Patient’s name and age are changed and details slightly altered to protect identity.
By Barb Gorman, Communication Specialist “Mildred” is a 94-year -old woman who came to Portland two years ago to be closer to her daughter, “Rachel”. Mildred needed help managing her health conditions. She used oxygen at night because of heart failure, and required frequent lab tests due to a chronic blood disorder. She decided to move into an assisted living facility (ALF) where staff could help her with transitions and provide day and night support.
Soon after her arrival to the AFH, Mildred experienced a major stroke. Housecall Providers clinician Amy Long, GNP, first saw Mildred when she was newly released from the hospital. Though cognitively intact, she was experiencing urinary sepsis (infection), so both Mildred and her daughter thought the end was near. As it turned out, it was not.
At their first appointment Amy asked Mildred about her wishes regarding hospitalization and reviewed the POLST form with Mildred and her daughter. Together Mildred and Rachel decided that if she was to have another acute illness she did not want to return to the hospital. Another one of Mildred’s goals was to discontinue any unnecessary medications, and to focus her treatment solely on palliative measures.
Amy contacted Mildred’s hematologist to share her treatment goals and discuss discontinuing one of her medications. Ultimately, it was decided that the prescription in question was necessary to keep Mildred comfortable. Nine months passed with no major disturbances – she was stable and comfortable and her periodic labs were fine. Amy visited her for a regular follow up after hearing reports that she was confused and that her hand was swollen. Her examination revealed nothing significant, and Mildred seemed comfortable and reasonably well. Amy decided to do an ultrasound of her arm just to rule out a blood clot, warning Rachel that if one was present the chances of a stroke are higher. (Amy later learned that no clot was present.)
That night at 8:30 p.m., Amy received a page from Rachel that her mother had just had a stroke and was not responding. She realized it was time for Mildred to go on hospice. (Because of the prior discussion with her mother, Rachel knew the hospital was not an option.) Amy arranged for Mildred to be admitted to hospice in the morning and ordered comfort medications for the night. At 2:30 a.m. the next morning, Amy received word that Mildred had passed away peacefully with her daughter at her side.
Amy contacted Rachel three days later and learned from her it was the best death she could have imagined for her mother.