![]() Mouat destroyed the stockpile in her drawer. The hospital quickly adopted corrective measures making it easier for them to get drugs during off-hours. Within days, all six nurses provided the state investigator with voluntary, unguarded statements of admission. The investigation began after another nurse complained to supervisors. And if I can provide it, that’s what I am going to do.” “And my judgment here was the patient needs medication now. “What we do as nurses is we make choices and we make judgments,” Brackman said later. For a patient who had been writhing in pain all night, Alene Brackman took two more. For a patient with a prescription but little money to pay for his medicine, Lynn Zavalney grabbed another handful. For a patient on liquid morphine who suddenly could no longer swallow, Sasser grabbed a handful of morphine suppositories from Mouat’s drawer, after getting a doctor’s phone pledge to deliver a written prescription later in the day. There were only about a dozen incidents in all, the Helena nurses later estimated, although without records that couldn’t be documented. “I’m continually having to remind physicians how to go through the procedure.” “I don’t think doctors really think one way or another of how nurses get prescriptions filled,” added hospice nurse Ruth Sasser. “But historically, taking care of terminally ill patients has been something that the physicians don’t do particularly well.” Peter’s, told a Board of Nursing hearing examiner. Peter Kozisek, medical director at the Hospice of St. “We do very well at alleviating illness and taking care of patients. Jamie von Roenn at Northwestern University said they did a poor job of even learning whether their patients hurt, and 85% said they believe the majority of cancer patients in the United States are under-medicated. Nearly two-thirds of physicians recently questioned by Dr. The medical community generally agrees that doctors-partly because they lack training in pain management, partly because they fear painkillers’ side effects, partly because they are influenced by the nation’s war on drugs-don’t do enough to ease patients’ suffering. and finding the on-call pharmacist after that is chancy. The hospital pharmacy gives priority to hospital inpatients-it’s often a three-hour wait for others. State law requires a new written prescription each time you get more morphine for a patient, and that’s especially impractical now that we treat so many dying patients outside the hospital, in hospices or in their own homes. ![]() We can’t easily get prescriptions filled. We can’t always forecast pain with dying patients, since conditions change rapidly, they would argue later. ![]() Getting drugs on short notice through the official procedures sometimes was just too cumbersome for the nurses. Whatever the precise impetus, by the fall of 1989 a supply of morphine suppositories and other painkillers had accumulated in Mary Mouat’s unlocked desk drawer. There was the morning when Verna VanDuynhoven found a patient-after waiting five hours for painkillers-curled in a fetal position, covered by urine and feces, refusing her daughters’ help. There was the night Ruth Sasser sat until dawn with a morphine-dependent patient who hours before had been discharged from the hospital without a morphine prescription. There was the night when Deborah Ruggles, after getting stuck for three hours in a snowstorm while trying to fill a prescription, could hear her patient’s screams as she finally drove up to his house. Looking back now, it is hard to say just which event persuaded the six hospice nurses to start stockpiling morphine for their dying patients. Then, just as abruptly as it flew open, the curtain once more fell dark across the window. Voices were raised, arguments advanced, confessions offered. This spring in Montana, a curtain was pulled back on the way in which health care for the dying truly functions below the surface of laws and public discourse. In this fashion, what began as a routine proceeding over an unauthorized stash of painkillers blossomed, for a moment, into an impassioned, free-ranging debate about how dying people should die. What have these hospice nurses been doing? Montana law doesn’t allow the hastening of death. Hold on, the state’s lawyer, Steven Shapiro, was responding. That’s why this matter strikes a resonant chord. ![]() “We don’t talk about this issue, but we’re facing it all the time. “It’s good that the public is raising these questions,” John Guy, the administrator of St. Let me tell you about how my father died. Who cares if the painkillers hastened death? letter writers from across the country were arguing. By the time the case came before a Board of Nursing hearing examiner in mid-April, it was clear that something beyond the immediate facts of the Hospice Six affair was driving the confrontation.
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