Friday, December 18, 2015

Honor Them: Patient & Volunteer Vets

Don, Carl and Captain Schermerhorn
A certain camaraderie exists between two people who have served in the military that seems to span experience and generations. We've seen this in the depth of many relationships forged between Agape veteran patients and Agape volunteers who have served in the U.S. armed forces. 

This past week, we experienced something new: an honoring ceremony for two vets, both patient and volunteer. Patient  J. Carl Montoya (United States Army) and Agape volunteer Don Straney (United States Navy) both were honored for their service to our country in an "Honor Them" pinning ceremony. Volunteer, family, caregivers and staff of Agape and Villa Manor Care Center, where the ceremony was held, gathered to witness a deeply moving event.

This ceremony, carried out by U.S. Army Captain David Schermerhorn, was established by All Veterans Funeral & Cremation to honor as many veterans as possible for their sacrifice and service. All Veterans was founded in 1989 by a US veteran who was passionate about every service member receiving recognition, not just on Veteran's Day, but the other 364 days of the year.

Andrew Martinez honored 
Not letting any opportunity for recognition pass by (and acknowledging the importance of home front support), Captain David recognized Carl's wife, Esther, for her support of her husband as a service member. Carl's brother Andrew also was recognized for his own military service.

The room was heavy with emotion and humble strength. What a privilege to be there!




Friday, October 16, 2015

Can We Still Grow at the End of Life?

I REMEMBER cradling my newborn baby girl in my left arm, amazed that she could fit between the palm of my hand and my elbow. Fifteen years have since passed and today she stands 5 ft., 9 inches. Physically, she is almost fully grown; emotionally, like all of us, more growth is needed and will continue throughout her life.

When we think of growth, we focus on the physical; it's what we can see and measure in concrete terms. Emotional growth is less measurable and more difficult to describe, yet it unfolds before our eyes and can be quite apparent as behavior is demonstrated.

However, even more difficult to wrap our minds around is spiritual growth, which has a plethora of definitions and depends on one's faith tradition or perspective.

MY ROLE AS A HOSPICE CHAPLAIN is not to reduce spiritual growth to a simple, one-line definition. Instead, it gladdens my heart to present to hospice patients and their families a bold, incredibly energizing idea: Death is not without hope; growth can happen at the end of one's life.

When you think about it, this is mind-blowing! It's counter-intuitive because we are so focused on what we can see and measure (like measuring our children's height with pencil marks on a door frame). When someone is dying, when biological systems are failing, how is it possible for growth to happen? 
Yet (I dare say), the end of life possesses the potential for a kind of growth that is unfathomable at any other point in one's life.
Jesus said, "Unless a kernel of wheat falls to the ground and dies, it remains only a single seed. But if it dies, it produces many seeds" (John 12:24 ).

WHEN A TERMINAL DIAGNOSIS comes to us, our instinct is to think, "This is the end." Certainly, it may mean that the end of this life is drawing near. What if, however, as hospice professionals, we were able to help those involved see that it can mean much more than the end?  What if they could see they are, together, on the verge of something beautiful being birthed? The process of dying is difficult, but it is a sacred event that is ripe for transformation in the lives of those involved. It begs courage to enter into this way of thinking, but it offers such potential.
  
THIS POTENTIAL at the end of life can be encapsulated in one word: Hope – hope that something larger than oneself is happening. In patients and families I have met, I have seen both ends of the spectrum, from hopelessness to hopefulness. This could be expressed as, "I'm done; I just want to die," or, "As I die, I want to teach my children how to die and not be afraid of death."

My patients have taught me the truth of what Jesus said in John 12:24:  That life can be birthed out of death. My hope with each patient and family I meet is to introduce them to unseen possibilities and encourage them to step into a blank canvass upon which something beautiful and inspiring will emerge.


Wednesday, August 26, 2015

Retired Doc Finds Surprise, Challenge as Hospice Volunteer

Retired physician Larry Larsen’s path to medicine started with a pause. It was 1979, and he was a grad student making his way from Denver to St. Louis to begin study at St. Louis University School of Medicine. He and his wife, Jeanne, packed up their few belongings and headed down the stairs of the spartan three-story apartment building they’d called home. Before stepping out the door, Larry stopped. His thought, one that would reverberate off the halls of his experience years later, was: “I hope I don’t ever get to a place in life where I can’t get back to this.”


Larry’s medical studies, through service in the U.S. Army, led him from St. Louis to an internship and residency through William Beaumont Army Medical Center in El Paso, Texas (1983-86), and then on to one year of internal medicine at Ft. Ord,  Calif. Having completed a PhD in pathology prior to medical school, he was interested in a fellowship where he could apply that background. In 1987, he began a sub-specialty Allergy-Immunology Fellowship at Fitzsimons Army Hospital in Denver and then served as staff in the Fitzsimons allergy training program. He worked for two years in private practice in Denver and then moved to Salt Lake City in 1995 to pursue an opportunity in clinical research.

In 2004, at 54 years of age, Larry was diagnosed with prostate cancer.  This diagnosis, and the treatment and course which followed, has had a profound influence on his point of view and course in life. Initial treatment included a robotic prostatectomy, new at the time. PSA (prostate-specific antigen) levels showed recurrence of the tumor in 2006.

In 2007, Larry left Salt Lake City and the field of medicine (he doesn’t like titles or the word “retire”), and he and Jeanne returned to Denver to be near family. 

“Something was bothering me,” he says. ” I wanted to be able to close my eyes and feel good about my life in my last days.”

THROUGH HIS CAREER, he explains, he had lost sight of his original ideal: living a simple, non-presumptuous life. He decided to take a CNA class. (He found it one of the most enjoyable times of his life.) He also decided to volunteer for hospice.

“We happened to live by Broomfield Hospice, so I went in, looked around and applied for the volunteer program.” Larry wanted to continue volunteering when he and his wife moved to south Denver.  He had heard good things about Agape Hospice and resumed his role with Agape.

Larry says he doesn’t let his professional background “interfere” with his role as volunteer.

“I'VE LEARNED WHAT'S IMPORTANT for patients are the everyday little necessities. Their days are made better through small intentions: making sure they have a nice bed, combing or brushing their hair, sitting and talking with them.” When patients aren’t feeling their best, he notes, a foot rub or basic care provided by CNAs makes a significant impact.

“I’ve realized how hard the CNA job is, and undervalued,” he says. “When I started in hospice, I thought, ‘I’d really like to help the nurses and CNAs, make their days easier.’”

Larry has been surprised and challenged by volunteering. He tells the story of a patient, just 20 years old, who had bone cancer. She was reliant on others to take care of her needs.

“I was bringing a lunch tray into her room when I first saw her. I walked in the door, and I almost had to take a step back,” he says. “She looked like a 12 year old. Her clothes were pink, and there were shawls and hats with pink feathers. It didn’t look like the typical 20-year-old’s room. This was a person who was denied a lot.”

He knew she had started treatment young, missing out on her young adult days. She had coordination problems and found it difficult to handle utensils. Larry tried to help her, and the young woman began to cry, saying, “Let me do this.”

“That was a deep experience. I hadn’t listened to her wish for independence,” he says. “That is one I’ll never forget.”

Larry explains that one of the most important things he has learned from volunteer classes about hospice, or practicing any kind of medicine, is, “It’s not about me.”

“When you enter someone’s door, you leave all your personal baggage and judgments outside. You take them for who they are. This is easy to say, but not always easy to do,” he says.

HE ALSO HAS A KEEN AWARENESS of the need for psychological help when people are facing serious illness or the end of life—and the stigma still associated with seeking mental health services.

“People have to be made aware that there is nothing wrong with it. If you’re willing to take care of your diabetes, it’s no less important to take care of your psychological health. Patients and family may need counseling or medication (even temporary). Because being close to death, things may open up in your life that have been suppressed.”

Larry recalls a woman in her 70’s, “very kind,” who was in her last days of life. She had been married to an abusive husband who, by her account, had made her life miserable. She hadn’t spoken about this with anyone. Sitting with “Dr. Larsen,” hospice volunteer, gave her the opportunity to tell an important part of her story, “to get it out into the open.”

Getting to what's most important starts with a pause. Larry began anti-androgen therapy in 2013 and continues with this treatment today.

“Because I value quality over quantity of life, I have not pursued any additional therapy, such as chemotherapy or radiation, as I don’t favor the risk-benefit value there—though radiation has come a long way since I was what I consider a reasonable candidate for it,” he explains. He is quick to say this is a personal decision for each individual to make.

“Anti-androgen therapy is not a cure and gradually the cancer cells out-smart it, which is becoming so in my case. And that’s okay,” he says. “My work with hospice staff and volunteers keeps reminding me that it’s not about me.”  

Thursday, July 23, 2015

He's My Friend...He's My Brother


Last weekend, Agape volunteer Gary G. attended the celebration of life for one of the patients he supported for eight months.  His patient Frank* actually passed away in May. Not long before his death, Frank’s hospice nurse, Mary, asked him how his volunteer visits were going with Gary.  Frank was quick to respond, “Gary is not my volunteer any longer—he’s my friend.” I love that sentiment. Every weekend, Gary would drive from Centennial to Longmont to visit, not his patient, but his friend.  

When Frank died, his son communicated to us that the service was for immediate family...and Gary. The family held a celebration of life last weekend, and Gary was included. 

This happens with Gary time after time, as with Ed*, another of his patients. Ed had a son, and sometimes he wasn’t quite sure who was visiting – his biological son or “brother Gary.” Gary and the family rolled with it. Ed knew he had special people who came to visit on a regular basis. When Ed died, Gary was invited to this service, too.  He was at the funeral home and the graveside where Ed was interred with full military honors. 

Gary pays tribute to others. Yet what a tribute to Gary that he has been invited into one of the most intimate times of peoples' lives. Thank you Gary and all of our magnificent Agape volunteers. 


Grateful for you ~ Beth


*Not actual names

Thursday, July 16, 2015

Time to Live

The news that treatment is no longer effective (or that an older person is in decline), can seem like the end of hope--or a big, fat fail. Thought of cure or extended time turn to questions like, "Why" "What if?" and "What now?"

Yet knowing time is limited also presents an opportunity: to step back, take a breather and take control. But how? 

Agape Hospice care starts with a question: "What's meaningful to you?" For starters, people want to feel better. Less anxious. Less nauseated. Less sick. They want to be thought of as individuals and not defined by their condition, treatment or symptoms.

They tell us they'd like to go fishing or camping, enjoy a Twinkie, or get their hands dirty in the garden. Patients say they'd like to write letters or memoirs. To paint. To tie up loose ends with relationships. They want to accomplish things. Most want meaningful time with friends and family.

Our physicians, nurses, CNAs, social workers, chaplains and volunteers form a team expressly dedicated to helping people feel well enough to accomplish what's important. Our team is really good at relieving a person's symptoms while helping him or her to be as alert as possible. Sometimes, when people's bodies aren't having to work so hard to compensate for pain, discomfort, sleeplessness or anxiety, their condition actually improves. With Agape, people also get practical, emotional and spiritual support according to what they want and need.

If possible, why wouldn't anyone make the last weeks or months of life as rich as any other time? People fear death, suffering and the unknown. That's natural. They should not fear hospice care.

Saturday, June 20, 2015

Crying Over Strawberries at the Checkout

So you're in the grocery store on a picturesque Colorado day: warm, bright and filled with summer promise. You're loading your quart of ripe summer strawberries at the checkout and thinking about the possibilities. Sliced strawberries, spongy cake and freshly whipped cream. Smoothies. Icy cold strawberry margaritas. You catch the scent of the berries as they pass into the sales clerk's hands through the scanner and into your canvas bag (cheers to yourself for saving the planet one bag at a time!).

But before you can swipe your card, you're hit with a pang of something you can't place, like a loaf of day-old baguette leveled to the gut.

By the time you home in on your car and place your heavy eco-friendly bag into the back of your car, you're in tears. That is to say, you're beginning to convulse with sobs. One minute you're thinking about strawberry shortcake and drinks on the patio, the next you're bemoaning your lack of a scrap of anything resembling a tissue.

In the words of Marge Gunderson in the movie "Fargo" after she apprehends her depraved suspect, you think, "And here ya are, and it's a beautiful day. Well. I just don't understand it."

Then, like the ends of a seat belt, it clicks. Picking strawberries on a summer's day. The scent wafting through the air. Father's Day. Your Dad.

Agape bereavement counselor Karrie Filios calls this a trigger, and as confounding as it can seem when it hits, it's a normal part of grief. It can happen weeks, months, or years after losing someone you love.

Life is full of triggers that may remind us of a people we've lost: the smell of fresh-cut grass, Old Spice or a trip to Ace Hardware. Such episodes can be painful and surprising. They can also be a gift, our body's way of remembering and bringing a memory to mind.

Slice those fresh strawberries. Make fruity margaritas and toss those red gems on shortcake with loads of whipped cream. Then toast the person who not only played a significant part in your life, but lives on in your heart and your remembering. And to remember is to honor.


Tuesday, June 2, 2015

Art Buchwald's Victory Lap: A Case Study in Hospice & Beyond

Alas, the people who come to visit me now look at me with great suspicion. They want to know if the whole thing was a scam. They can’t believe, after I said goodbye, I’m going to Martha’s Vineyard instead of Paradise.
Art Buchwald, The Washington Post, 3/23/2006

When celebrated columnist Art Buchwald checked himself into a residential hospice in February of 2006, he expected to live two or three weeks. His doctors told him he had no kidney function, and Buchwald—who was 80 years old and facing a number of health challenges— decided to forgo dialysis.
Apparently, one of Buchwald’s kidneys didn’t get the memo. It continued functioning, and Buchwald lived to “hold court” in the community room of The Washington Home and Hospice for almost five months.
At the end of this time, he didn’t die. He checked himself out of hospice and went back home to Martha’s Vineyard. He lived another six months, spending time with friends and family, before his kidneys failed and he passed away. (Buchwald said the lesson in this experience was “Don’t trust your kidneys.”)
In the time between being admitted to hospice and dying, Buchwald led a remarkable life. He visited with family and friends (and enemies), hand-picked his eulogizers and wrote a book about his end-of-life experience (“Too Soon to Say Goodbye”). He wrote columns twice a week for the Washington Post, was interviewed by a host of national media icons and, to use his words, “became a poster boy for death.”
In 2006, The National Hospice Foundation honored Buchwald with the Hospice Champion Award. In 2008, in recognition of the positive attention Buchwald brought to hospice care, the National Hospice Foundation created the Buchwald Spirit Award for Public Awareness.
Robin Morton Murray
Taken from the Agape Healthcare  "By Your Side" publication

Wednesday, March 25, 2015

Own Way, Own Time

I stopped by the care facility to see my female patient after having communicated with my Agape supervisor about updates for a couple of days.I had been out of town for a couple months. 

Her husband was there when I arrived and she was in bed, unresponsive, with an oxygen mask.

Once again, her husband seemed to have some anxiety about the process, worrying out loud about things like the fact that she hadn’t eaten anything in several days and that she was not responsive to people.

I did my best to chat with him about how in my experience, every death is different, each follows its own course, and that his wife and her body were doing what they needed to do. I assured him that she did look comfortable and also said the process will unfold on its own time and there was no way to say for sure when she would take her last breath.

Overall, her husband seemed grateful that I came to visit. He read me a couple of Bible passages that he found encouraging about death. I sat very briefly with the patient herself, held her hand lightly and said hello and I could see she was doing what she needed to do. I told her how much I had enjoyed spending time with her and said, again, that I would read about Merle, the freethinking Dog, and remember our journey—Merle, the patient, me—together.

I was surprised when I realized how long I’d been seeing this patient.  We started with Bible reading and that was great, but once we proceeded to “Merle’s Door, Lessons from a Freethinking Dog,” we had something that just the two of us shared.

Agape Volunteer, Clay Bonnyman Evans

Tuesday, March 17, 2015

Why Hospice? Why Now?

Why hospice? Why now?

The question itself is in the initial nursing assessment that Agape Hospice uses during the meeting and admission of a new patient. Of all the things a hospice team wants to know when we meet a new potential patient and family, the most salient of all is the simplest: "Why hospice, and why now?" 
We want to understand what has happened in life and in the medical system that has brought you to hospice care. We want to assess what you know about hospice and what you expect from hospice care.  We want to understand how we can help address the most pressing and important needs that you want addressed at this very moment.  Most of all, we want to start learning your story, and seeing how we may join you as you make your way through the last chapter.

Those of us who work in hospice also have a "Why hospice? Why now?" story to tell.  I'd like to take a moment to share mine with you.

I am a nurse.  After nursing school, I pursued a job in acute adult medicine, otherwise known as a "floor nurse."  I worked with adults facing illnesses, both acute and chronic, in the hospital.  It was in this capacity that I was first exposed to death and to hospice.  

I once had the experience of caring for a hospice patient on the night shift at the hospital where the plan of care included ice cream, pain medicine, and doo wop music on the radio. I'd check on her periodically and offer up strawberry or vanilla. She held my wrist while I spooned the ice cream in and I realized she was moving her shoulders and hips. 

"You're dancing," I exclaimed in shock, but she only giggled.

There was another time I spoke with a 27-year old patient acutely aware of the nearing end of her life. She and I shared a pizza and gratitude for each other for the roles we'd been able to play in each others' lives. I was also 27 at the time.


There were also times when I witnessed families struggling alone to understand and accept the decline of a loved one. Or doctors and other practitioners overstating the possible benefits of aggressive treatment. And other futile sorts of ways that medicine and surgery were emphasized over comfort and quality of life.

Most of the time, I was happy with whatever patients my charge nurse chose for me.  But there was a time that I balked at my assignment because it included a patient on hospice care who was likely to die during my shift.  The charge nurse was surprised when I made a mild protest.  She said, "I chose her for you because I thought hospice was your thing."  I immediately apologized, not knowing why exactly I'd protested, and asked to keep the patient.  After a few days of reflection, I thanked the charge nurse that had made that assignment, because she'd helped me realize that hospice is in fact, "my thing."

About a year after that experience, I was asked by a current hospice employee if I would be interested in a job in hospice.  I wasn't entirely sure that I was ready when I went in for an interview.  I wasn't even entirely certain when I accepted the job.  But I decided to follow the path that was showing itself to me, and I have never once regretted it.

Once in awhile I'll meet someone new who asks about my work.  Inevitably they say something to the effect that it must be "so hard" to work in hospice. I like to take the opportunity to tell people why hospice is so great. I am there to help the patient and family direct the interventions, which can be things like ice cream for dinner and meditation. I can be a person who is willing to listen and hold someone's hand while they process their emotions about dying.  I can say, "Let's just forget about taking your blood pressure," if it's uncomfortable. 


Why hospice? Why now?  For me the answer is that hospice allows me to connect with other people in some of the most meaningful ways. I get to treat the small things like they're small and the big things like they're big.

Vicki Quintana, RN

Wednesday, January 28, 2015

A Colorful Connection


In this edition of Wednesday Warmth, I thought I would share a heart-warming story about a big success between a volunteer and her hospice patient.  Although new to Agape, volunteer KK has a wonderful history as both a RN and former Recreation Director.  She recently participated in a care conference with us for one of the patients from whom she was volunteering at a local facility. 

The daughter of our patient was visibly emotional and incredibly dedicated to her mother’s care. She indicated that her mom is “no longer of this world” and spends her time in silence holding her doll – having both limited eyesight and hearing. 

Week in and week out, KK would make her visit, though the interaction was quite limited until last week. KK found a connection… coloring! At first this little lady didn’t know what to do, but when KK picked up the crayon and started coloring in the book herself, her patient followed suit!  For a full 15 minutes, she colored,  and she SMILED.  Was it inside or outside the lines? I don’t know, but it was beautiful. 


KK called the daughter to share this success and both rejoiced in this very special and colorful connection. Thank you to KK and all of our amazing volunteers.  ~ Beth