Patients’ Corner: Listening to the Wishes of our Patients

June 15, 2013

This section of the E-News will highlight patient stories so that our readers can get a greater sense of the work our clinicians and hospice team members are practicing in the field every day.

Patient’s name and age are changed and details slightly altered to protect identity.

Patient Helen gets a regular checkup from Ginger Harris.

Patient Helen gets a regular checkup from Ginger Harris.

“Robert” is an 85-year old man residing in an assisted living facility (ALF) in NE Portland. Just weeks before he became a Housecall Providers patient, Robert was living in his own home independently. He suffered a fall, taking the brunt of it on his spine and starting an internal bleed. Because he was on a blood thinner for atrial fibrillation, the bleed compressed his spinal cord rendering him quadriplegic. Once in the hospital, he was taken off blood thinners and within days experienced a pulmonary embolism. This meant a longer stay in the hospital for Robert, and a stint in a skilled nursing facility before being moved into his current residence at the ALF. That’s when he became a Housecall Providers patient.

When Ginger Harris, HCP Family Nurse Practitioner, met with Robert recently he was lucid and interested in discussing, when prompted, his goals of care. He no longer wanted to receive blood thinners, so Ginger went into detail about what that would mean to his health and the likelihood of another clot forming. He didn’t want treatments that would prolong his life, opting instead for ones that would continue to make him comfortable. He told Ginger that he had experienced a long and happy life and was at peace with dying.

After hearing his wishes , Ginger recommended that Robert be enrolled in a palliative care program, where comfort—and not cure—is the treatment goal. This would allow him to decide what treatments he wanted to receive in the future. His care team at the ALF agreed and supported his enrollment in the program.

The facility contacted Robert’s local family members, who were unaware of his desire to stop some life-prolonging treatments like discontinuing the blood thinner medication. Further, Ginger recognized that Robert’s POLST (Physician Ordered Life Sustaining Treatment) form did not currently reflect his new wishes. (A patient’s POLST provides specific instructions about the level of care the patient wants to receive as end-of-life approaches.) Ginger recommended Robert and his family begin the process of reviewing and preparing the necessary changes to the document.

“Not being afraid to ask the tough questions is a critical piece of the care and support that we offer our patients and their families,” Ginger says. “Listening to the patient as they tell you what they want their treatment to be–this is the type of medicine we practice at Housecall Providers.

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