Medical Marijuana

This is a controversial subject, so please keep an open mind as you read.

Disclosure: I do not use marijuana. I smoked a little in high school and during college, but like a lot of things I did when I was young, I out grew it. Getting high is not fun to me. I do not like the way drugs or alcohol make me feel and I do not condone recreational use of any drug.

Another Disclosure: I have worked with patients who used medicinal marijuana, legally prescribed and obtained in the state of California or Oregon. I support the legalization for medicinal purposes only – not recreational. Please, if this treatment is desired, do so legally and let your doctors know. This is a drug, and it may react with other medications.

Okay, now with that out of the way, I hope you understand I would not publicly support the use of medicinal marijuana unless I knew it would benefit my patients, other patients, and babies. Yes, babies, adults, senior citizens. Terminal conditions, chronic conditions, and temporary conditions. It is not for everyone, and does not treat all conditions. I am most familiar with cancers, seizures, nausea, anxiety, and pain.

Kentucky Senator Morgan McGarvey filed a bill in the 2017 legislative session, and he recently spoke in front of the Interim Joint Committee on Health and Welfare and Family Services. If passed, medicinal marijuana will be available through physician recommendations and only for extreme end of life cases. Some believe the bill is too restrictive and the much needed drug should be more accessible for chronic conditions and for those going through cancer treatment, not just at the end of life. Any legislation is better than no legislation, I believe, because it initiates discussions about the therapeutic effects of cannabis. It would also prevent the arrest of dying patients who buy weed from the neighbor’s kids so he can eat a meal without vomiting.

Cannabis plants have over 300 identified cannabinoids. Hemp cannabis contains very few cannabinoids and those that are present have nearly no medicinal properties. Medicinal marijuana comes mainly from two types of cannabis plants: sativa and indica. Each strain, or unique breed, has a different ratio of cannabinoids (see links below for more information). I can attest that patients do benefit from use of THC, CBD, CBC, or a hybrid, but the CBD oils and tinctures do not have the “high” that most people associate with marijuana as that comes from the THC.  Clinical trials support the use of CBD oil to control seizures in children and adults.

I will not disclose the identity of any patients, but here are some of my experiences of those using medicinal marijuana:

A 92 year old female, stomach cancer spread to bones in hospice. She couldn’t tolerate narcotics, so she smoked a joint every morning and ate a brownie at night.

A 75 year old woman with colon cancer in hospice developed severe abdominal pain with intractable vomiting and pharmacy prescriptions didn’t work.  The family begged for another option. I said I’d call the doctor for a recommendation, but they had their own plan. I never asked where they got it but within 24 hours her pain and vomiting was gone. She was sitting up eating tapioca pudding, smile on her face.

A 50-something year old man, had never used marijuana until diagnosed with brain cancer. Used it to control seizures by inhaling nebulizer tincture of CBD. He was a physicist, and felt the CBD kept his mind more clear than narcotics.

A very ill 6 year old boy, on hospice due to a genetic disorder that caused multiple seizures daily, as many as 200 a day…nearly constant seizures. He took multiple medications, all given through a tube in his belly. The family moved from their life-long home to a state with legalized CBD oil and a clinical trial.  A month later, he talked for the first time and started eating real food. Three months later, he discharged from hospice and the feeding tube removed. Six months later, he went to school for the first time. Today he takes CBD oil three times a day and just a couple other medications. Best happy ending I’ve seen.

 

Check out these links:

Senator pushes to legalize medical marijuana in Kentucky
http://www.wlky.com/article/senator-pushes-to-legalize-medical-marijuana-in-kentucky/10203686

THC, THCA, CBD, CBC, CBN: Medical Marijuana Composition, The Chemicals in Cannabis
https://unitedpatientsgroup.com/blog/2014/04/11/thc-thca-cbd-cbn-the-chemicals-in-cannabis

The ‘nuns’ that grow medical marijuana
http://www.cnn.com/2016/04/07/health/cnnphotos-marijuana-nuns-sisters-of-the-valley/index.html

Why I changed my mind about medicinal cannabis | Hugh Hempel | TEDxUniversityofNevada

Cannabis oil treatments are helping children with seizures

Marijuana saves father’s son

 

The Inpatient Hospice

Hospice works to provide caring, compassionate care while death occurs naturally.

There are many patients who I will never forget.  Some died in my arms.  Some had amazing families.  Some lived in abusive conditions, extravagant homes, or on the streets.  What I’ve learned in my adventures is that everyone has a story, and I am honored and humbled to be a part of and to witness a few moments at the end of their story.

One of the first nights I worked at the inpatient unit I admitted a young man.  He was in his twenties, over 400 pounds, and trached (this is when a tube is placed through the throat in order for you to breathe, sometimes with a ventilator).  The ambulance bought him in after his family called; they could not care for him and they wanted him transferred out of their home right away.  He was dying.

Hospice transfers patients from home to the inpatient unit during periods of crisis, uncontrolled pain, new onset of seizures, or other medical reasons.  Transfers were not uncommon, even during night shift. It was the middle of the night and he arrived alone, no one but uniformed paramedics accompanied him.  This was a young man who required a lot of help – he couldn’t move himself, clean himself, or communicate easily.  He was alert; he was having difficulty breathing, and he seemed to be in pain.  Did I mention he was actively dying?

I assured him I would do everything to help get him comfortable.  He tried so hard to say something to me, but the tube in his throat that kept him breathing also prevented his vocal cords from working.  I got closer, listened as best I could, and was shocked.  “Kill me,” whispered through his trach.  I pulled back with wide eyes, not sure if I’d heard correctly.  That’s not how hospice works!  Hospice provides caring, compassionate care while death occurs naturally, but we do not euthanize patients.  He grabbed my wrist, using every bit of energy to repeat “kill me, please.”  It was clear that time, said with his pleading eyes and his trembling body.

His breathing was labored and he grimaced when moved, so I said “I’ll get you some pain medication.”  His eyes squeezed shut, tears rolling to his side.  He was in pain and I could treat that, but I couldn’t kill him… that’s not what hospice does!  But he was saying it, no doubt in my mind.  It seemed he’d been through so much and a young man in his condition was not what someone would think of as dignified.  He was in pain, so the Dilaudid and Ativan I gave helped him relax.  I was still at a loss.

Thank goodness the other nurses on duty where experienced and I asked them to take a look, curious to see what they thought.  “He’s still in pain,” the charge nurse said, “give him another dose of Dilaudid with Ativan.”  I gave the maximum the doctor ordered three more times before my shift ended.  The next night I worked, he was gone.  No one mentioned him, but I had to ask.

“The doctor came in and increased his medications.  He died peaceful around noon.”  The nurse told me she was with him when he took his last breath.  No family came; no one at their home even pick up the phone when she called so a message was left that his remains were sent to the mortuary.  They still hadn’t called back when I arrived that night.

I was appalled at how the family treated this young man during his last days.  Thank God they had the decency to send him to hospice and allow the loving, compassionate nurses there to take care of him.  No one should be in pain – physical, emotional, or spiritual.  The hospice nurses, including myself, made sure this young man was cared for, comfortable, and died with as much dignity as possible.

The Big Question

Having been raised in a Catholic home, I was taught that Saint Peter would be waiting at the Pearly Gates with a large book containing the names of every human being, and if you had been a good person he would grant entrance to heaven. Otherwise, you would descend into hell. As a child, there were many times I worried that the keeper of the keys to heaven would see my name on the naughty list. I spent a lot of time in the confessional.

As I matured and became educated in science, logic, and reason I fell away from my Catholic beliefs; religion to me was seen as a means for authorities to control the masses, and history of the Christian Church confirmed my beliefs with facts and historical evidence. Even now I see many outdate parables in the bible involving selling children and stoning sinners, things that would put a person in prison a very long time today. I’ve drifted from Catholicism and into other religions and eventually decided we all are worshipping the same energy. There is only one God, one Source, one Divine presence. And the Big Question – is heaven real? Yes, heaven is real.

My first experience in hospice was as a volunteer at the hospice inpatient unit. I wasn’t yet sure about a career change, so exposure to hospice patients seemed like a logical yet noncommittal step in that direction. The first assignment was to sit with an elderly woman until her family traveled from out of state to be with her. What I witnessed in her room forever changed my way of thinking.

I do not recall her name, but she was from the era of the 1940s because there was a wedding photo of her and her husband next to her bed set in that time period. The nurse told me she has severe dementia and had not spoken a word for years. She was heavily medicated for comfort and unable to move on her own; she had not opened her eyes since they found her on the floor in the nursing home. Technically, she was comatose. It’s likely those in this condition are able to hear, not with their ears but with their spirit, so I talked with this woman while we waited for her family. I told her I was sorry she had fallen and was in a hospice, and because of the religious artifacts in her room I said a few prayers over her. I said that her family was in route to see her and to hold on a while longer so they could see her before she leaves us. For the next couple of hours I made small talk, held her hand, wiped her eyes, and let her rest. She never once moved or made a sound.

It was getting late and I was nodding off in the chair next to her bed. I jumped at the sound of her voice, saying “Bernie…”, and then I saw her hand, her frail, contracted hand, lift up and reach toward the ceiling. I stood up to see her eyes were wide open and she had a peaceful smile across her lips as she repeated, “Bernie…my Bernie.”

“Oh my,” a voice from the hallway startled me. The daughter and son-in-law were at the door, chins dropped, amazed at the sight.

“Is Bernie her husband?” I asked.

“No,” said the woman. “Bernie was my brother. He died last week, that’s why we were out of town. But we didn’t tell Momma. She doesn’t know.”

There is no way to explain for certain how this happened – how her ability to speak, move, and see returned. How she was seeing her recently deceased son in the ceiling tiles. There’s no way to know what she really saw, and why she was calling Bernie’s name. I know what I believe. I was witness to the connection between two souls on different planes of existence. I believe I was witness to the transition between life and death, a holy place where spirit lifts our souls from this world to the next. Something is out there, and loved ones are waiting.