Caregiving for the Terminally Ill with Wesley Vietzke, M.D.

By Wesley Vietzke
WebMD Live Events Transcript

Join Wesley M. Vietzke, MD, to discuss caregiving for the terminally ill.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Event_Moderator Welcome to WebMD LIVE! Our guest today is Wesley Vietzke, MD, and the topic is "Caregiving for the Terminally Ill." Dr. Vietzke is currently in private practice, restricting his practice to nursing home residents. He is interested in working to allow patients to live as comfortably as possible with the common problems that complicate all of our lives. Welcome, Dr. Vietzke! How are you today?

Wesley Vietzke MD I am fine, moderator. What is the first question?

Event_Moderator What kind of experience have you had with caregiving for the terminally ill?

Wesley Vietzke MD I have practiced internal medicine for thirty years, and in the past several years have devoted myself entirely to the care of people in nursing homes. That experience has led to an intensified exposure to the issues of the terminally ill.

anglck_WebMD What is your caregiving philosophy for someone who is terminally ill?

Wesley Vietzke MD That is a very complicated question, in a simple guise. Basically I am interested in an individuals's comfort and dignity. At the end of like issue of winning a war against a disease, seem inappropriate to me

carolyn_12_WebMD How can I help my mother remember to take her meds? I don't live with her but visit often.

Wesley Vietzke MD There are many tricks that we use to help with this. Some use a series of little boxes clearly marked with the time of day that the pills are to be taken. These need to be filled periodically. Some just put out the bottles, and call three or four times a day to remind the patient. A constant issue is the total number of pills. The less, the easier. Try and talk with her doctor to see if any can be eliminated.

Event_Moderator What do you find people are most unprepared for when taking on the role of primary caregiver for a family member who is terminally ill?

Wesley Vietzke MD There are as many answers to this, as there are people. I think many people underestimate the shear work of it. Hard, dirty work. Unless they have worked in nursing or a medical field, they are not prepared for changing garments, bed clothes. Many also find the emotional work more difficult than they had anticipated. It is not they do not love, and have not communicated before, but now there is such a load, such a pressure to let it all hang out, get all the good byes, done, etc, etc, that it quickly becomes exhausting. One doesn't have to do all of that, all at once. but one needs to be available, and ready. So the things that are hard, that aren't in the movies, or on TV, are the hard nurses aid work, and the constant emotional drain.

Event_Moderator Do you find that caregivers themselves become more susceptible to illness because of this mental and physical exhaustion?

Wesley Vietzke MD That is another general question that is hard to answer. Sadly, some do. But most of us do not ordinarily, because we are prepared for it, we know how to set the limits required, and take breaks. The problem is, of course, that we are criticized for not being available enough. One must strike a balance. Overall, A caregiver, professional or personal, should be able to find a balance, but he/she should have someone (ones) to talk to.

anglck_WebMD What is hospice care like? And what should I look for when searching for one?

Wesley Vietzke MD Hospice Care is devoted to the comfort of the patient who is clearly about to die, and his/her family. You should look for an actual "Hospice" - I believe that there is a national roster of such organizations. You may also look at local home-health agencies, and Visiting Nurse Organizations, who often provide this kind of care. Ask to speak to a representative caregiver, ask about there philosophy. Some of these only care for cancer patients, as they started out to do some 25-30 years ago. Most now care for anyone with a clearly fatal and progressive problem, that isn't going to be "cured", or treated vigorously any more. The original requirement for consideration was a death expected in 6 months, but that has become more flexible. The main concern is Comfort not Cure.

Event_Moderator Would you say the 'comfort not cure' philosophy is how hospices differ from hospitals?

Wesley Vietzke MD Yes, emphatically. The problem, in my view, and not many of my colleagues would agree with me, is just that. That is why Hospice was begun. Oncologists would not stop trying to cure obviously resistant and dying patients, and were just making them worse. No one was helping people die. Well, dying , like birth, is part of life, and should be part of the practice of medicine. There is a model of care that I like; George Annas talks about an ecological model for medical care, where in health is managed through out life. It is not a military model where battles are won and lost, because that in fact, is and illusory notion, anyway.




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