Go Retire Psychiatrist

This is an excellent podcast episode about General Inpatient Hospice Care and I am proud to have been part of her early professional career when I interviewed her for residency at The University of Iowa Health Care. She and Dr. John Wilde gave an absolutely stunning presentation about hospice and palliative care in response to moderator Dr. Gerard Clancy’s questions.

The discussion included remarks about certain medications for delirium in the context of the process of dying. While consulting psychiatrists usually would advise against giving anticholinergic medications to delirious patients, patients who are dying and delirious could actually benefit from such drugs.

On the other hand, as a consulting psychiatrist, I was called to the ICU to help manage a very agitated, (terminally ill if I recall correctly) delirious patient who had to be physically restrained because he was so violent he was repeatedly bouncing the bed off the floor. The ICU team had tried everything short of intubation and sedation. It was a long time ago and at the time, intravenous haloperidol was the only tool I had. I tried it for a couple of days. It didn’t help. He died a couple of days later.

When my brother died in a hospice, he was delirious. I simply sat with him. He wasn’t violent or even agitated, but he had that hypoactive delirium that disconnected him from external reality. I was fixated on watching him die. Some friends of his stopped by to visit and distracted me from that by telling him how they loved him like family. When I finally looked back, he was dead.

Clear, careful communication is essential in this area of medicine. Choosing your words is important. Certain phrases should be avoided, like “withdrawal of care.” You never withdraw care.