hospice uses more than medication

I just sent an email to my Hospice team, responding to a request for sedation for anxiety for a patient with non curable cancer living at home. My team was having difficulty with medication control, and one of my nurses calmed the patient using a Reiki treatment.

I was reminded of a State Survey, where i was defending a nursing home's care of a resident who did not respond well to our pharmacologic approach. Mr Vaughan, Head Nurse of our State's Office of Health Care Quality asked of the nurses and myself, "what non pharmacologic remedies did you try?"

Our Hospice has been using Reiki extensively to help patients as the near what traditionally we calll death and Reiki refers to as "transition." Many non pharmacologic approaches can help, i have found Music therapy very powerful. Sometimes simply a volunteer with a calm and caring human voice and human touch can help.

One wisdom i have learned is that medications such as lorazapam and haloperidol do not take away the fear of the unknown, the fear of death. One of the central tenets of hospice has been our capacity to help patients and families "connect," and to be more comfortable in living the later portions of their lives. Sogyal Rinpoche, a famous Buddhist author, wrote of seeing one of his teacher's near death, who said, " i want every human being not to be afraid of death, or of life; i want every human being to die at peace, and surrounded by the wisest, clearest, and most tender care, and to find the ultimate happiness that can only come from an understanding of the nature of mind and of reality."

We want to relieve pain, absolutely of course, but, in facing anxiety, let us not view that as a symptom to be only medicated. Our patients have a very limited remaining opportunity to come to understanding, to make connection in their own path, to convey love and compassion to the world, and, in addition to medication, we should try other reasonable skills and modalities which we have at our disposal - we should be aware that, in giving a medication we may suppress the anxiety, but also, take away the few precious remaining moments of clarity, in which patients can live in a meaningful way.