HER CHOICE

The hospice nurse and I went out to admit “Caroline”, fifty-seven years old, to hospice.  Caroline was diagnosed with metastatic rectal cancer only fourteen months ago.  The doctor said she needed to undergo surgery to remove the tumor; while adding that she would have to undergo chemotherapy treatment prior to the surgery.  Caroline and her mother, “Connie”, met up with three more oncologists at different medical centers hoping to hear that Caroline does not have to have chemotherapy.  Unfortunately, all four of the oncologists gave the same advice; chemotherapy and then surgery. 

Unfortunately, Caroline had, in the past, two family members who did undergo chemotherapy with horrific side effects.  These events set strong negative thoughts inside of Caroline; whereby she would never opt for chemotherapy treatment.   Hence her cancer continued to grow which strongly affected Caroline in such an arduous way.   

Caroline’s mother, “Connie”, is her caregiver.  Connie doesn’t fully understand her daughter’s wishes, but will totally support her.  I so respect Caroline and Connie, but sadness did embrace my soul.  I was able to hug Connie so tightly while she gently cried.  I know so many of us strongly feel, at a loss of a child, “This is so out of order.”  I would like to find a reason, but so know that there isn’t one.  God bless Caroline and Connie.

HER CHOICE

She heard metastatic rectal cancer

only fourteen months ago.

“Before we do surgery to remove the tumor,

you will need to undergo chemotherapy.”

 

She strongly opposed getting chemotherapy

as feared the potent chemicals would only hurt her.

After consulting three more oncologists, she heard the same,

“No surgery if you choose no chemotherapy.”

 

She has strongly stood by her decision; her choice,

even though, now, she is tremendously weak.

She is no longer able to eat or drink fluids.

                    The nausea has dictated all.    

 

She is only fifty-seven years old.

Her mother says she has always been a mighty soul.

“She will stand by her convictions;

                    she will stand by her choice.”

 

Her mother appropriately cried during our visit;

“She is begging to die; she is so ready to go.

I don’t want to lose her; not now or ever,

but I have to respect; I so have to honor;

                    Her choice.”

 

HIS SPIRITUAL BELIEFS

We admitted, “Dennis, eighty-eight, to hospice today.  Dennis suffers from Alzheimer’s Disease and has been in a recent decline whereby he is weaker and more confused. In addition, he is sleeping a lot more and eating less.  

Dennis lives in an Assisted Living facility with his wife, “Doris”.  Doris was admitted to hospice a few weeks ago as well.  The couple had two children.  Their one son died three years ago after a short illness.  Their daughter, “Janet”, lives a few blocks away and visits her parents daily. 

Talking with Janet, it was so obvious how much she loved her parents.  She told me amazing stories about her father and how much he loved her mother.  The couple have been married 66 years.  Dennis worked hard his entire life, but still always had time for his family.  He still wants to work hard as Janet shared how he will walk up to the facility staff and ask them if they need any help.  

I was so amazed by his loving words about his wife.  To me that is so lovingly and as powerful as any spiritual or religious belief.  Dennis, you are an inspiration. 

HIS SPIRITUAL BELIEFS 

 

When admitting a patient to hospice,

there are a lot of questions that arise.

My favorite question to ask is,

“What are your spiritual beliefs?”

 

Most folks immediately think of religion,

but it is so much more than that.

It involves one’s belief about life;

or “What it is all about?”

 

These last two months have been a bit rough,

as he has been in a recent decline.

He is becoming more confused

as Alzheimer’s is rearing its ugly head.

 

His daughter shared stories about his life;

how he worked three jobs to support his family.

His primary goal was to be there for them as well.

Expressing his love was a high priority.

 

I asked her about his spiritual beliefs.

“He didn’t identify with any religion

as he was never a church goer.

He truly has no religious beliefs at all”.

 

She asked him once, “What do you believe?”

His answer was so magnificently phrased.

“My meaning for existence is Mom.

                    I so deeply love all of you.”

 

It is so clear; so evident that

he is the most spiritual

                    of us all.

 

SO SIMILAR

I met “Monica” on a Wednesday.  The next day, Thursday, I then met “Jennie”.  There were so many similarities between these two women.  Both had the same diagnosis of Ovarian Cancer that had metastasized.  Monica was diagnosed only thirteen weeks ago; while for Jennie it has been approximately two years.  Both women underwent chemotherapy treatment.  For Monica, the chemotherapy did not work at all as her cancer continued to grow.  For Jennie, her treatment worked until recently. 

Both women chose to stop chemotherapy.  Both chose to allow their cancer to run its natural course at home surrounded by their family and loved ones.  They both totally accepted their fate without fears as their spiritual beliefs help them cope and gave them courage.   What I saw and appreciated so was the strength of these two women.  They have also given me hope about life and afterlife.  Bless them for their beliefs and pure acceptance.

SO SIMILAR 

 

I met her yesterday for the first time.

She’s been in a rapid one-month decline.

It is so sad as she was diagnosed with cancer

               a mere thirteen weeks ago.

 

She’s been hospitalized several times

as the chemotherapy did not work.

“I want to be discharged today

in order to die in comfort at home.”

 

I met her this morning to also admit to hospice.

She too, has the same diagnosis of cancer.

Her chemotherapy, as well, is no longer effective.

“I’ve had a good life.  I have no regrets”.

 

Both have clearly stated their wishes;

to be at home, surrounded by loved ones.

To be able to die their way; in comfort and in peace.

                    Their similarities amaze me.

 

They are only seven years apart in age.

Way too young to face these challenges.

One is so divinely spiritual;

while the other a devout Catholic.

 

Both have a positive outlook on life

as well as an accepting viewpoint on death.

Both so lovingly embrace their family;

knowing that is the best gift of all.

 

They both embraced my heart so deeply.

Their love; their grace; their beliefs.

Such beautiful moments to experience.

No words can ever grasp this significance.

 

But then astonishingly,

                    So similar.

THIS IS LIFE

We received a referral today for “Kelly”, an eighty-four-year-old woman who has been in a dramatic decline x 2 weeks.  Previously she was independent with all of her activities of daily living.  Now she is so weak, she has to use her walker to get around.  As a result of pain when eating, she is on a pureed diet.  She has lost a tremendous amount of weight in just two weeks. 

Kelly is very matter of fact and completely focuses on the moment.  She is realistic and so accepting of her life no matter what challenges she might face.  She has been divorced for many years and had two children.  Her son died ten years ago.  When talking about his death, she has accepted it by strongly believing and stating, “This is life”. 

Kelly’s daughter lives nearby and is not involved much at all.  Kelly asked that I call her fiduciary to let him know she was admitted to hospice.  He is the primary contact person.  This is the normal process for Kelly as she accepts whatever comes her way with a realistic, easy calmness.  

Kelly was very grateful for our support and thanked us for just being supportive and involved.   “I feel so much better with hospice’s support.  Thank you”.   Well, I say to you Kelly, “Thank you too, for letting us know how we can help you.”  Appreciation does run both ways.

THIS IS LIFE 

 

This sudden two-week decline

has hit her mighty hard.

She today, strongly stated, “I have no energy”,

now needing a walker to ambulate.

 

Her diet consistently is pureed food

as it is painful for her to eat.

She has lost eleven pounds in two weeks,

as all she wants to do is sleep.

 

She was recently hospitalized

to undergo a biopsy and so many other tests.

She found out today her diagnosis;

uterine cancer that has likely spread.

 

She realistically stays in the moment;

knowing there is no further treatment; no cure.

“I so wish that this would be quickly over, but then,

               This is life.”

 

She had two children,

but her son has preceded her in death.

Her primary contact is her fiduciary;

an attorney who will manage her care.

 

“My daughter doesn’t want to be involved,

and I so strongly wish that I could go today.

What is this all about?

                    I truly don’t really care”.

 

“This is life”.

 

GUIDELINES

Each hospice follows Medicare’s guidelines.  We have to follow Medicare’s policy or we could lose our license.  A diagnosis alone is not enough.   Physicians make a hospice referral when it is their understanding that the patient has six months or less to live based on their illness and health history. 

“Marilyn’s” physician referred her to hospice after she took a fall two weeks ago.   She went to the Emergency Department after the fall to be checked out.  Not surprisingly, the fall shook her up a bit.  Marilyn has never married and has no children, but her dear friend, “Diane”, lives a few blocks away and visits daily.  Diane adorably calls herself Marilyn’s “faux daughter”.  

Marilyn lives alone, but has hired caregivers a few hours each day to help out.  The caregivers help with laundry, housekeeping and other chores.  Diane helps out a lot as well.  Marilyn uses a walker to ambulate.  She has been walking a bit slower since the fall, but still doing okay.  Diane helps out with meals and does the grocery shopping. 

When the nurse and I entered the home, Diane walked us out to the backyard where Marilyn was sitting.  Marilyn immediately started to share the history of the home as has lived there for many years.  It was so beautiful as there were Redwood trees all around.

 The nurse needed to ask about her health history in order to have an acceptable diagnosis for hospice admission.  There was none.  It was wonderful as she was so healthy.  She was a joy to be around.  She told us many life stories while putting a humorous spin on things.  I would love to stop by again to just say hi.  She was a delight.

GUIDELINES 

 

Medicare has specific guidelines

when admitting a patient to hospice.

Diagnoses alone are not enough.

Certain elements of decline are also required.

 

She took a fall at home two weeks ago.

She’s been in a slow decline since then.

She now has good days along with bad days,

but still able to manage fairly well.

 

She never married and has no children,

but her “faux” daughter visits daily.

In addition, there is hired help a few hours each day,

but she is still able to manage many needs quite well.

 

The nurse asked about her health history.

“Do you have any diagnosis we should know?”

The patient said she had back pain at times,

“My doctor told me that can come with age”.

 

We could not admit her to hospice.

She was healthy and doing quite well.

We were so amazed and surprised by her

as in two months she will celebrate a birthday.

Whereby she will turn a wonderous age;

                    She will be 101.