The First (Awful) Visit from Hospice

Your doorbell rings. You glance out the window and spot two people. They are wearing identical nametags with the word Hospice in a large font. Though expected, they are strangers at your door.

Yesterday, you’d met the hospice’s admitting nurse at the hospital. She’d promised that “your hospice team” would soon phone to schedule a first visit. A person—you couldn’t remember the name—had called several hours before. Soon had become now.

For a moment, you consider not answering the door. You don’t like meeting new people. You don’t like strangers in your home. They will judge your lousy housekeeping. They will make messes. They will ask questions you’d rather not answer. They will irritate your already irritable and very sick spouse.

If you didn’t answer, would they leave?

Do you really need hospice?

What if your beloved gets better? In the past, the disease seemed to be winning and then, like a miracle—along with lengthy hospital stays, terrible chemo treatments, and more trips to the doctors’ offices—your spouse bounced back to nearly normal.

But this time, normal seems impossible.

They ring the doorbell again.

You glance again. One has a black nylon case that looks like a carry-on for air travel. The other grips a slender briefcase. They appear friendly. (Looks can be deceiving, though . . . )

You hate dislike strangers.

In the background, from the bedroom that suddenly seems like a hospital room, your beloved—your soulmate and lover and life-partner—coughs, and then moans. There’s been so much pain, so much suffering. Maybe leaving the hospital was a bad idea?

You open the door.

They politely introduce themselves. One is a nurse. The other is a social worker.

And now the strangers invade your home. (You should’ve dusted. You should’ve prepared tea or coffee to offer them. You should’ve worn something different. You should’ve . . .)

Your world has changed again.

+      +      +

As a Christian minister, I am most familiar with the Biblical verses about welcoming the stranger. One lovely example is Matthew 25:35, where Jesus talked of “being a stranger and you welcomed me.” This is a tradition inspired by and inherited from Christianity’s Jewish roots.

The Hindu’s Taitirya Upanishad (1.11.2) declares, “Let a person never turn away a stranger from his house, that is the rule.  Therefore a man should, by all means, acquire much food, for good people say to the stranger: ‘There is enough food for you.’”

For Muslims, the fourth chapter (or Surah) of the Qur’an states, “Do good unto your parents, and near of kin, and unto orphans, and the needy, and the neighbor from among your own people, and the neighbor who is a stranger, and the friend by your side, the wayfarer, and your servants.”

I could continue quoting sacred scripture from other religions that “welcome the stranger.” I could add references from various cultural, national, historic, regional (and more) traditions that also “welcome the stranger.” But there is probably no need.

All of us know there is a value in welcoming people into our homes, into our lives.

But welcoming hospice is scary. Aren’t they the worst kind of strangers? Don’t they bring death in with them?

+     +     +

I usually called before visiting when I was a pastor at a church. Especially if going to someone’s home, I’d make an appointment. With church members in a hospital or nursing facility, I rarely checked beforehand, but would try to arrive at a good time for him or her. But I was their pastor! With few exceptions, I was always welcome and welcomed.

When I worked as a hospice chaplain, it was different. I became the stranger at the door. Welcome? Sometimes. Unwelcome? Yes, sometimes.

With my first visit to a new family and patient, I would call, explain my role, and seek a time best for them. And then, later that day or week, I’d arrive at their door.

Someone would open the door. They didn’t know me. I didn’t know them.

+     +     +

Inviting hospice into your home is never easy.

A loved one is ill.

That illness will cause his or her death.

Once, the illness was probably part of an ongoing “battle.” There would be defeats, but also victories. The doctors would offer choices of treatments. Even in the darkest days, when (for example) a cancer treatment caused hair loss and nausea, there would be the proverbial silver lining because “soon” the tumor would shrink or stop growing and a doctor would talk about what to do for the following months or years or . . .

Then, it came down to only months.

Then weeks. Days . . .

And hospice came knocking at your door.

The first encounters with hospice are difficult. There will be phone calls to establish appointments. A nurse works with you to determine the needs and frequency of visits. Chaplains and social workers request time with you, bringing more forms and questions. Would you like a home health aide to assist with bathing? What about a volunteer to sit with your loved one while you take a break or go grocery shopping? What about . . .

I refuse to sugarcoat the first visits from hospice.

It. Will. Be. Overwhelming.

These are strangers. This is the scariest time of your life. It is your home, your schedule, and your loved one who is hurting more than he or she ever has before.

No hospice is perfect. The hospice staff will arrive too late or too early. They will say something to bother you or be too silent when you need reassurances. Mistakes will be made. Everyone involved is only human.

But every “stranger” at your door from hospice is there to serve you. He or she knows—truly knows—that you are frightened, and they will make every effort to listen to what you need, and try to work with you to make your beloved as comfortable as possible.

I hope you welcome the stranger.

They are not at your door to bring death, but to bring life.

(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

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  1. This encompasses the feelings we both had. They made Ron’s end of life, easier for both of us. Even in death, there is beauty.❤️

    • Pam –

      Thanks so much for reading and responding. I’m glad I wrote something that touched your feelings. Take care!

  2. Great read. Several years ago my mother was diagnosed with cancer. After lots of soul searching she made the decision not to undergo any chemo or treatment to extend her life. She chose to live the rest of her life without the devastating effects these drugs or radiation would have on the quality of her months she had left. We were lucky enough to become part of the Horizon hospice family. Being the only daughter and child in the same
    town I was her main caregiver. That first visit is a tough one. To sign your own DNA is not easy! The nurses from Horizon were always AMAZING . Most of all they were very loving and respectful to my mother all the time. I loved the fact that we always knew what was happening on her journey . When it came time that my mom could no longer continue to live at home, they helped us find the Monarch. I know there is a special place in heaven for all these wonderful peiple. Even though I thought I was ok after her death these people knew better. They continued to help me heal and to stop second guessing some of the choices I had to make regarding my mom.

    • Carla –

      Thanks for taking the time to read, and for your comments. I’m glad you had (after the first “tough” visit) a good experience with hospice. And, as someone who now works in bereavement, I’m also glad that Horizon continued to follow and support you. Take care!

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