Harvard is testing ecstasy

Here's an article from the Washington Post discussing a new FDA approved Harvard study on the illegal drug ecstasy to see if it helps terminal cancer patients deal with the psychological and spiritual issues that come along with hearing that you are going to die in the next few months. To start I'll tell you that I don't know a thing about ecstasy except for a vague notion that it is often linked with people in nightclubs. I'm nowhere near up to date or "hip" enough to know anything about this drug, and I say that with a bit of pride. I also missed the whole '60's experience, and feel that having been a part of that may shed light on the hopes of this drug. With that said, I do have some strong feelings about the "purpose" of the study, and, to be honest, have had this post open on my computer for quite a while as I sorted them all out.

My immediate gut reaction upon reading this article is that I'm all for the psychological use of these drugs. If there is a person with some serious psychological issues and this drug can help a professional deal with those problems, then I'm in! Any other use seems to become a bit shady to me though. The article seems to imply that one of the expected uses for the drug would be, in its most basic form, to help make people more comfortable talking to their friends and families about subjects that are hard to talk about. There is a fine line on using a drug for this intent, and I really think we better stay away from the line. (I also know from my younger days that if you get a few too many drinks in me I'll bear my soul to anyone who walks by, but I rarely woke up the next morning feeling good about what I had done or said, but that may be a whole other story.)

When my father had cancer he and my mother had some top secret discussions about death and the future, but he never mentioned these things to the kids. I wish he would have, but he didn't. Would ecstasy have made him comfortable doing so? Maybe. If you need to take a drug to say something does it make taking the drug right? I'm not sure. Let's go one step further. If dad would have taken ecstasy and opened up to me and I was uncomfortable talking to him about his death, would it be okay for me to take some ecstasy to loosen my tongue? How do you draw the line?

As a Christian I find the idea that taking this drug will help your spiritual experience at the least absurd and probably somewhat offensive. To believe that a drug is needed to help with the spiritual experience you have to accept two things as fact. First, God is not big enough to reach you without your first being "primed" by a drug. Second, the people who came before us/before the advent of this drug were unable to have a satisfactory spiritual experience. I accept neither, and thus can not accept that there is a need for a drug to enhance the spiritual experience. (I shared this article with two of my chaplains while mulling over what to write in this post and they both had a huge laugh at the portions of the article that dealt with the spiritual experience. I had to kick them out of my office because they wouldn't quit making jokes about the whole concept.)

To summarize, I'm all for any new drug that may help medical professionals do their job. I want to make sick people well. I draw the line there. The thought of prescribing a drug because you think someone isn't talking about/dealing with their terminal illness as well as you want them to, is just flat crazy. Some people just don't want to talk, and just because you or their family wants them to open up doesn't make it necessary. Finally, the idea that we need a drug to help our spiritual experience is far from my belief and experience, and I know I'm not near alone in that belief or those experiences. People sought enlightenment through drugs in the '60's, and as far as I can tell that trial run wasn't a huge success. Let's not try again.

I know my thoughts are going to be controversial. I know my thinking here is somewhat simplistic. I know some will disagree. I'd love to hear from some even minded people who are much smarter than me in the comments below. I could easily be wrong about the medical uses. I don't believe I'm wrong about the spiritual uses, but I'll accept any thoughts or comments from anyone who agrees or disagrees. The world's too big for me to think that I know everything.

Must read post

There is a reason that I link to Grand Rounds each week, and this weeks post from The Cheerful Oncologist is a great example. It's a must read and a site you really should bookmark and check on a regular basis.

Thanks for the great writing doc.

Grand Rounds

This weeks Grand Rounds is up. Check it out.

Welcome to the Hospice Wife

Just wanted to say hello to my wife, whom will probably be checking the blog for the first time ever today. You may be asking yourself, "Why has she never seen the blog before?" That's a reasonable question. The answer: I failed to mention that I was blogging.

I started the blog in July, and sometime in September or so I realized that I had never told her. Because I am a total wuss, I have been waiting for a few months for a good chance to tell her and minimize the ridicule that would come with not telling her. That chance came last night. The ridicule came as expected, and then I went to sleep. I'm sure I'll hear more about it today.

With all that said. I'd like to welcome my wonderful, beautiful, and most of all understanding wife to the blog. I love you!

His attorney will contact you soon

A quick link to remind every hospice administrator why we pay those massive insurance rates.

If this was one of your patients, you'd be on the phone with your attorney right now trying to figure out if he could sue you since you provided the oxygen tank he used to catch himself on fire.

As the song says:

Everybody knows the world is full of stupid people.

A Christmas story

Here's a very touching story about what one community has done to make sure one hospice patient got his white Christmas. I'm having trouble watching the video, but maybe you'll have better luck.

As long as I can find stories like this one, I'll never lose faith in the heart of the human race!

AIDS and hospice: one example

As promised, I'll pass on info on hospice programs that are working with AIDS patients. Here's an article that tells how "VITAS of Broward is partnering with nurses in South Africa and Jamaica to improve end-of-life care for the growing number of patients in the final stages of AIDS", and more importantly how you can help.

Grand Rounds 12

This weeks edition of Grand Rounds is up at Parallel Universes. Thanks to Dr. Emer for hosting and for including my recent post on AIDS and hospice in the group.

Go over there and you just may find a new favorite blog!

HIV/AIDS and hospice

December 1st was World AIDS day, so I thought this was a good time to say a bit about how the hospice community in general is doing at caring for AIDS patients. The little I have to say? We’re not doing very well. I’ll tell you why.

First, most AIDS patients are not referred to hospice because it (somewhat like Alzheimer’s) is almost impossible to predict when a patient with AIDS is going to die. You can take two people from almost any given phase of the illness and one could easily live years longer than the other. Since doctors must certify that they believe a patient generally has six months or less to live, it is hard for a doctor to, in good conscience, make a hospice referral. Given this fact, few AIDS patients are referred to hospice, and most of those are very close to death.

Second, and probably more importantly, is the fact that most hospices, from a business standpoint, don’t want AIDS patients. We are paid the same amount of money no matter what the diagnosis of the patient is. We are paid the same no matter how much care the patient needs. We are (and this is the one that most applies to AIDS patients) paid the same no matter how many medications we buy for the patient. If the medication, medical equipment, treatment, or care that a patient receives is related to his/her terminal illness, then hospice pays the bill. AIDS patients are a loosing game for the business office of any hospice. They are almost always going to require many medications and more staff time than the average patient, so hospices don’t try to get AIDS patients. Please understand that I’m not saying that hospices will not accept AIDS patient. I’m sure there are some that have an unofficial policy to avoid at all costs admitting an AIDS patient, but I hope and believe that those agencies are the exception not the rule. The key is that hospice does not try to get into the AIDS community. The large hospice companies spend a lot of money marketing doctors and nursing homes, but I can almost guarantee that those marketers do not stop by facilities that specialize in AIDS patients. If there was a facility that only cared for COPD patients you’d have to beat the hospice marketers away with a stick! There are facilities like that for AIDS patients, and they have probably never seen a hospice marketer. The bottom line is that AIDS patients are not a good business decision for hospice agencies.

I’m sure there are some shining examples of hospices that do a lot of AIDS work. (In fact, I’d love for you to tell me about them and I’ll highlight them in a later post.) Yes, I have no doubt that there are examples of companies who have thrown caution to the wind, but these are not the norm. I’d also like to add the one other reason that I believe hospice is not used, and it’s one that I’ve noticed from personal experiences in caring for AIDS patients. The AIDS community is a tight knit group. They take care of their own, and don’t need/want/expect a lot of outside help. I’m not going to go into the reasons this is true, but I do believe this is a reason that AIDS patients don’t seek hospice care.

I have no solutions for this problem. I only write today to inform. If I knew what we should do about this I’d tell you. I don’t.

NHPCO award winners

Congrats to the winners of NHPCO's photo and writing contest (opens a .pdf file). The pics and the essays are moving take some time and check them out. (I'm sure the poetry is also, but that's just not my thing.)

Grand Rounds 11

Grand Rounds, which is a collection of posts from many different medical blogs, is up for the week. I'll try to remember to link to it every week. Hope you find someone you want to read on a regular basis.

Thanks to Dr. Charles for hosting this week.

Debate on longevity

Instapundit has a link to a debate on the BBC website about longevity. One side says there is a great breakthrough coming very soon that will vastly increase our lifespan. The other side says they've been saying that for centuries (literally). Interesting reading.

Grief advice for the Holidays

NHPCO has put up this page of advice about grieving during the holidays. The advice is good and needed.

As a person who has read all the books, I know the holidays are a time when grief is strongest. As one who has lost someone very near and dear in the past couple of years, I can tell you that there are times when the holidays flat out suck. If you have not been through it, then take my word for it and pass this info out to everyone you know that has lost a loved one this year.

One of Jimmy Buffett's songs says:

I have good days, and bad days, and going half mad days.

That's a good summary of what the holidays are like for those who are dealing with the loss of a loved one.

The survey says - hospice is rarely negative

A recent survey showed that 49% of the population has had experience with hospice and that 98% of them had positive experiences (hat tip NHPCO). Now stop and think for just a moment about that number in light of what a hospice experience is. I’m going to generalize here and say that the definition of a hospice experience is that these people have had a loved one who was diagnosed with an incurable disease and has since died.

These are not the times in our lives where good experiences abound! Very few of us go through the death of a loved one and come out the other side without regrets. Many of us come out wondering if we made the right decisions, and some of us in hindsight wish we would have gone to another doctor/tried another treatment. . . With that in mind, it is amazing that 98% of people who have had a hospice experience believe the experience was positive. I’m not saying that I’m surprised, but I do find the number to be somewhat amazing.

Why am I not surprised? Because hospice is a great thing. (Did you think I’d say anything else?) When I first started doing hospice work I would take my ID tag off in the car after work before running errands because I didn’t want the person in the checkout line to think I was some sort of blood sucking ghoul. Now, I often take it off because I’m in a hurry to get home and know that there are decent odds that a stranger will notice my ID and stop me to tell me how wonderful hospice is and to thank me for doing what I do for a living.

I’m writing another post for another time on why I think hospice is so popular with those who have experienced it. Today, I just wanted to get your brain to chew on the fact that, against some serious odds, hospice is almost unanimously seen as a good thing by those who have experienced it first hand. How many other parts of the medical community can say that? Hospitals – few love their hospital experience. Doctors – Some are popular, but I doubt that 98% of patients would respond positively when asked about their doctor. Nursing Homes – nobody loves their nursing home. Why hospice is different is for another day. Today, I’ll bask in the warm light of all those people who are happy that I decided to become a blood sucking ghoul. I invite all of you who work in hospice or refer your patients to hospice to take a moment to feel good about what you’ve done. Odds are your patients feel good about it!