Breaking My Anonymity

Ever since I started this blog, I have been writing under the pseudonym "Mia Adams." My reasoning for this was based on my own personal experience of coming across one of my health care providers on-line and my fears that she would somehow reference me (even indirectly) in her posts. Not wanting to create that same fear in my patients, I decided to use a pseudonym.

As part of that, I opened up a separate email account for this blog. However, as you may have noticed, I have not been posting as frequently as I once was. And as a result, I have also not been checking that email account very often either.

Unfortunately, I am technically unable to change my email address for this blog (as both addresses are gmail accounts which conflict with the google-based applications for blogger). But I will at least unveil the woman behind the curtain, so to speak.

My real name is Melaina and my real email account is Melaina RN at gmail dot com. So please send any correspondence to that account if you would like to receive a timely response.

I have given a lot of thought to this blog recently and am considering picking it back up again. Of course, I am thinking of potential new directions to take it in. With the advent and increased popularity of video posts, I may explore that avenue. Though for the time being, revealing my real name seems public enough, I think. :-)

But I welcome your input as well. I have received so many wonderful and supportive comments on this blog, even during my own silences. Thank you so much for the feedback. I would like this to continue to be a space that enriches the lives of my readers as well as continues to stimulate me to explore new subjects and areas, especially pertaining to issues such as quality of life, palliative care, bioethics, hospice and the end-of-life. Please send any suggestions for topics or any questions that I have left unanswered. I'm hoping with a little attention, I can bring this blog back to life.

Thank you so much for reading!

Sincerely,
Melaina

Last 24 Hours Illustration

Sorry for the long silence on this blog. I have been spending my time off-line drawing comics as a new creative outlet, which has taken up the time I used to spend writing this blog. Lately, I have been starting to draw illustrations pertaining to the end-of-life and I thought it would be appropriate to start posting these on this blog. Definitely a change of pace from this blog's former content.

The Great Cremation Ground

One of my colleagues just came back from a trip to India and told me about a place called Manikarnika Ghat, also known as "The Great Cremation Ground."

According to Hindu mythology, being burned here provides an instant gateway to liberation from the cycle of births and rebirths. Karmic bonds are suppose to be burnt along with the body, which is how one is liberated from needing to be rebirthed. It is said that the funeral fires at the Manikarnika ghat have been burning for thousands of years. A constant stream of corpses come to this ghat to be burnt, day and night. According to my colleague, most corpses do not get enough time to burn properly and are often unceremoniously dumped, half burnt into the sacred river.

I have never traveled to India, but if I do, this certainly seems like an interesting place to check out.

Estimating Time of Death

I am not in the practice of having to estimate time of death, as generally patients in the hospital are being watched routinely, and thus the time of death is already known. But I am on a list serv where someone posed a question that elicited this link. I thought the link was an interesting resource and might be useful to others, so I thought I'd post it here. This link is to a tool for estimating time of death, according to the Method of Henssge. It is based on temperature and puts into account various environmental factors including clothing. Check it out.

Your Truth: Dementia and Grief

I apologize, once again, for my on-going silence on this blog. I've received a number of emails from readers encouraging me to post again. I appreciate the dedicated interest in this blog from my readers.

I recently attended a fascinating lecture on dementia and grief. Inspired by this lecture, I am going to pose a hypothetical scenario for your consideration. As per my standard format, after the scenario, I am going to ask some questions and will later post my response to the scenario.

Mrs. Horton is an 86 year old with middle stage dementia. She is no longer able to recognize family members nor dress herself. She is able to walk, using a walker, and frequently gets lost in the hallways of her nursing home.

Mrs. Horton's 61 year old son recently died of heart attack. Prior to his death, her son had come to visit her in the nursing home at least three times every week. Mrs. Horton was informed repeatedly of her son's death, but she does not have the short-term memory to retain this information. She asks where her son is multiple times every day.

1. Do you repeatedly inform Mrs. Horton that her son died, even though this news is distressing to her? Would telling her the truth be retraumatizing her or banging her over the head with the news?

2. Understanding that disclosing this news can be distressing to both Mrs. Horton and to the bearer of this news, what are some different ways you might respond to her repeated request for her son?

Thank You, Blue H News!

blue-H-sign
Originally uploaded by miaadams.

I have been rather neglectful of this blog as of late. Despite my silence, I am delighted to report that Blue H News picked up one of my blog posts and published it in the January 2007 issue of their newspaper.

Thanks so much for the press, Blue H News!

Your Truth: Chemical vs. Physical Restraints

Another hypothetical scenario for your consideration...

This patient is an 86 y.o. female with dementia who is actively dying. She has become delirius, but still has the strength to get out of bed and is at a high risk for falling and injuring herself from the fall. In addition, she has a intravenous (IV) line that is being used for pain medicine that she keeps trying to pull out. The doctor has suggested the use of sedating medications to keep her from pulling out her line and from falling. But the family states they would like to keep her alert and thus they refuse the medications offered. Instead, the family prefers that wrist restraints are applied, tying the patient to the bed rails to prevent falls and to prevent the IV from being pulled out. NOTE: Both types of restraints are avoided while the family is visiting, but the family leaves to sleep at night.

1. What education could be offered to the family to ensure they are fully informed of the options to ensuring this patient's safety?

2. What other options might be considered beyond pharmacological or physical restraints?

3. What are your own feelings about chemical verses physical restraints and how might these feelings impact your attitude towards this family's decisions?