Thursday, May 13, 2010

The Comfort Zone.


I see this often on charts of patients who have been referred to hospice services while they are still hospitalized.

C.M.O. means, "comfort measures only".

When I go in to see the patient, they are rarely comfortable. First, the harshness of the overhead lighting makes the room have a very cold, clinical feeling. Some patients are oblivious to that as they are comatose, or semi-comatose, but they still look quite restless. Why? Because comfort measures only has nothing to do with comfort. What it means is that the hospital staff have pretty much discontinued all medications, all life support, all treatment and are waiting for "nature" to take its course, i.e. for the patient to die. They often have them on some type of IV pain medication, such as Morphine, but usually the patient is woefully under medicated.

It is a sad sight, no doubt. One that I have witnessed countless times.

I hate that term anyway, 'comfort measures'.

We do use it in hospice frequently as in "We will try to make you or your loved one as comfortable as possible."

But what does that mean and can we really do that?

Comfort is very subjective. Quite personal. I am not sure that we can even articulate exactly what we mean by comfort anyway.

I know that most think that it means not having any pain. But pain is also subjective. I have been to see countless patients, who are clearly in some pain, tell me that they are comfortable. They do not want to be too sedated. And I don't blame them. Many want the time they have left to be a time when they can interact with life. That makes them comfortable. And happy.

So, I was thinking, what makes me comfortable? How would I like to be treated?

I know that I would like to have pain medication, but I agree that I would not like to be snowed. I wouldn't want to have a feeling of shortness of breath, so I would like supplemental oxygen (not allowed when in the CMO mode in hospitals, but allowed under hospice) and I would like to be in my own home, in my own bed. If I really needed a hospital bed, I would need to have it dressed in comfortable sheets, blankets, and pillows. Pillows are a big thing to me.

I would like my dogs on the bed, my reading materials handy and a perfect cup of tea. Nice pj's, too. I would like to feel clean, so to be able to be washed up becomes important. And of course I would want my family nearby, that is a given. I would also want my area to be tidy, as a messy room never made me comfortable. And somehow, even if I am unresponsive, I feel as though I will still know. (hint, hint)

I think about that when I visit patients. Most family members are wringing their hands trying to think of what to do to make mom or dad or sis or cousin more comfortable. I try to help them envision how the ill person once lived. Did they like a bright room? A darkened room? Did they have a favorite comforter, a special pillow, a book they read over and over again that you can read aloud now? These are things they might like, I say. Even if they are unresponsive to verbal musings, they can still use other senses, such as touch and smell, and they can certainly hear, even though they may not respond. So comforting sounds may be nice as well. It may be good to keep the bedroom door open so familiar sounds filter in. Eerie silence can be uncomfortable to many.

When people are quite ill, they may want some solitude. But there can be a fine line between solitude and isolation.

As well as a fine line between pain relief and true comfort.

So, if you have a loved one or a friend with any type of pain or illness, you may want to try to put yourself in their place. Many people like to bring flowers to an ill person. And as nice as that is, there are other more comforting things you could provide.

A great smelling hand cream (with a hand or foot massage to go with it), hand sanitizer infused with fragrance (yes, they sell them), a beautiful inexpensive throw, a nightgown that is soft and lovely, warm, fun colored socks. A pretty cup and straw to drink from, a basket full of hankies, a selection of teas, a homemade

You may say that these are things only a woman might enjoy. And that is true, to some extent. But men like nice pillows and warm blankets, too. They may enjoy having the game on if they enjoyed sports, even if they can no longer really watch. They may enjoy having their buddies over to watch that game as well. Everyone need not be so quiet and sit there and wring their hands. That provides such little comfort. A friend sitting next to a buddy reading him his daily newspaper is also a great touch.

I once had a patient who never ended her day without a scotch on the rocks. She was semi-comatose, and they were giving her mouth care with a sponge-tipped toothette. So we decide that at 5 o'clock in the evening, everyone would gather for cocktail hour and they dipped that sponge into a bit of scotch and placed it in her mouth. You could tell the patient enjoyed that taste. And why not. Why deny someone the pleasure of a favorite taste? And it became a nightly routine for the family until that patient could no longer participate. It was comfort not just for the patient, but for all.

So, think about what makes you really comfortable. Write it down and have everyone in your family do it as well. Call it "Our Book of Comfort for the (blank) Family." Then, whether someone is really sick or just has the flu, or is simply down in the dumps after a really bad day, you can better serve them and help make them to be as comfortable as possible.

Because real comfort makes people feel loved and safe.

It is the best we can do and takes so little to do it.

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