We received a referral from a local hospital to meet with one of their patients and talk with her about comfort care measures and hospice support. Our hospice often does "Informational Visits" to educate patients and families about our program. I love doing these types of visits as it gives family knowledge about our program and answers a lot of questions for them. It helps patients and families know if and when they are ready for hospice.
"Jeanine, sixty-four, had a long history of lung disease. She was admitted into the hospital due to a respiratory emergency. She was in the ICU as needed a lot of medical attention. I spoke with the staff who informed me that Jeanine was declining on a daily basis. She was becoming weaker by the day.
Jeanine had family living several hours north of us. She knew she needed Skilled Nursing Placement and was hoping the staff could locate a facility in that area near her family. Due to Jeanine's medical needs, it will be a huge challenge in just finding a facility. After talking with Jeanine, I sensed she knew she likely would never leave the hospital.
It was a bit difficult talking with her as she spoke so softly and slowly. I held her hand while we spoke hoping to give her comfort. It just broke my heart seeing what she was going through. She had so much taken away from her due to her illness that her only want was her basic need of not being short of breath.
I hope Jeanine finds her comfort and her peace. I am praying and rooting for her.
HER BASIC NEED
They said to talk about hospice;
about comfort care and her grief.
Her daughter died four years ago.
"She'll mention her when you talk."
She was just lying quietly there
as I walked into the hospital room.
Almost too weak to talk.
Long pauses between each word.
She spoke about being short of breath,
but then quietly told me about her daughter.
Truly believing she's in a better place,
while her face just shined motherly love.
She immediately changed the subject back
to how hard it was to breathe.
She wanted to be strongly sedated
so the struggle would go away.
I spoke about hospice support.
How comfort care is what they do best.
Physical, spiritual, emotional.
They are so successful in what they do.
She was declining rapidly.
Getting weaker by each day.
I sensed she knew she wasn't getting better.
Also aware she'll never make it home.
She appeared content after we spoke.
I hope I gave reassurance about her basic need.
There is treatment so that never again
will she ever have to be
short of breath.
Saturday, September 15, 2018
Sunday, September 9, 2018
MOM'S WISHES
We admitted, "Linda", ninety-two, to our hospice program today. Linda has five daughters. Two of her daughters live nearby; while the other three reside out of state. Linda has been in a recent decline due to heart disease. She was hospitalized last week and discharged back home today.
All five of her daughters were at her side. Mom's biggest complaint is weakness and having trouble swallowing. Her diet has to be pureed in order for her to get any nutrition. Two weeks ago, Linda was able to walk independently. Now she struggles to get up out of her chair needing a lot of assistance.
Linda easily verbalizes her wishes. She is ready for this all to be over. She has strong spiritual beliefs and has no fears about dying. Today, she expressed to her family that she will stop eating and drinking, hoping it will hurry her death along. All of her daughters, lovingly claim they want to follow Mom's wishes, but each of them have a different interpretation of what she wants.
The patient's words are so direct and clear. The hospice nurse and I totally understand that she is ready to die and wants to do what she can to hurry things along. We spoke with the daughters about hospice's goal is to follow the patient's wishes. On the other hand, we also understand that it is not an easy thing for any of us to allow someone we love to go.
The patient has no quality of life and strongly does not want to live this way. Hopefully with hospice's support and guidance, we can help the patient and her family to cope with what lies ahead for all of them.
MOM'S WISHES
She's been so independent
for all of her 90 plus years.
She has always done life her way;
being determined, focused and strong.
That's what her daughters love about her.
She always speaks her truth.
A wonderful, loving mother to them,
but now she is taking care of herself.
Her recent decline has been swift.
She's become dependent and needs a lot of help.
She doesn't want to live this way,
"I am so ready for all of this to be over."
She has chosen to stop eating or drinking
hoping it will hurry things along.
"I didn't think dying would be this hard.
When will I be done?"
Her five daughters want to follow Mom's wishes,
but none can agree with the others.
They ask her and listen to what she says,
but each clearly defends what they hear in her words.
They will bicker; they will fight
trying to strongly defend their side.
All knowing she is ready to die,
with none able to let her go.
There is no right or wrong way to die.
It is such an individual want.
We will continue to follow her wishes;
while helping her daughters
to follow and respect them too.
All five of her daughters were at her side. Mom's biggest complaint is weakness and having trouble swallowing. Her diet has to be pureed in order for her to get any nutrition. Two weeks ago, Linda was able to walk independently. Now she struggles to get up out of her chair needing a lot of assistance.
Linda easily verbalizes her wishes. She is ready for this all to be over. She has strong spiritual beliefs and has no fears about dying. Today, she expressed to her family that she will stop eating and drinking, hoping it will hurry her death along. All of her daughters, lovingly claim they want to follow Mom's wishes, but each of them have a different interpretation of what she wants.
The patient's words are so direct and clear. The hospice nurse and I totally understand that she is ready to die and wants to do what she can to hurry things along. We spoke with the daughters about hospice's goal is to follow the patient's wishes. On the other hand, we also understand that it is not an easy thing for any of us to allow someone we love to go.
The patient has no quality of life and strongly does not want to live this way. Hopefully with hospice's support and guidance, we can help the patient and her family to cope with what lies ahead for all of them.
MOM'S WISHES
She's been so independent
for all of her 90 plus years.
She has always done life her way;
being determined, focused and strong.
That's what her daughters love about her.
She always speaks her truth.
A wonderful, loving mother to them,
but now she is taking care of herself.
Her recent decline has been swift.
She's become dependent and needs a lot of help.
She doesn't want to live this way,
"I am so ready for all of this to be over."
She has chosen to stop eating or drinking
hoping it will hurry things along.
"I didn't think dying would be this hard.
When will I be done?"
Her five daughters want to follow Mom's wishes,
but none can agree with the others.
They ask her and listen to what she says,
but each clearly defends what they hear in her words.
They will bicker; they will fight
trying to strongly defend their side.
All knowing she is ready to die,
with none able to let her go.
There is no right or wrong way to die.
It is such an individual want.
We will continue to follow her wishes;
while helping her daughters
to follow and respect them too.
Saturday, September 1, 2018
SHE CRIED
We received an urgent referral to admit, "Kathy", sixty-two years of age, to our hospice program. Kathy was diagnosed with brain cancer one year ago. Even though Kathy had been through continuous treatment., her cancer continued to grow. Kathy and her husband, “Ken”, were just informed two days ago that there is no more treatment available to help her.
Reading Kathy’s chart, prior to going out to do the visit, made me so sad. As it spoke about her symptoms, it added anxiety, depression and how often she cries. Reading that in her chart, my thought was, “I don’t blame her. I would likely feel the same way."
Kathy earned her PhD in Psychology and did so much amazing work with children. She was renowned for creating multiple children’s programs. She was published and taught classes at the local State University.
Kathy’s suffered from right sided paralysis and needed a wheelchair to maneuver around. She needed help with navigating her wheelchair. Kathy also suffered from expressive aphasia which meant she totally understood what was being said to her, but could not verbalize or speak any proper words to reflect what she wanted to say.
The hospice nurse and I sat around the kitchen table with Kathy and Ken. Throughout the visit, Kathy quite often would cry. She would try to verbalize a thought and could only speak one word or two. You could see frustration in her face. She and her husband are still processing the news they received two days ago. In addition, I am sure by the nurse and I describing hospice supports, reality burst forth as well.
My goal, as with every hospice patient, is to give them support to deal with their illness in the way that works for them. With my words to Kathy, I was wanting to give her much needed support. After the visit, the sadness I felt remained. I hope and pray I was helpful and not hurtful. If not my words, I hope the softness in my voice gave comfort.
SHE CRIED
Reading her chart
before I met her,
I felt so sad.
Life can be so unfair.
A brain cancer diagnosis
only one year ago this month.
Chemo, radiation, medication.
Her cancer continued to grow.
She has right sided paralysis.
Needing a wheelchair to get around.
Depression, anxiety, memory loss.
Frequent charting of how she cried.
She totally understands what you are saying,
but cannot express any words.
Her brilliant mind is trapped inside her body.
Throughout the visit, she so easily cried.
I shared that her family and friends so love her.
Not because she's published a book, or set up programs,
but because of who she is; her heart and her soul.
of which she will always and forever be.
I don't know if she was comforted or saddened
as I expressed my words of support.
It broke my heart to see her pain
as it was again that her emotions did show
as she suddenly
and so tearfully cried.
Reading Kathy’s chart, prior to going out to do the visit, made me so sad. As it spoke about her symptoms, it added anxiety, depression and how often she cries. Reading that in her chart, my thought was, “I don’t blame her. I would likely feel the same way."
Kathy earned her PhD in Psychology and did so much amazing work with children. She was renowned for creating multiple children’s programs. She was published and taught classes at the local State University.
Kathy’s suffered from right sided paralysis and needed a wheelchair to maneuver around. She needed help with navigating her wheelchair. Kathy also suffered from expressive aphasia which meant she totally understood what was being said to her, but could not verbalize or speak any proper words to reflect what she wanted to say.
The hospice nurse and I sat around the kitchen table with Kathy and Ken. Throughout the visit, Kathy quite often would cry. She would try to verbalize a thought and could only speak one word or two. You could see frustration in her face. She and her husband are still processing the news they received two days ago. In addition, I am sure by the nurse and I describing hospice supports, reality burst forth as well.
My goal, as with every hospice patient, is to give them support to deal with their illness in the way that works for them. With my words to Kathy, I was wanting to give her much needed support. After the visit, the sadness I felt remained. I hope and pray I was helpful and not hurtful. If not my words, I hope the softness in my voice gave comfort.
SHE CRIED
Reading her chart
before I met her,
I felt so sad.
Life can be so unfair.
A brain cancer diagnosis
only one year ago this month.
Chemo, radiation, medication.
Her cancer continued to grow.
She has right sided paralysis.
Needing a wheelchair to get around.
Depression, anxiety, memory loss.
Frequent charting of how she cried.
She totally understands what you are saying,
but cannot express any words.
Her brilliant mind is trapped inside her body.
Throughout the visit, she so easily cried.
I shared that her family and friends so love her.
Not because she's published a book, or set up programs,
but because of who she is; her heart and her soul.
of which she will always and forever be.
I don't know if she was comforted or saddened
as I expressed my words of support.
It broke my heart to see her pain
as it was again that her emotions did show
as she suddenly
and so tearfully cried.
Sunday, August 26, 2018
WHY?
The hospice nurse and I went out to admit, "John", to our hospice program. John was diagnosed with Lou Gehrig's Disease five months ago. John was a very determined individual. He honestly spoke what was on his mind. He did not want to live this way. Moments after we entered his home, he brought up the End-of-Life Option Act.
John had this strong belief that it was his time to go as did not want to be dependent. He had a strong love for his wife of thirty-four years. He wanted to make sure she would be okay after he was gone. John recently paid off their home loan to make sure she would not have any financial burdens. His love for her was so clear.
A strong sense of sadness overwhelmed me during the visit. I did not understand why. The nurse and I spoke after the visit. Both of us felt strong sadness for this patient and his wife.
A few hours later, I started to see how similar he was to my friend Amye, who died two weeks ago today. Such similar personalities and stories. The beauty of deep love between this couple; along with sadness regarding his terminal prognosis.
Grief is so unpredictable. It comes and goes so randomly. Throughout my career, grief counseling has been such a strong component of what I do. But, when it is on a personal level, I did not recognize my own emotions. Grief, no matter what form it presents, is so normal for us all.
WHY?
It was a routine admission.
We went out to meet both he and his wife.
He told us about his needs; his wishes.
He definitely told us his truth.
I quickly felt a heaviness deep inside;
along with a strong emotion of sadness.
I really didn't understand why.
Although, a while later, it all made sense.
He immediately spoke about his end of life;
not wanting to live this way.
It was the same determination she had.
Matter of fact with strong needs.
His diagnosis was recent; as was hers.
Both terminal from the start.
Treatment options available
with a slow decline.
He cared so much about his family;
as she did about hers.
Never to be a burden to anyone.
Ready for it all to be over.
I truly understood.
I've so recently been there before.
No longer needing to ask,
Why?
John had this strong belief that it was his time to go as did not want to be dependent. He had a strong love for his wife of thirty-four years. He wanted to make sure she would be okay after he was gone. John recently paid off their home loan to make sure she would not have any financial burdens. His love for her was so clear.
A strong sense of sadness overwhelmed me during the visit. I did not understand why. The nurse and I spoke after the visit. Both of us felt strong sadness for this patient and his wife.
A few hours later, I started to see how similar he was to my friend Amye, who died two weeks ago today. Such similar personalities and stories. The beauty of deep love between this couple; along with sadness regarding his terminal prognosis.
Grief is so unpredictable. It comes and goes so randomly. Throughout my career, grief counseling has been such a strong component of what I do. But, when it is on a personal level, I did not recognize my own emotions. Grief, no matter what form it presents, is so normal for us all.
WHY?
It was a routine admission.
We went out to meet both he and his wife.
He told us about his needs; his wishes.
He definitely told us his truth.
I quickly felt a heaviness deep inside;
along with a strong emotion of sadness.
I really didn't understand why.
Although, a while later, it all made sense.
He immediately spoke about his end of life;
not wanting to live this way.
It was the same determination she had.
Matter of fact with strong needs.
His diagnosis was recent; as was hers.
Both terminal from the start.
Treatment options available
with a slow decline.
He cared so much about his family;
as she did about hers.
Never to be a burden to anyone.
Ready for it all to be over.
I truly understood.
I've so recently been there before.
No longer needing to ask,
Why?
Saturday, August 18, 2018
LET ME KNOW
"Aunt Sylvia", eighty-three, suffered a major stroke ten days ago. After a short hospital stay she was transferred to a skilled nursing facility for rehab to help her get stronger. Aunt Sylvia's disease continued to progress to where the physical therapy did not help at all. It was, at that time, that the medical staff and family all knew that her time was near.
The family moved her to a small Board and Care Home in order to allow her disease to run its natural course in comfort. I went out to do a visit today to give the family support. I found Aunt Sylvia unresponsive with erratic breathing. She had long pauses between breaths. The patient's niece, "Kim", was sitting at the bedside.
Kim immediately started to share stories about her aunt's life. Kim so respected her aunt and told me beautiful stories about the wonderful events her aunt experienced throughout her life. The life review validated her aunt's impact on all of the family. Her aunt looked so beautiful lying there. It was such a gift that Kim gave me by sharing these lovely stories. We both benefited from them. I was at the bedside a little less than an hour, but felt I truly knew Aunt Sylvia by the time I left. Thank you Kim.
ADDENDUM: Hours later, in the middle of the night, Aunt Sylvia died peacefully. Kim was seated at the bedside saying her goodbyes. A beautiful gift to all.
LET ME KNOW
Her illness came on suddenly
with an unexpected, rapid decline.
Independent one day; dependent the next.
Now only hours to maybe a few days.
She is now unresponsive and bedridden,
with long pauses between breaths.
Her niece, sitting by her side; holding her hand;
telling life stories about her precious aunt.
She had to let me know how special her aunt was.
She was an environmentalist; a naturalist.
Shooting hundreds of beautiful photographs
from travels all over the world.
She was a first grade teacher.
Loving, gentle and kind to all.
Teaching her nieces all about life
through her actions, her beliefs, her heart.
Sharing her aunt's life stories
validated all the good she had done.
Wanting no one to ever forget her.
So strongly just wanting to;
just needing to;
let me know.
The family moved her to a small Board and Care Home in order to allow her disease to run its natural course in comfort. I went out to do a visit today to give the family support. I found Aunt Sylvia unresponsive with erratic breathing. She had long pauses between breaths. The patient's niece, "Kim", was sitting at the bedside.
Kim immediately started to share stories about her aunt's life. Kim so respected her aunt and told me beautiful stories about the wonderful events her aunt experienced throughout her life. The life review validated her aunt's impact on all of the family. Her aunt looked so beautiful lying there. It was such a gift that Kim gave me by sharing these lovely stories. We both benefited from them. I was at the bedside a little less than an hour, but felt I truly knew Aunt Sylvia by the time I left. Thank you Kim.
ADDENDUM: Hours later, in the middle of the night, Aunt Sylvia died peacefully. Kim was seated at the bedside saying her goodbyes. A beautiful gift to all.
LET ME KNOW
Her illness came on suddenly
with an unexpected, rapid decline.
Independent one day; dependent the next.
Now only hours to maybe a few days.
She is now unresponsive and bedridden,
with long pauses between breaths.
Her niece, sitting by her side; holding her hand;
telling life stories about her precious aunt.
She had to let me know how special her aunt was.
She was an environmentalist; a naturalist.
Shooting hundreds of beautiful photographs
from travels all over the world.
She was a first grade teacher.
Loving, gentle and kind to all.
Teaching her nieces all about life
through her actions, her beliefs, her heart.
Sharing her aunt's life stories
validated all the good she had done.
Wanting no one to ever forget her.
So strongly just wanting to;
just needing to;
let me know.
Saturday, August 11, 2018
I SO BELIEVE
I was asked to deliver some supplies to a patient’s home. When I arrived at the home, family was holding vigil. The patient was in a deep sleep and appeared comfortable. The patient’s niece, “Monica”, said that her aunt had not eaten or taken in any fluids for several days. The patient appeared imminent.
Monica didn’t know what to say to her aunt when she was asked, “What can I do?” That was when I gave her some advice about several things to share with her aunt. Monica and I spent about thirty minutes talking about end-of-life, coping and grieving. This is a very large family. They were all supportive to the patient and to each other. It was a beautiful thing to see.
I so believe that Monica did speak with her aunt right after I left as I found out later that the patient died thirty minutes after my departure. This is something I hear about quite frequently. I cannot prove it to be true at all, but I so believe it is. That is the beauty of the heart and the soul.
I SO BELIEVE
I went out to only deliver supplies.
I found family holding vigil.
She's no longer eating or drinking.
They all know her time is near.
She said her aunt has no fears
but wonders why it is taking so long.
Her Native American beliefs give her comfort.
"She is so ready to go."
She asked her niece, "What can I do?"
Her niece didn't know what to say.
I offered, "Tell her to just let go.
She'll know when her time is right."
Surrounded by her family,
thirty minutes later, she was gone.
She clearly heard her niece's words.
She knew they would be okay.
This is a frequent occurrence.
Expressions of love at the bedside.
Patients are unconscious, or so it seems,
but then their spirit; their soul clearly hears.
They are reassured by their loved ones words.
They know it is their time to go.
The depths of love and comfort surround them.
I can’t prove it while another may deny it,
but all of this
I so believe.
Monica didn’t know what to say to her aunt when she was asked, “What can I do?” That was when I gave her some advice about several things to share with her aunt. Monica and I spent about thirty minutes talking about end-of-life, coping and grieving. This is a very large family. They were all supportive to the patient and to each other. It was a beautiful thing to see.
I so believe that Monica did speak with her aunt right after I left as I found out later that the patient died thirty minutes after my departure. This is something I hear about quite frequently. I cannot prove it to be true at all, but I so believe it is. That is the beauty of the heart and the soul.
I SO BELIEVE
I went out to only deliver supplies.
I found family holding vigil.
She's no longer eating or drinking.
They all know her time is near.
She said her aunt has no fears
but wonders why it is taking so long.
Her Native American beliefs give her comfort.
"She is so ready to go."
She asked her niece, "What can I do?"
Her niece didn't know what to say.
I offered, "Tell her to just let go.
She'll know when her time is right."
Surrounded by her family,
thirty minutes later, she was gone.
She clearly heard her niece's words.
She knew they would be okay.
This is a frequent occurrence.
Expressions of love at the bedside.
Patients are unconscious, or so it seems,
but then their spirit; their soul clearly hears.
They are reassured by their loved ones words.
They know it is their time to go.
The depths of love and comfort surround them.
I can’t prove it while another may deny it,
but all of this
I so believe.
Saturday, August 4, 2018
FOUR O'CLOCK
2/18/69-7/26/18
My dear friend Amye died one week ago today. California has the End-of-life Option Act where terminally ill patients can choose to take medication to end their lives. There is a sequence of events that precede this last step; multiple visits to physicians, a psychiatrist and a pharmacist. Amye chose this option as she was so ready to go. From the initial cancer diagnosis eight months ago, Amye knew there was no cure. One thing I loved about Ayme was her ability to tell her truth. She was a straight shooter and had strong beliefs.
There are about 90 capsules that need to be opened and poured into a glass. Then you add water to dissolve the mixture. At four o’clock, without hesitation, Ayme drank the medication. Within five minutes she was in a deep sleep. For the next seven and a half hours, the only movement was Ayme’s breathing. She looked so peaceful and calm the entire time.
At her death, her face was so beautiful. She had a slight smile which let us all know she made it to the other side. I felt a sense of relief knowing that Ayme did things her way and was at total peace. For her, it doesn’t get any better than that. God Bless you dear Ayme. You will always be remembered in all of our hearts.
FOUR O'CLOCK
I was driving back to the office
when I noticed the clock said four.
It is exactly one week ago today,
at that exact time, when you willingly
swallowed those pills.
Within five minutes you were in a deep sleep.
For the next seven hours you did not move at all.
The only action involved was your breathing.
Your face was so calm; you were in peace.
You always wanted to remain in control;
never wanting to be dependent.
We all were honored and truly blessed
to witness your final farewell.
I hope you felt the love surrounding you
as we quietly said our goodbyes.
Yes, we all were so sad and grieving,
but knew you were flying high.
I will miss your sarcastic humor.
You and I laughed all of the time.
Thank you for sharing your life with me;
your greatest gift of all.
At four o'clock all of our lives did change.
It is something I will always remember.
But never forget, dear Amye,
your legacy will always
and forever
continue on.
My dear friend Amye died one week ago today. California has the End-of-life Option Act where terminally ill patients can choose to take medication to end their lives. There is a sequence of events that precede this last step; multiple visits to physicians, a psychiatrist and a pharmacist. Amye chose this option as she was so ready to go. From the initial cancer diagnosis eight months ago, Amye knew there was no cure. One thing I loved about Ayme was her ability to tell her truth. She was a straight shooter and had strong beliefs.
There are about 90 capsules that need to be opened and poured into a glass. Then you add water to dissolve the mixture. At four o’clock, without hesitation, Ayme drank the medication. Within five minutes she was in a deep sleep. For the next seven and a half hours, the only movement was Ayme’s breathing. She looked so peaceful and calm the entire time.
At her death, her face was so beautiful. She had a slight smile which let us all know she made it to the other side. I felt a sense of relief knowing that Ayme did things her way and was at total peace. For her, it doesn’t get any better than that. God Bless you dear Ayme. You will always be remembered in all of our hearts.
FOUR O'CLOCK
I was driving back to the office
when I noticed the clock said four.
It is exactly one week ago today,
at that exact time, when you willingly
swallowed those pills.
Within five minutes you were in a deep sleep.
For the next seven hours you did not move at all.
The only action involved was your breathing.
Your face was so calm; you were in peace.
You always wanted to remain in control;
never wanting to be dependent.
We all were honored and truly blessed
to witness your final farewell.
I hope you felt the love surrounding you
as we quietly said our goodbyes.
Yes, we all were so sad and grieving,
but knew you were flying high.
I will miss your sarcastic humor.
You and I laughed all of the time.
Thank you for sharing your life with me;
your greatest gift of all.
At four o'clock all of our lives did change.
It is something I will always remember.
But never forget, dear Amye,
your legacy will always
and forever
continue on.
Subscribe to:
Posts (Atom)