Stop the beta-blocker. Add morphine.

First, let me say that this blog entry comes more from the standpoint of a granddaughter than a PA because, frankly, as an orthopedic PA, I am not generally in the business of dealing with patients at the ends of their lives, AND I have just lost my vibrant grandmother to cancer. So forgive me if you don't agree with my point of view or if it isn't “evidence based.” It's love-based, and that matters to me right now.

So I ask: when do you stop the beta-blocker and start the morphine? Once someone has a terminal disease that is untreatable and you know that their life expectancy is no more than maybe 2 months at best, do you stop it then? How about if this person is nearly 93 and is ready to die? Is that the time to make the switch? Furthermore, why do you keep a 92-year-old woman with metastatic breast cancer on a beta-blocker at all? What is the purpose of a beta-blocker (or any chronic medication, for that matter) when a person is dying? Not dying in a year, or a few months, but dying imminently? Maybe this week?

I say, stop the beta-blocker and add morphine. And chocolate. And steak, if she can still manage it. I know that there is a balance between humane medicine, honoring a patient's wishes, and acting in a responsible way as a provider, but I think that in the era of “everything can be treated” (including hypertension in a dying woman!), sometimes that balance takes too much time to strike. We asked frequently for that balance for grandma, and eventually she fit the “protocol” to remove her from her chronic medications and add escalating doses of morphine as needed.

Ten minutes ago, I got the phone call that grandma is gone. Her balance is achieved. It didn't take too long in the scheme of things, I guess. And I do thank those who helped her to get there.