hospice

Simply put, my brother is not doing well.  Clinically, the only tool necessary is one's two eyes.  He's six foot four inches and barely weighs 130 pounds fully clothed.  His wife has wisely made the necessary decision to solicit the help of Hospice care.  That probably means a lot of different things to different people since it's a pretty loaded term.  So what does it mean for my brother?

1. Immediately, there is no change to his medical care.  The oral chemotherapy (tarceva) is NOT denied to him. 
2. It does, however, reflect a change of heart from an attitude of fighting the disease to one more of acceptance.  The goal of hospice is neither to hasten nor delay death.  The goal is to provide as much comfort to the patient and their family as possible.  It also seeks to allow a natural order of the death process allowing for whatever dignity to remain present.  Tweaking the pain medications, making it easier to get medical supplies (supplemental oxygen, hospital beds, etc), and providing psycho-social support services to the family are their tools.
3. In order to solicit the services of hospice, a doctor must sign off on the order which states that under the normal progression of the disease, the patient has less than 6 months to live.  With that said, miracles do happen and people are allowed to move in and out of hospice's auspices, but medically, there is nothing left for my brother to slow this thing down.  The end is rapidly approaching.
4. Hospice is not a place.  It's an attitude and provision of palliative services.  It can occur in the home setting, the hospital or nursing home.  My brother is not required to enter into any institution if he does not wish to.  He's at home where he wishes to be.

On behalf of my family, I want to thank everyone for all the prayers and words of encouragement during this rough time.  I also want to encourage them to continue to reach out to support his wife and kids in whatever way possible.