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

www.claybonnymanevans.com

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