A few years back, when my dad was dying, his body language told those of us who'd cared for him that he was in great pain. He couldn't articulate the pain, but it was obvious to us. The nurses and assistants at the nursing home where he lived could see it. The family could see it. It was the doctor who had to be convinced, as he only saw Dad once a month, and that visit was brief.
The nurse practitioner was helpful in that she saw him weekly, but his chart showed he slept a lot. True enough. But it was fitful sleep and when he was awake he spent his time lying rigid on his bed propped by one elbow, while he repeatedly slammed his first into the open palm of the other hand. It was obvious to us that he was trying to knock out his frustration and pain.
Dad was always a gentle person. This angry gesture was something we needed to pay attention to. The nursing home was giving him as much pain mediation as they were allowed to do. He was losing ground fast and we knew he needed the kind of care hospice can deliver.
It took some doing, but finally the doctor was convinced. Our local hospice was called, we did the paperwork and Dad was soon under their care. They worked seamlessly with the nursing home staff who knew dad so well. They helped my mother accept the fact that Dad was dying. Once on hospice, his pain was controlled and his angry behavior stopped. He was peaceful and as lucid as his damaged brain would allow. A couple of months later, he died peacefully in my arms.
Five months later, when my mother's intractable pain was at its peak and the nursing home could help no more, my 85 pound mother was put on hospice care. Under their care, she was pain free for the first time in years. We were given some quality time together before her wasted body finally, peacefully slipped away under the watchful eye of her two daughters.