Thursday, August 16, 2007

Terminal Agitation, The Hospice, August 14

When Linda told me that the nurse said Uncle Charlie was terminally agitated, I thought she was joking. It reminded me of old washing machines with their agitators and the talk of communist agitators during the 60s and what the old Italians call giving someone "agita." Agitation seemed like such a funny and soft word to describe anything to do with death and the hard facts of dying.

But the nurse said she wasn’t joking and after Linda got off the phone with her, we googled "terminal agitation" and there it was, on a page dealing with hospices.

Here’s what we read:

What is Terminal Restlessness or Agitation?

Those who work with the dying know this type of restlessness or agitation almost immediately. However, the public and patient's family may have no idea what is going on and often become quite alarmed at their loved one's condition. What does it look like? Although it varies somewhat in each patient, there are common themes that are seen over and over again.

Patients may be too weak to walk or stand, but they insist on getting up from the bed to the chair, or from the chair back to the bed. Whatever position they are in, they complain they are not comfortable and demand to change positions, even if pain is well managed. They may yell out using uncharacteristic language, sometimes angrily accusing others around them. They appear extremely agitated and may not be objective about their own condition. They may be hallucinating, having psychotic episodes and be totally "out of control." At these times, the patient's safety is seriously threatened.

Some patients may demand to go to the hospital emergency room, even though there is nothing that can be done for them there. Some patients may insist that the police be called ... that someone unseen is trying to harm them. Some patients may not recognize those around them, confusing them with other people. They may act as if they were living in the past, confronting an old enemy.

I got that from the Hospice Patients Alliance. Here’s there link:

But that didn’t come near describing what Charlie was going through.

He wanted so bad to get out of bed and stand up and walk out of the hospital that no word from Tony or the Nurses or the doctor could turn him aside. Charlie wanted to be on his feet and moving toward the door, and more than that. He wanted to walk out the door to the elevator and take the elevator downstairs and then walk into the parking lot and get into his candy-apple red 98 Mercury Sable and drive away from this hospice like a man being chased by the devil.

But he wasn’t going anywhere, even though he moved his feet toward the foot of the bed and he tried to grab the bed rails with his hands and pull himself up. He tried that over and over. You’d put his feet under the sheets, and he would try to lift his shoulders up off the bed. You’d tell him that he couldn’t lift himself up, and he’d try moving his feet toward the edge of the bed. And all the while he’d be talking about leaving the bed and getting stronger and walking out of the hospital. He’s spent days trying to get out of bed and telling us he was feeling fine and was ready to go home—even though he was down to 80 pounds and his skin and eyes were a sandy yellow color.

And when he wasn’t talking about how good he felt, he talked about people he had to call and things he needed to do, the projects he was working on and the places he needed to shop at. His mind was working overtime at time-a-half spinning through all of the unfinished business of his life. He was like a man on fire.


Urkat said...

It's interesting to me how we think that if we have commitments, there's no way death can touch us. Guess again.

PeteA said...

Heard the "terminal agitation" phrase for the first time a couple of days ago with my mom at a hospice house. I came across this blog on a google search. It could not be a more accurate description of the symptoms we are currently seeing. Thank you (from a fellow trumpet player).

John Guzlowski said...

PeteA, thanks for reading the post. I'm sorry to hear about your mom.

Uncle Charlie never got out of that hospice alive, but after a few days of terminal agitation he found some peace. His leaving us was quiet.