Palliative Care Vs Hospice

Palliative care and Hospice, both focus on making life easier for the person diagnosed with some chronic or terminal illness. Looking platonically, there is not much difference between the two. But there few major difference that are important and be taken care of.  

Palliative Care

• A patient can receive palliative care for cancer or any another serious illness. 
• Palliative care is dedicated to improving the quality of life by dealing with the symptoms from an illness( curative care).
• Palliative team generally comprises of professionals- Doctors, Nurses, Psychologist, Psychiatrist, Dietitian, Social workers.
• Palliative care is usually given in Hospital, Specialized treatment centers, Nursing Clinics, or Hospice Institutions.
• Palliative care can be received at any stage of the illness and by anyone. with serious illness regardless of the life expectancy

Hospice

• Hospice focusses on making life comfortable for the few months besides easing the pain and dealing with emotional issues.
• Hospice teams comprises of the immediate family members of the patient and visiting Doctors, Nurses, Volunteers, Social workers.  
• Hospice is in majority administered at home. The family member of the patient play a vital role. Though there are many specialized hospice centers or homes when a patient can get round-the-clock care.
• Hospice care is for patients where death is imminent i.e they have less then 6-months to live
• A patient can receive palliative care at hospice centers.

I love you, Papa!

The night it happened......

It was 5:00a.m, Papa woke up. He wanted to have tea. My heart sank. I choked.

I woke  my mother. She made tea.  Papa had half a cup of tea. He looked contended. And went back to sleep. He looked so normal, as if he just woke from fever and now everything will be fine. But I knew...nothing will be fine now...never.

Somebody,  I know once told me - when the day will come, you will know-  It will feel as if everything will be all right. I will notice a strange shine on my father's face. And I don't know why, but I always knew that papa will go on a saturday night. And today was saturday.

My instincts were telling me-the day has arrived. For past two days every time, I tried to take papa's blood pressure and pulse - the machine always showed error.

I went to my home, took shower and was packing my bags when I received a call from my aunt. My aunt informed me that palliative care team( of doctors) visiting papa has arrived and wanted to speak to me. I knew the news was "not good". I took the receiver, and the doctor said( what I din't wanted to hear)..."Your father is half gone, you can call your brother".

I was just stabbed in the heart. And blood was coming through my eyes. I packed my bag and ran down the stairs. My husband followed. I was shaking when I reached my daughter's school. I picked her up hurriedly. 

Back in the car, My husband said, everything will be okay...and I said "today is the day, and I know it". I called my younger brother. He was in office. I said bhai, "Come" and dropped the phone.

I reached home. My aunt told me, today papa had apple juice. After months of not eating or drinking anything, he even had porridge.  Papa was having difficulty in breathing. I decided to get an oxygen cylinder( owing to my Asthma,  I know how it feels when you can't breathe). I got the oxygen cylinder. But, I could see - It was not much of a help. 

It was 7.pm. My younger brother arrived straight from office.  I called papa. He opened his eyes and recognized my younger brother. He smiled at all of us.

Around 9 p.m:  I noticed papa's breathing had become more erratic and irregular. I decided to nebulize him. Papa was restless. I put the mask, and started the machine. Around 11:30p.m,  I held papa's hand and said, I will come in the morning. Papa put all his left strength together and screamed "don't go". And I din't...

I switched off the " Mahamritunjaya Mantra" and asked everyone to sleep. I said, I will sit. Everyone would sleep around papa.  Lights were switched off. And, I took my tablet and started reading. Every two minutes, I would check if papa was still breathing. Papa was extremely restless and was panting heavily.  He was struggling for life and life was moving away....far away!

My father was in deep pain.  But he was trying. He wouldn't give up. I was suffering.  I have to let him go......

At 12:35a.m, papa asked me to remove the mask. He wanted water. I gave him water and said papa, you can go now, I love you....

The time period between the breaths increased...and it kept on increasing...I woke my mother, aunt ...I called for my brothers, husband and uncle....

We all were there when papa took his last breath......1:15am,  26th October 2013!

I Love you, Papa!

Papa and the web

The next morning , the doctors came. I had spoken to her about a node behind papa’s ear. It looked like swelling but papa said it was painful. 

The doctor pricked the needle once, twice, thrice.... Papa screamed in pain. My very strong father was screaming " to stop". My mom could see no more. So she asked to stop.

The doctor said, aunty if we won't check how will we prescribe the medicine. I believe the doctors know before  us- the time has arrived. Then prescribing medicine to a person who is.....

I took my father not for some research. I knew nothing will help. I knew he was going. I just wanted some pain-less moments.

I am sorry papa.

Love you PAPA!

Chapter 5 - PICC line

After the first round of chemotherapy ended, the doctor advised us to get  a PICC line, it will be good for papa. I wondered how? Anways we had to get it done. But what was supposed to do good to papa, brought so many problems. Anyways, when the doctor said abut picc line, I wanted to know more about it. Since it was anew domain, i decided to do a research.

What is PICC line?

If i were to put it into  simple words - PICC (or peripherally inserted central catheter ) line is basically a very sleek tube made of biocompatible (silicon) material, is inserted in to the vein and is advanced till it reaches the chest. This helps the doctors in avoiding daily pricking and finding the vein(s) for tests, infusing chemotherapy medicines. And I was told it will help papa.

Hep Lock

A part of the tube is left outside. This opening on the outside is closed with a lid (or cover).  It is through this opening that the blood is taken for test(s) or chemotherapy medicines are induced. But in CANCER nothing comes without side effects. So did the picc line insertion. The whole process turned out to be very difficult and painful. Both before and after the chemotherapy session,  HEP lock ( flushing medicine) was used to flush (clean out) the intravenous (IV) catheter, in order to prevent any kind of blockage ( blood clots)  in the tube after the IV infusion(s). While  FLUSH (ing), it is important to care that no air bubble(s) is present in the vaccine (which may  further complicate the matters). 

Side effects

After every 7 days, it was mandatory to do the picc line "dressing" ( cleaning, flushing, and finally bandaging) in order to prevent any type of infection(s). Precautions were needed to be  taken so that no water enters in the picc line “area”.  As a result papa couldn’t  move his hand freely, wear his favorite full sleeved shirts or sweaters, or bath as frequently as he wanted.

Opening of the picc line tube

Since the “picc” line was inserted in papa’s right hand, which made things more difficult for him. The pain actually never subsided. But under the influence of some drugs, he would sleep for few hours, picc line only made it worse. He had to be alert  even while in his sleep- the picc line doesn’t get pulled out or pressed. He never slept literally. Usually the picc line is inserted in the left arm, heart being on the left side . That ways the tube inserted in smaller in length, therefore less chances of breaking. And since left hand is not used much so it becomes easier( unless you are a lefty).

Insertion of the tube

PICC line in india is usually inserted by a trained staff ( in papa's case-  by a  junior doctor). Although,  the picc line can be removed by anyone ( even by a family member) as long as the necessary precautions are taken care off. For papa, it was removed by the palliative staff who would visit papa at home after he became bedridden.

The picc line can stay upto 1 year with proper care before it is discarded . In papa’s case it was for 7 months. I got it removed only after the doctor’s declared “ nothing can be done”. After the picc line was removed, i noticed a black circular ring around the hole created by the insertion of the picc line. I told the doctors, they prescribed an ointment. The ointment did lessen the itching and but pain remained as it is.

By Side effects

Other side effects of picc line papa suffered were rashes, itching and swelling (in the throat), dizziness, and difficulty in breathing.

Having lived cancer (with papa), now for almost 2 years, i can say that cancer is not just one disease but a combination of many disease(s). And this is what killed papa. Though papa’s ordeal ended but mine’s is still continuing. I cannot forget the moments when papa would endure all the pain without a single complaint just to be with us.

Love you papa!