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.
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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
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.
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