I had visited Mr. Williams several times over the last few months.  In his early 60’s he had been diagnosed with lung cancer after years of tobacco use combined with working in the steel mills of Birmingham.  He had moved in with his sister. She lived in a “section 8 housing” apartment in a rough neighborhood.

His family was attentive but they were all working and going to school.  There were times when Mr. Williams was alone.  Quiana, his favorite home health aide, had alerted us at the IDT that he was nearly bed confined.  That week she had found the door unlocked.  Mr. Williams had told her he had left it unlocked so she could get in.

When I came to visit, I knocked and announced myself.  I could hear Mr. Williams so I tried the door and it came open.  Mr. Williams called me back to his room where I found him propped up in bed with food, water, phone, urinal, and TV all in easy reach.  Despite his diagnosis, Mr. Williams was always cheerful and we exchanged some banter and the latest on Alabama football. It wasn’t until I went to exam him that I found his bottle of morphine extended release tablets, morphine solution and a pistol all in the folds of the bed clothes!

Mr. Williams explained that…. He wanted to stay in his home and not go to the nursing home… His family needed to work and go to school…He needed to leave the door unlocked so his hospice teams and friends could come in…He needed to protect himself and his pain medication!  After all, hadn’t I seen his neighborhood?   He was quite proud of his solution.   Fortunately, we were able to rally family and friends to stay with him and the gun was no longer needed.

This was not the only time we would find a weapon in the bed both at home and even in the personal belonging of a patient transferred into our inpatient unit.  No staff or family member were ever injured but a handful of patients did commit suicide over the last 20 years since I first found the gun in Mr. Williams bed.

What should our response be as palliative care providers in the home?  Should safe storage of firearms be part of overall patient health and safety check? Providing counsel on safe storage, risk of accidental discharge of the weapon by a weak or confused patient? I don’t know. We do not need to engage in the political discussion of gun control with patients and families but at the same time we must do what we can to ensure safety of our patients, families and staff.  The reality is that firearms are a ubiquitous part of the landscape for care in the home.

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