Death By Design


Brad Macy, RN

Season 4, Ep. 33

The Macy Catheter was invented by Brad Macy, a veteran hospice nurse and recipient of 2013’s National Hospice and Palliative Care Nurse of the Year Award. The inspiration for its invention came directly from a memorable patient interaction.

Over the years, Brad has seen thousands of difficult symptom management cases while assisting patients and their families in the middle of the night. The most challenging cases were when the patient could not swallow medication and end-of-life symptoms were spiraling out of control.

One night, Brad had a patient who was experiencing severe terminal agitation. The patient was suffering; he was shouting, he was climbing out of bed, and he was clearly very frightened. Brad got orders to administer a sedative that would help calm the patient. Since the patient was unable to swallow, the prescribed route of administration was per rectum. He administered the sedative in tablet form rectally as prescribed, and waited “that difficult wait” for the patient to calm while giving the patient’s son emotional support. An hour later, the patient was worse. The desire of both the patient and his family were that he be able to die peacefully and at home. Brad called the doctor again for a repeated dose of sedative. While preparing to administer the second dose, he realized that the previous dose was still undissolved in the patient’s rectum.

Brad was left with a dilemma that is well-known by every experienced hospice nurse: how to help a patient who is experiencing severe symptoms and unable to swallow reach a state of comfort within the home setting.

Motivated to reduce the severe agitation and suffering of his dying patient, Brad found a way to give the medication as a suspension that would absorb quickly in the patient’s dry rectum. He crushed the tablet, added water, and administered the medication suspension into the rectum with a urinary catheter. The patient calmed down quickly and was sound asleep within thirty minutes. The patient’s son was deeply grateful for an easy solution that controlled his father’s symptoms with minimal subsequent discomfort or disruption. The patient died peacefully at home a few days later.

Given the successful outcome of this case, Brad decided to create an optimized device to facilitate this intervention. He subsequently co-founded Hospi with the goal of making a commercial device available that could provide comfort and relief for patients and their loved ones on a much larger scale than would be possible as a lone practitioner.

Hospi developed the Macy Catheter to improve the patient and caregiver experience with serious or terminal illness. The Macy Catheter is designed to maintain patient comfort and dignity while leveraging the speed and established benefits of rectal administration. The Macy Catheter is of particular relevance during end of life, as it can help patients remain comfortable in their home. It can also reduce the need for more costly and complex administration routes like intravenous delivery, which is seldom used in the hospice setting. The patented device has received 510(k) clearance from the U.S. FDA.

To learn more about Hospi Corporation, click here.

More Episodes