Do You Think Grandad’s Going To Make It?

There’s a joke in Dublin that goes like this: you see an ambulance screaming down the road with its sirens going and you say “Sure he’ll never sell any ice-creams going at that speed!”

I know I could never be an EMT. I could never be an ER nurse or, god forbid, an ICU nurse. It would bore me to death taking care of patients who can’t chat because they’re in a coma. And the constant adrenalin of the emergency environment would wear me out in about two days. There are emergencies at hospice, but they are mercifully few and far between. However, they can come in handy.

It’s my goal the next time I’m pulled over for speeding while I’m at work to flash my hospice badge and say earnestly “Officer, I’m on my way to give morphine to a dying woman who can’t breathe. You’re going to keep me here while you check my license and registration? She can’t breathe.” Of course, it’s 99% likely to be a complete lie, since I am rarely rushing to people who can’t breathe but I can’t wait to try it out and see if it works. Not that I speed. Just sayin’.

Sometimes I do have to rush to people though. And sometimes I rush to people and I really didn’t need to. There was that patient about whom I received a text from one of my co-workers: “Looks like he’s dying, come quick.” So I sped over there and on the way I called his daughter and told her to speed over there. Then we got there and he opened his eyes and said “Hi! Can I have some oatmeal?”

But sometimes the people I rush to really need to be rushed to. Breathing can change at the end of life and frankly, it can sound really awful. People make noises like they are drowning. It’s mostly because their swallow mechanism is gone, so the saliva that they would normally swallow just pools in the back of their throat and they have to breathe through it. Family members get really distraught and with good reason: it is most unpleasant to listen to. Our line, and it’s well researched, is always that by the time their loved one is making those sounds, they are well beyond feeling anything. But it’s distressing for everyone at the bedside, (including me, because there have been those one or two patients who have been conscious through it, and I was all out of comforting lines then). So there are certain medications (morphine, hyoscyamine) that we give to try and manage what is known outside of hospice as the death rattle. We never call it that. Among ourselves, we call it terminal secretions, and to families we talk about noisy breathing. I mean, who wants to hear from their hospice nurse: “So when he gets near the end, you might hear your dad give the death rattle. Don’t worry. It’s just his throat filling up with liquid he can no longer swallow. Really not a problem.”

Which brings me to hospice lingo. Like any specialty, hospice has its own specialized vocabulary, which, being a word freak, I love. Cheyne-Stoking, actively dying, imminence. We bandy these terms around among ourselves, but it’s just not a great idea to use them with patients or their families. Medical terminology confuses and alienates most folk. Unless they are physicians or lawyers. Lawyers like you to be as obtuse as possible so they can feel at home. And physicians already know what phenobarbitol is used for, so you don’t have to sugarcoat it. 

But for the most part, we try to talk in regular English. Near the end, mom may start to get some extra energy you wouldn’t have thought she still had in her. She might pick at the bedclothes. She might try to get up and walk around. Sounds better than mom’s got terminal agitation, give her a shot of haldol. 

We get pretty skilled at putting things in layman’s terms, but sometimes we just get it plain wrong. A coworker of mine tells a great story about an elderly patient she had, whose six-year-old grandson lived upstairs from him and loved him dearly. One day, she was helping grandad out of bed to the bathroom and the grandson was standing by. Grandad was by this time far gone in dementia and couldn’t understand anything that was said around him. The boy looked at her earnestly and said “Do you think grandad’s going to make it?” 

“Well,” began my friend, kicking into nurse-explains-death-to-young-child gear, “he is getting very close now to the end of his life and it’s unclear really how much longer he’ll be with us.” She went on a bit longer giving the kid a gentle lesson in letting go of grandad. He listened patiently. When she had finished, he said “I meant do you think grandad’s going to make it to the bathroom?”