Author Archives: richardzorza

Moving Modern Geriatrics to Take Advantage of Nurse, Family and Patient Intuitions

As our strategic plan moves forward in the health area, we are given a useful reminder in the New York Times of the value of instinct in alerting people to potential medical crises.  The Times article focus on the instincts of nurses, and is fascinating.  I have done a blog that asks if we can also take value from the intuitions of the family and the patient themselves

I suspect that we could “train” patients and families to be much more mindful about patient monitoring, including how to trust their instincts and how to communicate their feelings to the medical personal.  This, of course, should be accompanied by training of medical staff on how to take the most advantage of, and how to solicit such communications.  It is not hard to construct model ways of doing so.

I suspect that when things work, that is very much happening in our long term care facility already.  Nurses and care staff know the patients, and communicate with them regularly.  It makes such sense to empower them to raise their concerns, to train and encourage family and resident to do so too, and finally to ensure that all medical personnel not only listen to, but affirmatively seek such help as part of an inclusive team.

I am sure that this will fit in well with our general themes of community cultural change and inter-generational initiatives, as well as the specifics of modern geriatric medicine.

 

 

Successful Shakespeare Performances

Below you the see the full cast of the recent “Summer’s Lease” presentation of “Songs, Sonnets and Scenes” from Shakespeare from the Drama Group.  (Photo by George Newman.)

ensemble

They all look happy, as well they should.

The hard work, enthusiasm, and simple joy shone through all the performances.  They had a lot of fun

It would be unfair to focus on any particular performers.  Rather it should be noted that Director Tim Sabin’s work on intent and discernment showed through all the way.

More, please!

Denny Klass’ Thoughts on Palliative Sedation

Editor Note:  Collington is lucky to have as a resident and resource Denny Kass, a renowned expert on issues relating to death and mourning.  A recent Washington Post article on how doctors can and do take steps that have the effect of easing the path to peaceful painlessness within the constraints of current law caused us to ask Denny to reflect on the rapidly changing landscape for us at Collington.  The key  quote from the post is : “Under palliative sedation, a doctor gives a terminally ill patient enough sedatives to induce unconsciousness. The goal is to reduce or eliminate suffering, but in many cases the patient dies without regaining consciousness.”  The opinions expressed are personal to Denny.

Will someone help us die when we are ready? The question has been, in different forms, part of the ongoing conversation at Collington for a long time. Last year the majority of Collington residents signed a petition to the Maryland legislature supporting an Oregon-style assisted dying law. A bus load of residents lobbied for the law in Annapolis. In February this year four residents attended a two-day conference on assisted dying at the National Science Foundation.

In this brief posting I will think about a few issues and possibilities in assisted dying in a way that I hope can help our community focus the discussion.

Physician assisted dying (PAD) modeled on Oregon’s law is now legal in several states. I believe the recent appointments to the Supreme Court will make it harder for PAD advocates, and because its opponents link PAD with abortion, the Court may restrict PAD as part of reversing Roe v. Wade.

Not having Oregon-style PAD actually has little effect at Collington. Those laws do not really fit our situation. The laws permit physicians to give lethal drugs, after many safeguards, to people who have a disease, usually cancer, that will kill them within six months. The same prognosis qualifies a person for Medicare to cover hospice. Howeer, that’s not the way most of us will die.

As we look around us, we can easily see that advanced aging is a series of debilitating physical and cognitive changes that slowly eventuate in death. Many of us have included Do-Not-Resuscitate (DNR) orders on our MOLST forms in the hope that if death comes quickly, emergency responders will not reverse it. But that will not happen for most of us.

An article in the Washington Post last week explored palliative sedation, a long-standing way physicians in both acute care and hospice have been legally assisting dying for a long time. The practice rests on a distinction between active euthanasia — giving medications to cause death, and passive euthanasia — giving medications (usually morphine) to relieve pain that may as a side effect hasten death. Thus passive euthanasia is treated the same as withholding or stopping active treatment.  The article notes that the opponents of PAD accept this distinction. Palliative sedation will probably escape legal changes in assisted dying that I think are coming in the next few Supreme Court sessions.

The Swiss have a different kind of PAD law in which all competent individuals retain their autonomy to determine their own manner of death. Individuals can decide when death is preferable to living. The film You Before Me was about a young quadriplegic traveling to Switzerland to die. In early May, we read news articles about  104-year-old Australian scientist David Goodall who took what he called the Swiss option. I think, however, the ultra-conservative Supreme Court majority would oppose a Swiss type law in the United States.

In the present legal climate, we can ask whether palliative sedation could be extended to the trajectory of dying most of us are on. Old age is a terminal condition. Even though it is composed of many diseases and syndromes old age always ends in death. The question remains: Will someone help us die when we are ready? Each of us could decide for themselves when our failing capacities makes death a better option than living, and after we have made that decision, could we ask to be put into a drug-induced coma that will hasten death.

For many in our community individual autonomy is the prime value. The opponents of PAD do not hold individual autonomy as a prime value. They think whether we live or die is God’s decision. Our Collington community is open to many religious beliefs. If some of our members wish to wait for God to decide their time has come, we should provide whatever support they need to be comfortable while they wait. Could Collington provide as much support for those who decide death is better than living as we provide to those who choose to wait for God?

The Jacob Kijne Know Your Neighbor

Here is Jacob’s impressive “know your neighbor” talk from last Tuesday night.

Enjoy.  Hopefully it will stimulate others to share their stories.

The New Fountain

IMG_20180707_165957670

Many will remember the old fountain that recently stood forlorn and dry in the Courtyard.  It had been donated by long term resident Warren Unna, often described as the Washington Post’s first foreign correspondent. The fountain cracked and could not be repaired.

But now, we now have a lovely new fountain, as similar as possible to the original, happily bubbling to the side of the Courtyard.  The new location makes outdoor catering easier.  A million thanks to the Courtyard Group.

Enjoy.   Maybe it will stimulate thoughts about additional water projects.