MSI Press Blog

I have put off talking about this topic on Cancer Diary for a while because the memory is so painful. However, it did happen, and therefore it probably happens more often than one would think or hope. When it became time for Carl to go on hospice, we chose home hospice and looked forward to him being back home from the hospital with his family and having the support of professionals in our own.  Alas, that did not happen. Whatever could go wrong did go wrong -- and it would appear that with this particular hospice, it might have been regular practice rather than something going wrong. The easiest way to share is probably just to provide a list of everything that went wrong. (Any one of these might go wrong with any hospice, something caregivers should be prepared for. All of them going wrong is simply incompetence, uncaring, and abuse on the part of the hospice.) [In this list, Hospice C is the first hospice we worked with, the bad one, and Hospice B is the second one, the good one...

  Choosing hospice is choosing to die. That may sound like a stark statement, but it is, in my experience, a true one. Now, when confronted with cancer, one can choose to live at home, not receive treatment, and not be in hospice--at least, for most of the course of the disease. That is what my sister-in-law did. She chose to die naturally and not fight nature, in part because she had no insurance (and did not want to rack up major debt for her husband or jeopardize their life savings and house) and in as much part due to her religious beliefs. She did go on hospice during the last six weeks of her life; she needed medical attention, and the hospital, to which she was ambulanced, moved her to in-patient hospice as a compromise. She was placed in a very nice New Hampshire hospice, Hyder Family Hospice House , known simply as Hyder House. Not all hospices are this attentive, gentle with the family, well-appointed in interior ambience and amenities, or surrounded by such beautifu...

  ​This post follows up on an earlier Cancer Diary post on whether or not to choose hospice help , when and where. Choosing between in-home hospice care and care in a facility is a deeply personal decision that depends on various factors, including the patient's medical needs, the capabilities of caregivers, and the resources available.  It also may depend upon the relationship between the patient and caregiver, whether it is a spouse or an offspring who is providing the care.  While many patients express a desire to spend their final days at home, it's essential to understand both the benefits and the challenges associated with each option. ​ brighthh.com Carl so adamantly wanted to be at home and so hated the two short visits he had made to a care facility that I agreed to take on the caregiving, but it left a lot of emotional scars and question marks about whether we had thought things through adequately. The answer of course, is no. The question had to be answered alm...

  I like to follow the blog of Barbara Karnes , hospice nurse par excellence. Much of what she has to say to hospice nurses about end-of-life issues in general apply to caregivers of cancer patients in particular. Her latest post, " For some doctors, it just isn’t in their tool kit to stop trying to treat,"  reflects our experience very well. Only when Carl fell and needed four people to lift him and get him to the hospital and x-rays showed complete take over by cancer of four major organs along with blood clots in his legs and lungs did the doctor suggest hospice (although he also expressed a willingness to continue treatment -- a different treatment -- if we wanted). We chose hospice, but the period of time was short. Carl returned from the hospital and went on hospice August 7. He died August 16. I have always wished that the doctor had put the hospice option in front of us much earlier, perhaps even at the beginning of the 5-month period during which the doctor tried eve...

When facing advanced cancer, one of the most profound decisions patients and families encounter is whether to continue aggressive treatment or transition to hospice care. This decision is deeply personal, influenced by medical circumstances, values, and personal preferences. Today, I'd like to explore the considerations that might guide this difficult choice. Continuing Active Treatment: When It May Be Right Potential benefits of continuing active treatment: New treatments and clinical trials may offer hope, particularly for cancers with emerging therapies Some aggressive treatments can extend life meaningfully for certain patients Continuing treatment aligns with the desire to "fight" that many patients feel For some, pursuing all possible options provides peace of mind that everything was tried Considerations to keep in mind: Treatment side effects may significantly impact quality of life Time spent in treatment and recovery means less time with loved ones Some ...

  Earlier, I wrote about the two paths that erupted in front us when faced with a late-stage cancer diagnosis: to focus on living or to focus on dying. There are so many problems and so much confusion when told after a fall or a blood test or something else that seems otherwise innocuous that your loved one has advanced stage 4 cancer.  The worst thing about a late-stage diagnosis is time, or the lack thereof. Not just the time left for a cancer victim to live, but the time available to make decisions.  The first decision--to treat or go on hospice --is a significant one, and there is often no time to really think in through. From my own experience with more than one relative diagnosed with more than one kind of cancer at an advanced stage, there is an automatic, nearly instinctive choice made, not a reasoned one. Got insurance? Treat the cancer. Don't have insurance? Don't treat the cancer. Those are clearly not the most logical or even medically best or viable criteria...