It seems like Colorado is having a bad luck streak with their healthcare workers this year -- most recently in the case of a 29 year old former hospice nurse with Hospice and Palliative Care of Northern Colorado who was charged with forging prescriptions for Vicodin (hydrocodone) to obtain over 4,000 tablets of the medication.

Marguerite Irene Furgerson has been accused of using the names of at least three patients to forge prescriptions for the narcotic pain reliever, Vicodin. She is the third healthcare worker in Colorado accused of stealing pain killers this year. In another case, a 27 year old surgical nurse, Ashton Paul Daigle, substituted tap water or saline solution for the powerful opiod Fentanyl at Boulder Community Hospital. The third case is the most disturbing and involves a former surgical technician at Rose Medical Center with Hepatitis C.

Kristen Diane Parker worked at the medical center as a surgical technician until a drug test in April revealed she had taken Fentanyl. She told police that she injected the medication, which was meant to treat pain in surgical patients, into herself and then refilled the syringe with saline which would then be reused on patients of the surgical center. And if that alone isn't bad enough, Parker was infected with the Hepatitis C virus, which was passed on to at least 10 patients. She could be facing 34 years to life in prison.

Addiction to prescription pain killers is not a new problem but it does seem to be increasing. It can especially be a problem for doctors, nurses, pharmacists, and any other healthcare worker with easy access to pain medications. Hospice nurses could be especially susceptible with their easy access to powerful drugs in the home environment, where monitoring of medications falls in the hands of family and caregivers rather than the watchful eye of hospital systems.

Will I Become Addicted to Pain Killers?

How Painkiller Addictions Happen

It's summertime and despite the local swimming hole, ice cream cones, and lawn sprinklers, the heat can be downright uncomfortable - and even deadly. The elderly are at an increased risk of suffering ill effects from the heat. Normal changes that occur with aging, such as poor circulation, inefficient sweat glands, chronic illnesses, and medications can increase your risk for heat related illness such as heat stroke.

Hot days always put me and my colleagues on high alert. We make sure our patients have fans, plenty of cold water, and that they can recognize signs of danger. In my area, the community centers offer free activities, ice cream, and cold drinks in an air conditioned building. But what if you don't have a hospice agency looking out for you or can't get to an air conditioned center to cool down?

There are some things you can do to beat the heat.

• Stay indoors in a cool area. If you don't have air conditioning, close your windows and shades and use fans to circulate air.
• Stay hydrated. Drink plenty of water and avoid highly caffeinated and alcoholic drinks as they can further dehydrate you.
• Stay rested. Don't do any strenuous activity - just lie down and rest.
• Take a cool shower or bath.
• Apply cool, damp washcloths to the neck, wrists, and forehead.

If you begin to feel light headed, dizzy, or feel your heart racing, call your health care provider or 911 right away. Heat illnesses are usually very easy to treat when caught early on.

The Centers for Disease Control has more information about the elderly and heat illnesses.

Health Tips for Caregivers

Home Safety Tips

Michael Jackson's untimely death has sparked a lot of interest in and questions about the pain medicationDemerol. There are a lot of tabloid rumors that are as-of-yet unverified that Jackson was taking the drug and even that his personal physician injected him with it before he died. I'm not in the business of tabloid gossip and Hollywood reporting but I do know enough about pain medications to know that if Jackson was taking Demerol for pain, he was likely misguided and mistreated by his physician.

Demerol is a narcotic pain reliever that has been around a long time. It used to be used routinely in hospitals and clinics to relieve moderate to severe pain but is now being shunned for that purpose. Demerol really isn't a good pain reliever, compared to other opioids, and has a long list of risks and side effects. It's also highly addictive, making it's use for pain management even less desirable.

Demerol is no longer recommended for use as a pain reliever and is almost never used in palliative care and hospice anymore. The drug still has some valid uses, most notably as a medication given with others during anesthesia and sedation for minor procedures.

It's important to point out that the attorney for Michael Jackson's personal physician, Dr. Conrad Murray, released a statement claiming the physician did not, and never has, prescribed or given the star Demerol. Rumors are just that: rumors. Until final autopsy results are in, we can speculate all we want. As for now, your guess is as good as mine how we lost one of musics greatest legends.

Recommended Reading

Demerol: Not Recommended for Pain Management

Pain Management in Palliative Care

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Have you ever wondered what happens to pets of hospice patients if they can no longer care for them? Patients who go to an inpatient hospice in particular (as opposed to those in a home based hospice program) must worry about this since they would no longer be home to care for them.

Franny Syufy, About.com's Guide to Cats, alerted me to a wonderful program for pet lovers in hospice. The Pet Peace of Mind Program provides food, veterinary care, and personal care, such as dog-walking for pets of hospice patients in Tulsa, Oklahoma and may be coming soon to a hospice near you. Banfield Charitable Trust has vowed to promote and share the Pet Peace of Mind Program with non-profit hospices nationwide, and is even offering up to $5,000 in start-up money for hospices that decide to implement it.

I hope to see many more programs like it at hospices around the country.

What is Hospice?

It's still early and details are still coming in but it appears that Michal Jackson has died today. He was transported to the hospital from his Holmby Hills home by paramedics who performed CPR and reported that Jackson didn't have pulse. The major news sources haven't yet confirmed that Jackson is indeed dead so I'll update you as details come in.

It's a sad day in Hollywood.

Update: The Associated Press is reporting that Michael Jackson is indeed dead. My thoughts are with his family and surviving children Michael Joseph Jackson, Jr., Paris Michael Katherine Jackson and Prince Michael Jackson II.

Read the article in the New York Times

Television icon and the queen of poster pin-ups Farrah Fawcett, 62, died Thursday morning after battling anal cancer. Farrah was diagnosed with anal cancer in 2006 and it had spread to her liver. Farrah spent a lot of time in the hospital before her death and died in an intensive care unit, according to her publicist.

Best known for her television role on "Charlie's Angels" and for that famous poster of her posing in a red one-piece bathing suit, Farrah also starred in various other movies and television shows.

Her long-time off-and-on again lover and recent fiance, Ryan O'Neill, was by her side when she died. He was quoted in People Magazine about her death:

"She's gone. She now belongs to the ages ... She's now with her mother and sister and her God. I loved her with all my heart. I will miss her so very, very much. She was in and out of consciousness. I talked to her all through the night. I told her how very much I loved her. She's in a better place now."

Farrah's death is unfortunate and she will be missed by so many. Also unfortunate is that Farrah didn't take advantage of hospice services, which would have allowed her die peacefully in the comfort of her own home. Not everyone desires this kind of death, however, so perhaps Farrah did it her way.

Hospice FAQ's

What is Hospice Care

What are the Advantages and Disadvantages of Hospice Care?

Does Choosing Hospice Mean I'm Giving Up Hope?

Ed McMahon, the beloved second banana to Johnny Carson and famous for his introduction, "Heeeeeere's Johnny!" died early this morning in a Los Angeles hospital. The cause of death hasn't been revealed, only that McMahon suffered from multiple health problems in the last several years. There are unofficial reports circulating that McMahon suffered from bone cancer and it was reported that he was hospitalized in February of this year with Pneumonia.

It's reported that McMahon was surrounded by his family at Ronald Regan UCLA Medical Center when he passed away. It isn't reported whether McMahon was recieving palliative care services at the time of his death but it is unlikely that he was under the care of hospice because he died in the hospital. Let our thoughts and prayers be with his family and loved ones.

Read the full New York Times article about Ed McMahon's life and death.

Leading Causes of Death

Palliative Care for Cancer

An article in this months RN Magazine highlighted a program in Eugene, Oregon that is dedicated to making sure no one dies alone. The program, appropriately called "No One Dies Alone (NODA)" was started by Sandra Clark, a registered nurse who's experience with a patient in 1986 at Sacred Heart Medical Center prompted her to find a way to support patients who were going to otherwise die alone.

Vigil programs aren't new but they are certainly on the rise. Staffed by volunteers, vigil programs provide comfort, support, and compassion to dying people who don't have friends or family or who's loved ones can't make it to their bedside in time. Volunteers have requirements they must meet and must sign confidentiality agreements. Some programs require that vigil companions go through special training. Volunteers almost uniformly describe their experience vigiling at a patients bedside a rewarding and beautiful.

If you are interested in volunteering as a vigil companion, check with your local hospice or hospital to see if they have a program.

There are a lot of books out there about death, dying, grief, and mourning. Some are exceptional, others...not so much. I'm trying to read as many of them as I can so I can better direct my readers to the ones worth buying. I do have some favorites that I consider must-reads for anyone facing a terminal illness and their caregivers. Here's my list:

1. Dying Well by Dr. Ira Byock - A classic book about how to have a "good death". Dr. Byock is one of my favorite experts on death and dying.
2. The Four Things that Matter Most - Another book by Dr. Ira Byock and another excellent read. This book applies to everyone, not just those facing death.
3. The End-of-Life Handbook by David B. Feldman, PH.D. and S. Andrew Lasher, Jr. - Directed to both patients and primarily their caregivers, this book should be on your short list of ones to buy. And if you're ever lucky enough to hear one of these gentleman speak, you won't be disappointed. They are both exceptionally smart, compassionate, and funny.
4. Final Gifts - If you wonder what yours or your loved ones final moment might look like, this is a fascinating look into the dying process and the gifts it can bring us. Any hospice nurse can easily relate to the stories in the book, as they have likely witnessed similar extraordinary phenomenon.
5. The Gifts of Grief: A Film by Nancee Sobonya - This isn't a read, but rather an exceptional film about the grieving process. Grief and the healing process is examined through the stories of survivors. The film is often showed at grief conferences and support groups. If you have the opportunity to view this film, don't miss it!

There you have it, my short list of must-reads. The list is ever-growing as I read more books. Please recommend your favorite books in the comment section below.

You can read more Book Reviews with links to purchase the ones that interest you the most.

There is always a demand for compassionate and competent nurses in hospice and palliative care and it's a great field to be in. As a hospice nurse, you have the unique opportunity to be a part of something special, sacred, and deeply meaningful. You are there when patients and caregivers need you most.

But what exactly does a hospice nurse do? Do you need to be a Registered Nurse (RN) or will a license be enough?

Here is a Profile of a Hospice Nurse that may help you decide if hospice nursing if for you.