Hospice in End Stage Diseases (+ Kosish Cocktail)

Few days back I saw a ovarian Ca (with hepatitis B - HbsAg positive) patient in a private hospital, where I am attached as medical officer. The malignancy is end stage, and associated with metastasis and pain. She is a regular admission in that set up, mostly when pain is increased or she is having shortness of breath due to huge ascitis & pleural effusion. We drain her ascitic & pleural fluid and send her home back, just to wait she would return to the nursing home. 

In any of her admission, her daughter & son-in-law asked the consultant that they are arranging a doctor outside to see her. On this doctor's visiting day, I was not present as that was my off day. 


The doc from Jharkhand is running a NGO as well as Kosish Hospice - a palliative care system for end stage diseases. The system allows the near ones to take care of the patient. It is helpful to cut down the cost of health care as well as patient feels homely & is emotionally better.

The guy offers Kosish Cocktail to reduce pain with the following composition: 50mg Ketamine, 60mg Pentazocine, 8mg ondensteron, 2 ml 2% lignocaine, 3mg Midazolam + water upto 12ml - this to be given as 0.5ml subcut 6hrly.

I am not writing this article for any criticism or being judgemental. Hospice is something I heard first time during my Community Medicine course. If India can afford such set up that's really good. 

Coming to the next thought I had. Presently Anaesthesiology is not just a subject which teaches how to sedate a patient for operation and bringing back to normal state. It is now associated with critical care medicine, pain management as well palliative care medicine. However as I talked with my teachers, palliative care requires huge capacity of tenacity. 

Some people may find this article is inconclusive.