Themes from PAINWEEK’17

I had the privilege to attend this year’s PAINWEEK conference in Las Vegas from Sept. 5-9th. Though the schedule was grueling, the presentations and speakers were well worth the time investment.

Certain themes were recurrent during this 5-day conference. Below is a list of themes from PAINWEEK that standout in my memory:

  • Pain is a crisis
  • Opioid overdoses & deaths are a crisis
  • Pain is complex
  • Multimodal therapies and approaches are needed for excellent pain management
  • NSAIDS need to be used cautiously.
  • Non-pharmacologic treatment options need to be covered by insurance for chronic pain patients.
  • Coping strategies, resiliency, social support, exercise and cognitive behavioral therapy (CBT) are effective in pain management.
  • Pharmaceutical companies are continuing to create new abuse-deterrent opioid formulations but nothing is 100% tamper-proof.
  • Most opioids taken without a prescription are taken from friends and families.
  • Glial cells are active players in pain management and a new targeted site for pain management treatments.
  • Arachnoiditis is underdiagnosed and catastrophic if not treated. Failed back syndrome and spinal stenosis are two examples of problems associated arachnoiditis. MRIs can show nerves sticking to the lining of the arachnoid lining of spinal cord.
  • Low-dose ketamine (PO & IV) work on NMDA receptors and is another tool in our armamentarium.
  • Inflammation from Standard American Diet (SAD) leads to pain. Anti-inflammatory diets can help. (THIS topic hit home.)
  • Neuroplasticity may be reversible.
  • AND FINALLY, CONSTIPATION NEVER GOES AWAY WHEN TAKING OPIOIDS. Several effective products are now on market to treat Opioid-induced constipation (OIC.)

*Check out this link to the Clinical Pain Advisor for PAINWEEK’17 conference presentation coverages.

“HOPE” is found in Hospice Care

Have you ever noticed that the word HOSPICE includes the letters H, O, P & E… or the word HOPE. These four letters just seem to jump off a page when I read the word HOSPICE. The letters are even in the correct order! Not only can one find the word HOPE in the word HOSPICE, one can also find the feeling of HOPE at end-of-life in Hospice Care.

One on-line definition of HOPE from says HOPE is “the feeling that what is wanted can be had or that events will turn out for the best.” Everyone needs HOPE. One can not live without it. (See previous blog, HOPE in HOSPICE: Oxygen to Our Souls.)
But as death approaches, HOPE must be re-framed. No longer is the HOPE for cure and another year on this earth. HOPE instead transforms and focuses on comfort; time with friends and family; or sitting on the deck and watching a sunset.

Last October I had the privilege to speak and to be a vendor at the annual Alabama Hospice and Palliative Care Organization (AHPCO) Conference at Panama Beach in AL. On my vendor table I had different colored wine corks. I asked conference attendees to finish the sentence, “Hospice is ______” and to write their response on a cork. At the end of the conference, I went down to the beach; arranged the corks in the sand to read HOPE and took photographs.

Today I found one of my HOPE photographs and “inked” in the letters S, I, C. Now the photography actually spells HOSPICE. Maybe this picture isn’t worth a thousand words but I do think it is worth at least two dozen!


“End-of-Life Parables” YouTube Channel Launched


This YouTube channel is devoted to sharing end-of-life (EOL) concepts with laymen and medical professionals alike. Existential concepts like death and dying are often hard to understand and even harder to explain. As a hospice nurse educator and speaker, I’ve found that object lessons are helpful in representing the hard concepts in hospice and palliative care. This series of videos is called End-of-Life Parables. I pray that they may be helpful both to patients and families facing death and to health care professionals caring for them.

*More videos coming soon.

“End-of-Life Parables” Coming to YouTube Soon!

I’m excited to announce that Marsha Farrell Care Consulting has a new YouTube Channel entitled “End-of-Life Parables.”

This channel is devoted to sharing end-of-life (EOL) concepts with laymen and medical professionals alike. Existential concepts like death and dying are often hard to understand and even harder to explain. As a hospice nurse educator and speaker, I’ve found that object lessons are helpful in representing the hard concepts in hospice and palliative care. This series of videos is called End-of-Life Parables. I pray that they may be helpful both to patients and families facing death and to health care professionals caring for them.

The first three videos were filmed last month and will soon be released:

Parable #1: The Glove

Parable #2 Fuel For My Car

Parable #3 Baby Food

Stay tuned. Will love to have your feedback.

Marsha Farrell Care Consulting, LLC: A Proud Host of the Being Mortal Campaign in 2016

Being Mortal Awareness Campaign is Changing Lives Across the US

WASHINGTON, Jan. 4 — Through a national campaign that engages audiences through film and discussion, more than 40,000 people across all 50 states and the District of Columbia are taking steps to do something most adults avoid until it’s too late: discuss the kind of care they want when faced with serious illness and death.

The Being Mortal project began in February 2016 and to date, more than 650 organizations have partnered to engage their local communities in 771 Being Mortal events. Preliminary outcomes based on participant surveys indicate that 96 percent of audience members for the first time will decide on the person they want to make their healthcare decisions if they are unable, think about their end-of-life care preferences, and communicate those wishes to a loved one.

Of medical and healthcare professionals in the Being Mortal audiences, 100 percent report that the event will help them talk with their patients about matters related to advance care planning and end-of-life care. Perhaps more importantly, close to 90 percent of these professionals say that they are now more likely to talk with patients about care options and preferences earlier in the course of serious illness or the aging process.

The events include a screening of the PBS FRONTLINE film, Being Mortal, followed by a guided and reflective audience discussion that ends with participants understanding the concrete steps they can take to start having conversations with their loved ones and healthcare professionals. The Emmy-nominated film is based on the best-selling book of the same name by Atul Gawande, MD.

Ninety percent of Americans know they should have conversations about end-of-life care, yet only 30 percent have done so. Largely as a result this communication vacuum, 70 percent of those living in the U.S. die in hospitals despite an equal percentage saying they want to die at home.  The Being Mortal project is changing those numbers by encouraging conversation and action.

“While written advance care directives (ACDs) are important, the nuances of end-of-life care can’t be captured in a checklist,” said Julie Berrey, executive director of the John and Wauna Harman Foundation, which is funding the project. “Discussing deeply-held personal values and what matters most at the end of life before a serious illness occurs helps make shared decision-making easier for patients and families when a loved one faces a severe illness, especially in the absence of formal ACDs or when a patient can no longer participate in the discussion.”

Coordinated through Hospice Foundation of America (HFA), the project has exceeded expectations, which led to a three-month extension of the project through March 31, 2017.

“The overwhelming success of this project highlights the demand for education on the importance of having these conversations,” said Amy Tucci, HFA’s CEO.  “Ensuring quality end-of-life care is HFA’s mission so we think about this topic every day, but most people don’t think about it until they’re faced with serious illness. This campaign is helping people consider not only their own end-of-life care, but also care for their loved ones. I’m grateful to the Harman Foundation and all the wonderful organizations that continue to join us in this campaign to provide Americans with information they need to have their wishes carried out when it matters most.”

For more information contact Cindy Bramble, or Amy Tucci, or 1-800-854-3402. [MORE]

About the John and Wauna Harman Foundation
The John and Wauna Harman Foundation (Harman Foundation) is a private family foundation rooted in its donors’ humble beginnings. Thus, the Harman Foundation values humility, compassion, education, and a concern for the most vulnerable in our society. Its mission is to improve end-of-life care in America by encouraging all Americans to have meaningful conversations with family and loved ones about their end-of-life care wishes before serious illness occurs, thereby improving quality of life as death is near.

About HFA 
Hospice Foundation of America is a 501(c)(3) nonprofit organization. HFA meets its mission by providing programs for professional development, public education and information; funding research, producing publications, and by providing information on issues related to hospice and end-of-life care. Our programs for healthcare professionals are designed to improve care of those with terminal illness and those experiencing the process of grief, and are offered on a national basis. Our programs for the public are designed to assist individual consumers of health care who are coping with issues of caregiving, terminal illness, and grief.


Post courtesy of Hospice Foundation of America.

Presence instead of Presents

Merry Christmas and Happy Holidays to you all! This season always makes me a bit more reflective. Lately I’ve been thinking about what people want most for Christmas. By this time, most children have already written to Santa or sat on his lap to discuss their Christmas wishes. Adults too may have given lists to family members and friends of items that they would like to see under the tree later this week.

What do people really want? Is it the latest cool toy or the new pullover sweater in the beautifully wrapped box tied up with a ribbon? OR is it something else…something that cannot be wrapped? What if we are misspelling our Christmas desire and it is not presents (aka gifts) but rather presence (to be present?)

photo by Marsha Farrell
photo by Marsha Farrell

When I remember my favorite Christmases, my fond memories are not the toys that I received (though I did love the silly putty when it came out in the ‘60s). Instead, my favorite memories are the large family gatherings at grandparents’ houses with all of my cousins and lots of aunts and uncles. It was the time spent playing, eating and talking with everyone… being connected with people that I most loved.

We, people, are meant for connection with others. Connection is where we will find meaning this Christmas. The first Christmas was GOD connecting with us by sending baby Jesus to earth. Emmanuel, GOD with us. GOD’s Presence.

This season, let’s give our presence to those around us: our family, friends, neighbors, the elderly, the isolated caregivers, the widow or widower. Let being Present, your presence be your authentic present to others this year.

Caregiver Stress During the Holidays

I was privileged to speak at Marshall Cancer Care Center’s L.I.F.E. cancer support group meeting this week. The presentation was “This Little Light of Mine – Avoiding Caregiver Stress During the Holidays.”

Caregivers & patients often find themselves in demanding circumstances dealing with a disease and the medical treatments for managing the disease. When holidays come along, the caregiver may find him/herself feeling extra stressed with added holiday expectations and jobs. Soon the “most wonderful time of the year” becomes the most demanding time of the year. The ongoing and ever increasing stressors can sap the last ounce of energy from the caregiver and lead to burnout.

The L.I.F.E group’s discussions included tips for de-stressing during the holidays and focusing on what’s most important to the caregiver and care-recipient. Participants were given a list of Christmas jobs and encouraged to prioritize which activities to keep this year and which activities to let go.

Are the thoughts of Christmas causing stress for you and your caregivers? Call me today and book “This Little Light of Mine – Avoiding Caregiver Stress During the Holidays”.





HOPE in HOSPICE: Oxygen to Our Souls

How does a hospice patient maintain Hope (an essential element) and LIVE while their physical body is dying? defines hope as: “the feeling that what is wanted can be had or that events will turn out for the best.” Avoiding death and keeping the physical body alive is not to “be had” for a dying patient. Death comes and is inevitable.  Thankfully, humans are more than physical beings with organ systems. We are spiritual, social and emotional beings as well. The author C.S. Lewis once said, “You don’t have a soul. You are a soul. You have a body.” I like that quote.


The word oxygen isn’t an elusive word like hope. Science textbooks teach that oxygen is a gas essential for all living things. It is an element (#8) on the periodic table. These are scientific facts. Yet, there is a level of mystery to oxygen. I cannot see this gas that I breathe into my lungs every 3 to 4 seconds. (Most of the time, I don’t even think about breathing.) I breathe in…  I breathe out. Breathe in… breathe out. Though I can’t see oxygen, I’m undeniably aware of when I lose it and can’t breathe.


Hope, like oxygen, is essential for life, but you will not find it on a scientific chart like the periodic table. Hope is one of those esoteric words like love and faith. Though it’s hard for me to define Hope, I know what it feels like to have it. I also know what it feels like to lose it.

Perhaps the answer to the above question, “How does a hospice patient maintain hope and live … while /dying?” lies in “reframing” HOPE and focusing on the spiritual, social and emotional parts of our selves. Perhaps the hospice team can best help their patients maintain Hope by helping them conceive new “wants” that can be had.

My patient Elsie showed me how to reframe HOPE while dying in hospice care. Elsie was the matriarch of a large Catholic family. Family and God were central in her life. Unfortunately, Elsie was dying from adrenal cell cancer and ESRF (end-stage renal failure) and was no longer able to consistently make three trips/week to the dialysis center. Thanksgiving was coming and Elsie and her husband were talking about the upcoming family get together at one of her sons’ homes. All of the children, in-laws and grandchildren would be there. A few days before Thanksgiving Elsie announced to me that she had decided not to attend the family holiday dinner. Instead, she planned to spend the morning of Thanksgiving Day with her granddaughters who would all be home from various colleges. Elsie decided that she would spend Thanksgiving morning sharing her holiday recipes with her granddaughters and supervising the cooking in her kitchen. She realized that her energy was limited. She could either share family traditions with the next generation OR she could attend the dinner later that evening.

Elsie “reframed” her HOPE that Thanksgiving. She made memories with her grandchildren and passed on a bit of her legacy.  Elsie found oxygen for her soul that Thanksgiving morning in her kitchen. She breathed in HOPE deeply.

HOPE Haiku


Oxygen for one’s own soul.

Breathe in deep fresh HOPE.

By-Marsha Farrell RN

(written for Haiku Exhibition at Hospice UK Conference 10/20/2016)


Alabama hospice and palliative care practitioners met earlier this month at the 32nd Annual AHPCO Conference at the Perdido Beach Resort, Oct. 5th-7th. Here are the results from the words written on painted corks at the Marsha Farrell Care Consulting booth.

  • HOPE = 4x
  • COMFORT = 3x
  • CARE = 3x
  • LISTENING = 3x
  • REWARDING = 3x
  • A BLESSING = 2x


What word would you have chosen?


Being Mortal Project

Being Mortal Project

Being Mortal jpg.Huntsville, AL recently joined in a national dialog that asks, “Have you and your family had the tough conversations and planned ahead?”

The PBS program “Being Mortal” was shown at First Baptist Church Huntsville on Thursday, September 15, 2016. The documentary shares stories of terminally ill patients and their families as they confront their hopes and fears. It also looks at the relationships between the these patients and the doctors who are caring for them them during the dying process.

After watching the film, audience members dialogued with community experts in end-of-life care and advance care planning. A questionnaire was given to each participant as a part of the project. The questionnaire encouraged the participants to take specific action steps in making their end-of-life care wishes known to their families and to their doctors.

One question on the questionnaire read, “What one word describes how you feel after watching and talking about Being Mortal? _______”

Audience responses in Huntsville included: HOPEFUL, POSITIVE, POWERFUL, COMFORTABLE, SAD BUT TRUTHFUL and PLAN.

Have you made YOUR WISHES know yet?

Being Mortal Project
Being Mortal Professional Panelists from L to R : LaTanya Rhines, elder lawyer with TARCOG; Marsha Farrell, moderator; Carisa Proctor, RN transitions nurse with Hospice of North Alabama; Harold King, marketer with Good Samaritan Hospice and Dr. Monica Murphy-Williams, author of “It’s Okay to Die” and ER physician with Huntsville Hospital


The Being Mortal project is supported by the John & Wauna Harman Foundation and Hospice Foundation of America. Community Screening Host was Marsha Farrell Care Consulting, LLC along with community sponsor, TARCOG. Thanks to First Baptist Huntsville for providing a wonderful venue for this event. Thanks also to Hospice Family Care, Hospice of North Alabama and Good Samaritan Hospice for providing copies of Alabama’s ADVANCE DIRECTIVE FOR HEALTH CARE and snacks.