Comment by abeppu | Hacker News Reader

Comment by abeppu | Hacker News Reader

This subverts the message a bit, but my grandmother was sent to a hospice to die as comfortably as possible. I was out of state during her treatment up until this point, but when she was being moved to hospice care, I was told to expect her passing very soon. In this case, her doctors really seemed to have run out of good options; she just hadn't responded to treatment. But, after she was moved to hospice care, she began to improve. She actually healed and recovered enough to live a few more years at an assisted living home, well enough to walk the halls (slowly) for quite a while every day, and have her kids visiting all the time.

Why did she recover after she was switched to hospice care? The best explanation I have is that in the hospital, her access to opioids had been limited. Letting a patient have too much can be risky. But in the hospice, where death is regarded as impending, those risks don't matter and she could have as much as she needed to actually be comfortable. And not suffering, not being in pain was maybe what allowed her to begin to heal.

I don't think exactly that her doctors were wrong in believing that her death was imminent and that a hospice was the right place for her. But what if we created a healthcare system where clinging to life is so exhausting for the patient that embracing the inevitability of death is the most healing option?

> And not suffering, not being in pain was maybe what allowed her to begin to heal.

I think that is somewhat well known? I don't have good references about humans, but veterinarian James Alfred Wight (wrote books as James Herriot) has written about it, how lost cause lamb "miraculously" recovered after big dose pain killer (sorry, don't remember details, only his thoughs, how getting rest from pain helps).

It’s definitely true for some muscle injuries - the painkillers allow you to relax enough to start loosening up an healing.

> how lost cause lamb "miraculously" recovered after big dose pain killer

this probably have to do with movement (which applies to other animals and humans) if they feel pain they don't move, that slows down the blood circulation and the healing process.

Something, something, desk worker ...

This is ultimately what killed my mum. She stopped moving. Once that happens so many things in the body just don't work so well. Combined with her other ailments her body just didn't work properly any more.

She initially went down-hill after she was weaned off the steroids she had been on during treatment for a benign brain tumour. Obviously the tumour and the radiotherapy didn't help things, but her health dropped off a cliff when the steroids stopped, she lost all her strength. I often wonder if she'd still be around now if they had just kept her on them and worked on her mobility.

Keep moving. You don't have to run marathons or go to the gym for it to have a positive effect.

Sorry for your loss

Thanks. Luckily we managed to get her into a really good home for the last few months, which made the end easier on her, but that kind of age and innactivity related decline is a rubbish way to end your life. It's made me rather evangelical about keeping moving.

Pain -> stress -> cortisone -> body shifts to survival mode and shuts down longer term processes?

I think this is a pervasive problem in hospitals today.

I was in the hospital 5 weeks at the end of 2020, and I was very aware of all the extra challenges that it brought to healing. Poor sleep due to lights/noise/interruptions, sleeping with a strange roommate who had their own sleep disruptions. Low quality food with few options, and very little fresh fruits and vegetables. On top of constant pain, boredom fear and isolation (despite all the people around).

I understand the hospitals are resource constrained, and have reasons for many of the things they do, but at the same time I feel like rest, nutrition and psychological elements are largely ignored when designing today’s hospital experiences.

For what it’s worth this was in Canada, so at least I didn’t have financial stresses in addition, but perhaps there are other countries more human in their approach to care.

I was in the hospital for pancreatitis a few years ago, here in Austin. One thing that struck me was that they came around for their regular visits at least once every couple of hours, even with me being hooked up to all the machines. I never got to sleep more than one or two hours at a time for that entire period. And they screwed up my blood pressure medication and drove my Systolic up over 250, which lead to me learning a new level 10 of pain, and extended my stay in the hospital for a week. At least I learned that Morphine doesn’t work on me, but Dilaudid does.

Whatever else a hospital is, it is typically not a place that is designed for rest and recuperation and overall patient wellness. They want to push their curatives on you as quickly as possible and without a lot of regard for your mental well being, so that they can get you out quickly and move on to the next patient. Think of it more like a MASH unit, where you’re only supposed to be there for a short period of time before they stabilize you and ship you out somewhere else.

I grew up spending a great deal of my life in hospitals, because of my dad and his medical problems. And then my mom and her medical problems. But until recently, I never really understood things from their perspective. I hope I don’t develop hospital psychosis like my dad did, but I am definitely very wary of checking into a hospital unless there is no choice.

I also think that people underestimate good nursing, both for sick people and children. Hospitals are not necessarily great places to live. May be the care at the hospice actually gave her something to live for.

> I don't think exactly that her doctors were wrong in believing that her death was imminent

This is the crux of it. It's hard to predict exactly when people will die. Spend enough time with palliative care physicians and the phrase "if I had a crystal ball" is burned into your memory

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