
you think you've got
00:15:43.91\00:15:45.84
the family ready.
Is there still any
00:15:45.85\00:15:48.45
interaction with the
family and for how long
00:15:48.46\00:15:50.72
does that interaction
occur, because you know
00:15:50.73\00:15:53.05
they have some
healing that needs to be
00:15:53.06\00:15:54.44
occurring too. I
always tell families that
00:15:54.45\00:15:56.70
hospice just doesn't stop there,
00:15:56.71\00:15:58.39
hospice continues
on. The guidelines say
00:15:58.40\00:16:00.59
that for thirteen
months after the passing
00:16:00.60\00:16:02.65
of the patient
that bereavement care
00:16:02.66\00:16:04.70
can be given,
many hospices might be
00:16:04.71\00:16:07.05
through the chaplain service,
00:16:07.06\00:16:08.31
a nurse might still
stay in touch or a social
00:16:08.32\00:16:11.03
worker counselor,
that they can talk about
00:16:11.04\00:16:12.99
these issues and help
someone as they grieve
00:16:13.00\00:16:14.77
through the
process. You know I wish that
00:16:14.78\00:16:17.15
could be done more often because
00:16:17.16\00:16:18.49
I think of my
patients that aren't in hospice
00:16:18.69\00:16:20.90
and their loved one
dies and I see all the
00:16:21.12\00:16:23.97
depression and
grief that they go through
00:16:23.98\00:16:25.99
and they don't
really have that supports.
00:16:26.00\00:16:28.53
Now, if someone
was not in hospice
00:16:28.99\00:16:31.14
and wanted to get
some bereavement support,
00:16:31.34\00:16:33.49
what would you
advice them to do?
00:16:34.35\00:16:35.85
You know for
instance you know someone dies
00:16:36.05\00:16:38.47
suddenly and you
know you're heartbroken
00:16:38.48\00:16:40.39
there is really
no one else to go,
00:16:40.40\00:16:41.54
you know we were
that person you know
00:16:42.11\00:16:43.48
I guess the
church would be a place
00:16:43.80\00:16:45.14
they could go but
could they, they volunteer
00:16:45.15\00:16:48.02
for hospice or
get help from hospice.
00:16:48.03\00:16:49.71
They can volunteer
for hospice or even just
00:16:49.72\00:16:52.21
pick up the phone
and say and explain
00:16:52.22\00:16:54.06
the situation, I
don't know if any hospice
00:16:54.07\00:16:56.25
worker that would
turn that caller down,
00:16:56.26\00:16:57.91
I think that they
would like to talk to them
00:16:58.10\00:16:59.96
and maybe put them
in touch with different
00:16:59.97\00:17:02.14
support groups
because you know that's such
00:17:02.15\00:17:03.94
a major loss you
know, it's a loss of a loved
00:17:03.95\00:17:06.78
one or a spouse or
someone and you know
00:17:06.79\00:17:08.56
that's something
that requires healing
00:17:08.57\00:17:09.96
and it requires
healing, you know people
00:17:09.97\00:17:11.98
have to help with
that, that type of feeling.
00:17:11.99\00:17:13.73
Well, a common
scenario is a patient's
00:17:13.84\00:17:15.92
passing away, think of
all the activity you have
00:17:15.93\00:17:18.32
nurses coming in
and you have doctors
00:17:18.33\00:17:20.15
coming in. Bath
assistants, social workers,
00:17:20.16\00:17:23.17
everybody is
concerned, your friends
00:17:23.18\00:17:24.57
and neighbors. After the passing
00:17:24.58\00:17:26.28
everybody is
gone, whose left alone
00:17:26.29\00:17:28.04
as the spouse we
don't want that to happen.
00:17:28.05\00:17:30.05
Yeah and from the
heart standpoint that
00:17:30.17\00:17:32.00
could be one of the
most stressful things
00:17:32.01\00:17:33.89
there is on a heart
because all of a sudden
00:17:33.90\00:17:36.14
your stress hormones
go up, your loneliness
00:17:36.15\00:17:38.47
factor goes sky
rocket, so there is a whole
00:17:38.48\00:17:40.70
ministry right
there. Let's move on to our
00:17:40.71\00:17:43.12
next question, the
next question comes from
00:17:43.13\00:17:46.74
Ted and Ted writes
to us from the great
00:17:46.75\00:17:49.40
state of Alabama
and he says can hospice
00:17:49.41\00:17:52.17
care be given even
if a patient is in a
00:17:52.18\00:17:55.69
nursing home or a
hospital or they still love
00:17:55.70\00:17:58.08
them for that care.
They sure are James,
00:17:58.09\00:18:00.25
that's the neat
thing about hospice
00:18:00.26\00:18:01.81
no matter where
you live a hospice
00:18:01.82\00:18:03.51
nurse can come.
I've seen patients that
00:18:03.52\00:18:05.51
were living in a
camper, in a park
00:18:05.52\00:18:08.40
that was their
residence for that time.
00:18:08.41\00:18:09.94
I've read stories
where the hospice nurse
00:18:09.95\00:18:11.88
went underneath a
bridge down by the river
00:18:11.89\00:18:13.94
to take care of a homeless man,
00:18:13.95\00:18:15.16
'cause that's all they can do,
00:18:15.17\00:18:16.51
and it was compassion.
Hospice can take of you
00:18:16.52\00:18:19.23
where ever
you're at, many patients
00:18:19.24\00:18:20.79
are at home, some
patients are in assisted
00:18:20.80\00:18:23.19
living or nursing
homes. It doesn't have,
00:18:23.20\00:18:25.50
the comfort
doesn't have to stop just
00:18:25.51\00:18:27.11
where you're living,
it can be where ever that
00:18:27.12\00:18:28.65
you are. Well,
that's great you know when
00:18:28.66\00:18:30.90
I think about caring
for the terminally ill
00:18:30.91\00:18:33.14
another word that
you could actually use
00:18:33.15\00:18:35.10
is loving the
terminally ill and loving just
00:18:35.11\00:18:38.07
you know to me it
just means putting
00:18:38.08\00:18:39.42
someone else's
interest above your own.
00:18:39.43\00:18:41.10
And unfortunately
you know in modern
00:18:41.56\00:18:43.67
medicine now we're so
focused on the disease,
00:18:43.68\00:18:46.38
you know we have
to heal the diseased,
00:18:46.74\00:18:48.65
you know if we can
get the disease cured
00:18:49.58\00:18:52.51
we're successful,
but I'm getting you know
00:18:52.52\00:18:55.01
as I look at it
you know the disease
00:18:55.02\00:18:56.79
is sort of inconsequential what
00:18:56.80\00:18:58.96
we wanna do is heal the soul.
00:18:58.97\00:19:00.50
Jim, I've worked
in numerous areas
00:19:00.80\00:19:03.49
of medicine, be it
trauma, open heart surgery,
00:19:03.50\00:19:06.73
intensive care units,
but you know the greatest
00:19:06.74\00:19:09.48
reward that I
have is knowing that
00:19:09.66\00:19:11.36
I was able to grand
somebody their last wish
00:19:11.37\00:19:14.19
here on this
earth. That's just a
00:19:14.20\00:19:15.90
powerful reward,
I've gotten so much more
00:19:15.91\00:19:18.38
than that perhaps
some of the other curing
00:19:18.39\00:19:20.60
stories that I've
been involved with.
00:19:20.61\00:19:21.89
You know and it's a
shame 'cause you just
00:19:21.90\00:19:23.28
don't see people
running up to sign up to say
00:19:23.44\00:19:25.52
hey I wanna spend my
life taking care of people
00:19:25.53\00:19:28.24
that are terminally
ill, I mean you just
00:19:28.25\00:19:29.94
don't see that and
yet it could be so as you
00:19:29.95\00:19:32.49
say so rewarding. You
know the subject of death
00:19:32.50\00:19:35.00
is so taboo within
the Western culture,
00:19:35.01\00:19:37.10
yeah, that I myself did not know
00:19:37.11\00:19:39.33
and I can't say I persuaded it,
00:19:39.34\00:19:40.72
I felt like I was
kind of shoved by God into
00:19:41.02\00:19:43.62
this position with
my parents but coming
00:19:43.63\00:19:45.40
out on other
side. I think he gave me
00:19:45.41\00:19:47.60
a calling and I was
glad that I was able
00:19:47.61\00:19:49.49
to step forward. You
know this is sort of an
00:19:49.50\00:19:51.45
interesting story,
I'd a patient that was
00:19:51.46\00:19:55.15
terminally ill and I
can't remember whether
00:19:55.16\00:19:56.85
he was in hospice
or not but you know
00:19:56.86\00:19:58.53
he you know I said
you know you wanna spend
00:19:58.89\00:20:00.86
your time at home
and be around your things
00:20:00.87\00:20:02.96
and you know he
was ready spiritually.
00:20:02.97\00:20:05.03
And you know for
years he was a heart patient
00:20:05.37\00:20:08.10
he was on a diet
and he says listen,
00:20:08.11\00:20:10.06
could I have some,
some of this you know candy
00:20:10.07\00:20:12.66
or whatever I said
you know you can eat
00:20:12.67\00:20:14.54
whatever you want.
And he was so happy
00:20:14.55\00:20:17.44
with that you know
he just, he just really
00:20:17.45\00:20:19.23
ate whatever you
know I said you know
00:20:19.24\00:20:20.54
why not let's
make this guy happy.
00:20:20.55\00:20:22.25
And then the more I
realized I said you know
00:20:22.62\00:20:24.99
him eating he was
relieved he was becoming
00:20:25.90\00:20:28.35
happier and we got
him to release these
00:20:28.36\00:20:30.65
natural
substance called endorphins
00:20:30.66\00:20:32.69
and the happier he
became made him joke,
00:20:32.91\00:20:35.32
make him laugh,
looked back to his life.
00:20:35.33\00:20:37.48
And show him
what a success he was,
00:20:37.49\00:20:39.27
his pain control
became so much better
00:20:39.49\00:20:42.76
as his own natural chemistry
00:20:42.77\00:20:44.38
endorphins increased,
it was almost like giving
00:20:44.39\00:20:46.61
a pain lesson.
I've had patients that
00:20:46.62\00:20:48.40
have been cooped
up in their house
00:20:48.41\00:20:50.41
so to say over winter
and finally spring came
00:20:50.42\00:20:52.84
and their pain
medicine that they require
00:20:53.32\00:20:55.25
we needed more
and more and clearly
00:20:55.26\00:20:56.85
that their
disease process is winning
00:20:56.86\00:20:58.50
the battle. Spring
came and the wife asked
00:20:58.51\00:21:01.88
me is there anyway
that we can get him out,
00:21:01.89\00:21:03.65
we struggled, got
him in the car, they went
00:21:03.89\00:21:06.12
for a drive to see
the spring and the birds,
00:21:06.13\00:21:08.36
it was wonderful
and you know what Jim,
00:21:08.71\00:21:10.33
his endorphins
kicked in and I did not have
00:21:10.47\00:21:12.32
to use as much pain medication.
00:21:12.33\00:21:13.70
Beautiful,
beautiful, now I'm gonna ask you
00:21:13.71\00:21:15.40
personal question
you know out there,
00:21:15.41\00:21:17.39
there are people all over that
00:21:17.40\00:21:18.89
are terminally ill
and as society gets older
00:21:18.90\00:21:20.81
we're gonna have
more of these issues
00:21:20.82\00:21:22.29
do you find, you
probably work with Christians
00:21:22.55\00:21:24.80
and non-Christians
is there any different
00:21:24.81\00:21:27.31
approach that you
take to a non Christian
00:21:27.32\00:21:29.65
then in a
Christian, do you try to,
00:21:29.66\00:21:31.02
do you try to
introduce Christ to them
00:21:31.89\00:21:33.61
if they never had Christ before,
00:21:33.62\00:21:34.76
I mean how do you
work with the family,
00:21:34.77\00:21:36.44
I mean what's the
differences between
00:21:36.45\00:21:38.02
those two groups.
First, I like to explore
00:21:38.03\00:21:40.33
with them just
where their spirituality
00:21:40.34\00:21:41.98
is what's their
concept, and can you talk
00:21:41.99\00:21:44.23
about it, outright
at front, okay, okay.
00:21:44.24\00:21:46.39
I make it clear to
them right at front
00:21:46.40\00:21:47.83
what my beliefs
are, never trying to push
00:21:47.84\00:21:50.14
what I believe
upon them, but I want to
00:21:50.39\00:21:53.16
be able to know that
I offer them something
00:21:53.17\00:21:55.42
that maybe they
know nothing about.
00:21:55.43\00:21:56.89
And perhaps
they've been a Christian
00:21:57.25\00:21:58.89
all their life, but
they have this fear of dying
00:21:58.90\00:22:00.87
and I try to
encourage them and refocus
00:22:00.88\00:22:03.26
them to have that
daily walk, the daily
00:22:03.27\00:22:05.44
devotion with God, just
to make that difference,
00:22:05.45\00:22:07.68
keep God number
one in their lives.
00:22:07.69\00:22:09.17
You can see a huge
difference when they,
00:22:09.29\00:22:11.42
when they reach
this plato, this peak
00:22:11.61\00:22:13.88
of comfort. Yeah,
now I guess you see,
00:22:14.18\00:22:17.93
have you ever
been there when someone
00:22:17.94\00:22:19.56
passed? Many
times and at times it's
00:22:19.57\00:22:23.91
very peaceful, at
times it can be kind of hard.
00:22:23.92\00:22:26.49
Again, medicine
can make difference,
00:22:27.34\00:22:29.29
we can relax the
patient, make a difference.
00:22:29.30\00:22:31.25
But the biggest
difference I believe
00:22:31.26\00:22:32.83
is the touch of,
of a human being,
00:22:32.84\00:22:34.81
knowing that
somebody is there with them.
00:22:35.04\00:22:36.71
We've such a great
fear of dying alone
00:22:36.86\00:22:38.86
and knowing that
their families at the bed
00:22:38.87\00:22:40.55
side or perhaps
I'm holding their hand
00:22:40.56\00:22:42.83
or somebody else.
You can see the calmness
00:22:42.84\00:22:45.09
knowing that
they're not alone and Christ
00:22:45.10\00:22:46.76
is with us we're never alone.
00:22:46.77\00:22:48.04
That's great because you know,
00:22:48.52\00:22:49.80
you always
wondered how would people
00:22:49.81\00:22:51.34
that didn't have
Christ in their life how will
00:22:51.35\00:22:53.31
they deal then it
would really be a.
00:22:53.32\00:22:54.83
Now terminally ill
really doesn't fit when
00:22:54.97\00:22:57.60
you think about
a Christian's life
00:22:57.61\00:22:58.92
you know they're
not terminally ill
00:22:59.05\00:23:00.41
I mean they're
just gonna be ill for a
00:23:00.68\00:23:02.06
little bit longer
and then the next thing
00:23:02.07\00:23:03.51
they know is they
have something far greater
00:23:03.52\00:23:05.82
and in my
practice of medicine Ron.
00:23:06.25\00:23:08.39
I've learned through
the years that you know
00:23:08.40\00:23:10.28
the disease is just
part of the treatment
00:23:10.29\00:23:12.26
you know and if
you can change you know
00:23:12.56\00:23:14.71
the chemistry of
the body you introduce
00:23:14.72\00:23:16.92
the spiritual side,
get them to actually know
00:23:16.93\00:23:19.36
God to find the
peace, to find the love,
00:23:19.37\00:23:22.25
that's when you've
really made the biggest
00:23:22.48\00:23:25.08
difference and you
really getting to heal
00:23:25.09\00:23:27.54
what's really important.
00:23:27.55\00:23:28.68
Christ is the ultimate healer,
00:23:28.82\00:23:30.48
let's go to the
next question here
00:23:31.96\00:23:33.72
the question is let me
see who it's from here.
00:23:35.45\00:23:37.77
It's says have
you ever experienced
00:23:38.16\00:23:40.66
a person who did
not need pain meds
00:23:40.95\00:23:44.01
when he was
getting ready to pass
00:23:44.02\00:23:45.97
permanently? Many
times, death does not
00:23:45.98\00:23:49.38
have to be
something painful okay,
00:23:49.39\00:23:51.20
yes we do at times
have to give pain medication
00:23:51.21\00:23:53.54
to alleviate some
of the discomfort,
00:23:53.82\00:23:55.59
many times perhaps
the patient as we say
00:23:56.07\00:23:59.37
historically has
fallen asleep. Okay,
00:23:59.38\00:24:01.65
perhaps they need
a little pain med,
00:24:01.66\00:24:02.83
I don't wanna
say pain medication
00:24:03.11\00:24:04.57
but a little bit of
medication to help their
00:24:04.58\00:24:06.21
breathing a little
easier but many times
00:24:06.22\00:24:08.47
it's not unusual
for patient to close
00:24:08.48\00:24:10.27
their eyes and
fall asleep in Christ.
00:24:10.28\00:24:11.80
What a blessing I
think you know that
00:24:11.81\00:24:13.95
would be, what a gift you know
00:24:13.96\00:24:15.92
and I guess when they pray,
00:24:17.04\00:24:18.51
you know the
patients that pray for a
00:24:19.00\00:24:20.57
peace like this. Yes,
okay, let here's Martin
00:24:20.58\00:24:24.06
from Florida, is
writing us here and the last
00:24:24.07\00:24:26.46
one is from
Judy in New Hampshire
00:24:26.47\00:24:27.91
didn't include
Judy's name so sorry Judy.
00:24:27.92\00:24:29.55
Martin from Florida
says, I'm putting my father
00:24:30.10\00:24:32.84
in hospice this
has been advice by the
00:24:32.85\00:24:35.50
medical team, his
doctor, this has been
00:24:35.51\00:24:38.59
an agonizing decision for me.
00:24:38.60\00:24:40.38
'Cause I have the
power of attorney.
00:24:40.60\00:24:42.38
Will his own
doctor and pastor still be
00:24:42.74\00:24:46.00
involved in his
care, and Martin write this
00:24:46.01\00:24:48.46
from Florida. We
would encourage it,
00:24:48.47\00:24:50.81
it's always best
when someone familiar
00:24:51.38\00:24:53.38
is involved with
the patient's care,
00:24:53.39\00:24:55.47
the physician or
the pastor or chaplain
00:24:55.70\00:24:58.15
involved. We
would encourage them
00:24:58.16\00:24:59.82
to be part of it,
Medicare provides that,
00:24:59.83\00:25:02.64
you as the
patient have the choice
00:25:02.82\00:25:04.91
and if your
doctor's willing to stay
00:25:04.92\00:25:06.46
on the case. All
they have to do is work
00:25:06.47\00:25:08.53
with the hospice
team and be involved
00:25:08.54\00:25:10.82
with the case on
weekly or daily basis
00:25:10.83\00:25:12.99
if that's what they determined.
00:25:13.00\00:25:14.05
We want them to be involved,
00:25:14.26\00:25:15.91
the patient feels
better, the family feels better
00:25:16.07\00:25:19.50
and many times the
physician has maybe
00:25:19.51\00:25:21.73
seen this patient
for many years has formed
00:25:21.74\00:25:23.55
a relationship with
them and they wanna be
00:25:23.65\00:25:25.23
involved also. Okay,
now you've worked on,
00:25:25.30\00:25:27.91
around the terminally
ill for a number of times
00:25:27.92\00:25:30.81
what do you see
the greatest challenge
00:25:30.82\00:25:33.15
in caring for this
group and their families.
00:25:33.16\00:25:35.33
I think the greatest
challenge is perhaps;
00:25:35.75\00:25:38.10
there are some
unsaid baggage in the past,
00:25:39.09\00:25:41.54
okay. Perhaps, you mean like
00:25:41.55\00:25:43.32
relationship
baggage, a relationship issue
00:25:43.33\00:25:45.15
and perhaps that,
money. Money might be
00:25:45.16\00:25:48.07
an issue, okay and
maybe religion is an issue,
00:25:48.08\00:25:50.24
okay. Perhaps
there was just a simple
00:25:50.25\00:25:53.54
disagreement over
a Thanksgiving dinner
00:25:53.55\00:25:55.35
and the only way
that they can get along
00:25:55.36\00:25:57.05
was to brush underneath the rug.
00:25:57.06\00:25:59.77
But usually when that time comes
00:26:00.59\00:26:02.30
there's a heavy
heart and the patient
00:26:02.31\00:26:04.39
wants to make a
resolve or perhaps
00:26:04.40\00:26:06.20
the patient is
okay with it but that
00:26:06.21\00:26:08.24
son or daughter,
brother and sister wants
00:26:08.25\00:26:10.81
to have resolve.
They want to take care
00:26:10.82\00:26:12.66
of the issue before
it's too late and sometimes
00:26:12.67\00:26:15.03
those are the
most difficult cases.
00:26:15.04\00:26:16.67
Now, one of the
things that I've seen working
00:26:16.80\00:26:19.51
with the terminally
ills is I always try
00:26:19.52\00:26:21.35
you know to give them a change,
00:26:21.88\00:26:24.10
you know to open up spiritually
00:26:24.37\00:26:26.26
if they want to, if
they still can both them
00:26:26.27\00:26:29.45
and their families and
I just found that to be
00:26:29.46\00:26:32.15
so rewarding,
both to me and to them
00:26:32.16\00:26:35.09
you know I might
not be able to help
00:26:35.26\00:26:36.69
you anything
physically to heal you.
00:26:36.70\00:26:38.24
But maybe we can
help you know God
00:26:38.38\00:26:40.42
and you work things out before,
00:26:40.43\00:26:42.31
before the end.
But the family issue
00:26:42.32\00:26:44.58
I've seen all
sorts of things happen
00:26:44.59\00:26:46.44
with family, I've
seen them argue about
00:26:46.45\00:26:49.01
whether they
should put you know father
00:26:49.02\00:26:50.74
at the end of
life on a ventilator.
00:26:50.75\00:26:52.65
Even though he's
got terminally illness,
00:26:52.78\00:26:54.49
I've seen them
argue about money,
00:26:54.50\00:26:56.29
I've seen them you
know just argue about
00:26:56.44\00:26:58.13
everything, almost
right in front of him
00:26:58.14\00:27:00.34
and it's really
sad. Sometimes it's hard,
00:27:00.35\00:27:02.03
you just still like
getting everyone in room say
00:27:02.04\00:27:03.81
hey listen wake up
you know lets get on
00:27:03.82\00:27:06.21
the ship here
and lets focus on the
00:27:06.22\00:27:07.89
major issues. It
just sometimes can be very
00:27:07.90\00:27:11.03
frustrating from the
caregiver when you see
00:27:11.04\00:27:12.97
all the squabble
when, when you see you know
00:27:12.98\00:27:15.04
what's happening
here. One thing that how
00:27:15.05\00:27:16.92
you can get around
that as a individual
00:27:17.06\00:27:20.46
make your wishes
known, perhaps have a
00:27:20.47\00:27:22.46
paperwork drawn up
to express your wishes
00:27:23.92\00:27:26.18
that way there is
no argument it's down
00:27:26.51\00:27:28.45
on paper your
family know what you want
00:27:28.46\00:27:30.26
and they could
follow through also.
00:27:30.27\00:27:31.59
Okay, Ron we have a few seconds,
00:27:31.83\00:27:33.67
is there anything
you would like to add
00:27:33.68\00:27:35.21
to audience go
on as caring for the
00:27:35.22\00:27:36.87
terminally ill
before we close today.
00:27:36.88\00:27:38.69
I just want to say
that taking care of people
00:27:39.07\00:27:41.49
who are dying is
such a rewarding issue.
00:27:41.50\00:27:43.33
Volunteers are
needed, nurses are need,
00:27:43.34\00:27:45.37
yeah, step forward
remember Christ said that
00:27:45.61\00:27:47.85
he's preparing a
place for us and some day
00:27:47.86\00:27:49.76
we'll be there. And I
wanna remind everybody
00:27:50.67\00:27:53.26
in the medical care
not only it's the beginning
00:27:53.27\00:27:55.88
of life and through
the life but there is
00:27:55.89\00:27:57.64
proper care at
the end of life too.
00:27:57.65\00:27:59.33
And I wanna encouraged
everyone to continue to
00:27:59.44\00:28:01.61
praise God for we are
indeed wonderfully made.
00:28:01.62\00:28:04.42