Death is (Not) the Enemy

Hospice always fails you. With few exceptions, our patients . . . die.

Death is a defeat, often perceived as a human failure.

Death is to be battled, and everyone schemes to beat it.

Death is a problem to be solved. On the moon-bound and suddenly crippled Apollo 13, Commander James Lovell famously said, “Houston, we’ve had a problem.” The prospect of death, between earth and the moon, between our first wail as a newborn and before whatever last breath is taken, should be confronted and conquered.

Avoid death!

Anyone working in hospice has joined the grim reaper gang. We mingle with the life insurance sellers and funeral directors, the coroners and the grave diggers. We are purveyors and surveyors of the forbidden topic. While the rest of society runs from the dying, we stay.

A hospice nurse, training similar to her counterparts in the hospital corridors and emergency rooms, begins the day with a list of patients to visit. While her colleagues are calming a mother about to give birth or prepping for surgery, and will give their all to bring and extend life, the hospice RN has other thoughts . . .

  • Will my patient die today?
  • How can I help her or him die peacefully?
  • How can I honestly answer the family’s request to know when death will come?

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An Intruder to Hope

Our job, so said the doctor, is to not take away hope.

That was how a physician summarized the reasons for decisions made about a hospice patient.

Hope?

Hope . . .

Hope floats.

Hope springs eternal.

Always look on the sunny side.

Hope is passion for what is possible.

However long the night, the dawn will break.

Let your hopes not your hurts shape your future.

When you’re at the end of a rope, tie a knot and hold on.

I could continue the quotes, clichés, and truthful longings. Do you have a personal mantra for hope? One of the more familiar (and a favorite I’ve happily used) is Emily Dickinson’s, “Hope is the thing with feathers that perches in the soul and sings the tune without the words and never stops at all.”

So, what were the decisions made or considered by the doctor for the patient? Read More →

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In Hospice, Don’t Be Ruled by the Rules

During a patient care team meeting, the hospice medical director explained that he’d broken one of his rules.

My distant impression of the doctor—physically distant because of where he and I sit in the meetings and professionally distant since he cares for the patients in their dying while I support grieving families after death—is that rules are critical values for the way he lives his life.

However, the soft-spoken physician felt he had to break a rule. Instead of providing key information about the disease process, and the options for comfort care so the patient could make choices about the next steps, the doctor bluntly told a patient that he must be transferred from his residence to our in-patient hospice home. Now! There, the patient would have a better level of care for his needs. Moving was not his choice; it was the doctor’s demand.

The patient died before the next sunrise. He died with the sole member of his local family at bedside. For weeks, his dying had been lonely, problematic, and anguished. In his last hours, dying became peaceful. The doctor had used good judgment. But the doctor had also wrestled over “breaking” a personal, essential rule: whenever possible, let a patient take the lead in making an informed decision. Read More →

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