Saturday, December 24, 2011

HOME

Eighty-three year old “Donald” suffered from Parkinson’s Disease and Dementia.  He had been in a slow decline for years to where he now was bedridden and dependent with all of his needs. He was confused and could not carry on any meaningful conversation.

Donald lived with “Loretta”, his wife of sixty-two years. Loretta, eighty-one years old, was in good health with lots of energy which enabled her to care for Donald. They had one son, “Devon”, who lived across the street. Devon had been laid off from his job and was available to help his parents on a daily basis.

Donald’s needs were increasing to where Loretta could no longer care for him at home alone. It broke her heart to place him in a Skilled Nursing Facility, but she knew she had no other choice. Loretta didn’t drive so Devon would drive his mom to the facility where she would spend the day. Devon would return to pick her up at dinner time.

Donald was in the facility for about a week when he went into a coma. The family knew he was dying and remained at his bedside. Devon’s son was away at college and was able to fly home to visit his grandfather before he died. When his grandson walked into the room, Donald woke up for a few minutes and smiled at his grandson. Donald died the next day never awakening again. It comforts the family knowing that he was able to acknowledge his grandson‘s presence.

As a hospice social worker I contact families twice after a death. The initial call is a condolence call when the patient first dies. I make another call two to four weeks later to check in and see how the family is coping. I called Loretta today and she shared that she had just picked up Donald’s ashes and how it gave her comfort.

She is coping appropriately with excellent support from her family and her many friends. She was able to talk about her grief quite easily. She was aware that she will have some difficult days ahead, but also knows that it is the normal process of grief. With her outgoing personality and her willingness to reach out to her family and friends, I know she will be okay. She also knows she can call me or hospice if ever needed. I wish her well.


HOME


She wanted him to remain at home.
She hoped she could care for him there.
But his needs became too much for her.
She could no longer manage him alone.

She had to place him in a facility.
She knew she had no other choice.
She saw the good care he was getting,
but still it wasn’t like he was at home.

He was confused and didn’t understand,
but he must have known when she was there.
He would calm down when she entered his room
with her soothing words and gentle touch.

He died quietly one evening
with his family at his side.
She said it was peaceful.
It was good for us all.

She brought his ashes home today.
She said that something had been missing.
She placed them gently on the mantle.
“It’s so good to have him back home.”

Saturday, December 17, 2011

DEAR SANTA

Sixty-four year old “Gail” suffers from thymus cancer. She was diagnosed three years ago and has been through chemotherapy and radiation to no avail. She is divorced and is raising her two grandchildren; “Kelly”, thirteen, and “Arnie”, ten. Arnie’s developmental age is impaired due to being born with fetal alcohol syndrome.

Kelly and Arnie’s parents have not seen the children for years. Their father, Gail’s son, was in prison for seven years while their mother just left them on Gail’s doorstep one evening several years ago, knowing Gail would take them in. Gail lives in a very small two-bedroom home. The two children share a bedroom.

Gail has two other children who are devoted to her. Her son “Frank” is temporarily staying with her and sleeps on the couch to help out as she needs. He was recently laid off and is available to help out full time. Gail’s daughter, “Shelley” lives nearby and is with her mom on a daily basis. The plan is for Shelley and Frank to raise the two children after Gail dies.

Gail never complains and states, “I have had a good life.” She uses humor to cope and is realistic about her situation. She speaks openly about her dying which is a comfort to her children as Shelley recently stated, “It helps all of us to know how she is doing and what she is needing.”

I went out to do a visit today and Gail showed me the letter that Kelly wrote to Santa Claus. It made Gail cry tears of pride for her granddaughter. This is a family that doesn’t have much by society’s standards, but the love Gail has for her two children and her grandchildren is priceless.


DEAR SANTA


I wish for an I-pod
to hear my favorite songs.
I could download music so easily
and hear Justin Bieber sing.

Why does my Nana have to suffer?
Could you take away her pain?
She shouldn’t have to go through this.
It just is so unfair.

She’s been sick for quite a while.
I see her getting worse.
Santa, can’t you do something
to give her back her health?

It’s hard to see her suffer.
She’s been through way too much.
She’s raising me and my brother.
Why is she so sick?

Did I share my favorite music?
Did I tell you what I want?
The I-pod would be nice,
but then, my Nana is still sick.

Saturday, December 10, 2011

MAGIC WAND

Sixty year old “Laurie” suffers from pancreatic cancer. She is undergoing chemotherapy in an attempt to reduce the tumor to lessen her pain. Pain has been the biggest struggle for Laurie in the past. The chemotherapy is working and her pain is now at a tolerable level.

Laurie lives with “Walt”, her husband of nineteen years. They have no children. Walt was previously married, but his first wife died after a short illness. He was widowed ten years before he met Laurie.

Laurie is from a large family who are very involved, lively and exceptionally verbal with their thoughts and emotions. Laurie’s family is a sharp contrast to Walt and his family dynamics. Walt has a tendency to “stuff” his feelings and remain silent. Laurie wants Walt to talk to her and her family about his emotions and grieving process, but Walt has never learned how to do so.

I went out to do a routine visit today and was met at the door by Walt. Laurie was napping and not available during the visit. Walt said he wanted to ask me something. He told me about having a panic attack a week ago in the middle of the night. It woke him out of a sound sleep and scared him. He said he just wanted to scream. He felt so out of control.

The two of us talked for a while and it came out that Walt had many fears about facing his emotions. We talked about how it was for him when his first wife died after a one month illness. He said he just took a step and kept going. He added that he never has addressed any of those feelings. Walt said that as a child, he tried to talk about his feelings and was always stopped by his mother saying, “I have had it worse than you have it.”

Walt was receptive to meeting with our hospice bereavement interns to help him with his grief and emotions. He has stuffed his feelings for over six decades. Learning to undo how he processes his feelings will take some time. I was proud of him to have taken that first big step today.


MAGIC WAND


I wish I had a magic wand.
I wish I could ease his pain.
Emotions trapped so deep inside
struggling to come out.

The panic attack scared him.
It woke him from a deep sleep.
He knew it had to do with her dying.
He felt so out of control.

He learned years ago to stuff his feelings.
He was taught this as a young boy.
Do not ever complain.
Others have it worse than you.

Now he needs to talk about it,
but doesn’t know where to start.
He wants to address these deep feelings,
but is afraid of what will come.

He took a baby step today.
It was a healthy start.
It will take him years of hard work though,
to sift through all that pain.

But then,
I wish I had a magic wand.

Saturday, December 3, 2011

SHE DRINKS

Sixty year old “John” suffers from brain cancer. He is confused and very forgetful. He was a systems analyst by trade and gets frustrated because he knows he can’t remember things. John lives with his wife, “Janet”. They both are admitted alcoholics. When we initially opened them to hospice two weeks ago, they both proudly proclaimed that they each had been sober for over one month.

Janet and John have a son who lives an hour away. He visits as often as he can. He is an accountant and can work from home, which makes his schedule flexible to be able to visit his parents when needed. Another son died four years ago from an accidental drug overdose while in jail. Janet easily tears up when talking about the loss of her son.

Six weeks ago, Janet fell, while drunk, and fractured her left shoulder. She has had several surgeries on her shoulder since then as she had not been keeping her arm immobile as directed by her physician. Due to the fracture, she is unable to care for John.

John has declined to where he is bed bound and not eating. He has stopped talking and it isn’t clear how much he understands. Likely he has just a short time to live. Fortunately, the couple have the funds to hire twenty-four hour attendant care. In addition, due to her own limitations, Janet has hired someone to help her with cooking, cleaning, household chores and transportation.

Yesterday, I went out to do a routine visit at 9:30 in the morning. I found Janet so drunk she could not even walk. She was stumbling and the caretaker was helping her to the kitchen table. Janet and I sat in the kitchen while she drank a half pint of tequila with a beer chaser. She said she started to drink again three days ago. She said she couldn’t be strong any longer. She admitted to drinking one pint of tequila and six beers daily. Her son called during the visit and she told him that she had started to drink again. Fortunately he is now aware.

I followed up with a call to her today and again found her drunk. She said she started to drink just today. She did not remember our visit yesterday and I reminded her that yesterday she said she had been drinking for three days. She then quickly said, “I will stop, I will stop.” I wanted to update her son, but she told me not to call him as he has enough stress.

I will follow this case closely to monitor safety for her and her husband. Fortunately hospice has a tremendous follow up bereavement program. She will need help for a long time to come and hopefully we can help her with the support she needs.



SHE DRINKS


She is crying.
She is laughing.
She is drinking.
He is dying.

She swallows her tequila
with a beer chaser
from the moment she awakens
until bedtime has come.

She slurs her words.
She stumbles and falls.
She can’t face his dying,
so she drinks.

She says she can’t remain strong.
She no longer has it in her.
Old habits die hard
so she takes another swig.

He’s in good hands
with the care she has hired.
They attend to her too
while she drinks.

She is crying.
She is laughing.
She is drinking.
He is dying.

Saturday, November 26, 2011

HORSES

 "Paul”, ninety years old, suffers from lung cancer. He has been on hospice for about two months. He is declining rapidly to where he is now very weak and sleeps most of the day. Paul lives with his wife, “Joan”, who is eighty-six, but so full of life and energy.

Paul and Joan have three adult children and many grandchildren. The family is very close and all are devoted to Paul and Joan. Joan does not look or act her eighty-six years. She is very social and, in addition to her family, has many close friends and neighbors. She is very talented and has many interests. Joan paints water colors, plays the piano and currently is writing her second novel.

Joan has a strong interest in genealogy and has researched Paul’s family history as well as her own. Paul was a World War II hero as he was the pilot of the plane that first spotted the Japanese at Midway. Paul proudly showed me the one room in their home where he has displayed all the newspaper articles and medals he received while serving in the war.

During my visits, Joan will start sharing family history. She remembers all the details which make her stories so interesting and colorful. During my visit today, she started to share stories of the loss of members of her family. Seeing Paul’s decline in the recent weeks has brought up past memories that she has experienced.

During the visit, she shared the story of her father and how he died. She said his love for horses came from his father, her grandfather. Her grandfather was a cowboy and also rode horses throughout his life. She said he once raced against Jesse James in a horse race.

It gives her peace and comfort knowing that the moment her father died was the perfect moment for him. 


HORSES


She has a colorful family history.
She’ll easily spin you a tale.
Anecdotes, adventures, olden times.
She’s a natural-born story teller.

She’ll proudly talk about her family.
So many people no longer around.
How she was there for many until the end.
Lasting memories she’ll never forget.

She shares stories about her father
and his lifelong love of horses.
Never without a cowboy hat
as he proudly rode throughout his life.

Late in life, a heart attack left him frail.
Her mother had to pick up the slack.
One day she wheeled him to the front porch
so he could watch her work in the yard.

Suddenly he saw children leading some ponies.
They were slowly walking past his home.
An unusual event never occurring before.
It was then he quietly slipped away.

It gives her peace and much comfort
knowing he died the moment he did.
One final image of the horses he so loved.
Further coloring of the already vibrant family tree.

Saturday, November 19, 2011

CARDS

Fifty-six year old “Sandra” suffers from ovarian cancer. She was referred to hospice several months ago because her cancer had spread to her stomach. Sandra has been divorced for years and raised her two children alone. Sandra‘s twenty-eight year old son lives with her. Her daughter lives nearby with her husband and young daughter.

Both children are devoted to their mother. Sandra is still able to manage many of her needs, although is slowly declining and becoming weaker. She stays home alone while her son is at work. She has many visitors throughout each day as well as phone calls from family and her large network of friends. Sandra is a very social person with such a positive outlook on life. She says she doesn’t miss working, but does miss the social interaction that goes along with it.

I went out today to do a routine visit and Sandra shared how she had been so sick the previous week. She had been weak, nauseas and couldn’t keep anything down. In addition, her eyes have started to become painful where she has stopped reading for a while wanting to give them a rest. Sandra loves to read, but in her typical positive way, says that she can always get someone to read to her. She is doing much better this week. Sandra’s experience of last week steered our conversation about her dying. She is a Christian with a strong belief in God and the afterlife.

Sandra picked up a book from her nightstand and shared some of the words of wisdom from a few of the pages. The book focused on recognizing the bright side of life. Sandra cannot control having cancer, but she has all the control in how she deals with her disease. Sandra stated that she prefers her days to be good days. The book wrote about the positive aspects of playing the cards that you have been dealt.

Sandra has no fears about dying or the afterlife. Her positive attitude has guided her throughout her life and I have no doubt that she will continue to play all the cards that she holds in her hand.


CARDS


She has such a positive attitude.
She always prefers the bright side.
No matter what cards have been dealt,
she’ll continue to seek out the aces.

She feels life is like a deck of cards.
One must always play the ones in their hand.
You can never rely on what card is coming next,
so it is best to accept the ones that you have.

She has been dealt some bad cards in her life.
Things have not always been easy or smooth,
but she’ll carry on, present a smile,
and do the best that she can.

She wants the end of her life to be happy.
She hopes to enjoy the days she has left.
She wants to always be remembered with a smile,
not with, sadness, sorrow or regret.

Her convictions about life may be simple,
although I know her legacy will be great.
“Success is when you find joy in your life
by playing the cards you have been dealt.”

Saturday, November 12, 2011

PAIN

Sixty-eight old “Catherine” suffers from lung cancer. She gets short of breath very easily although is able to manage well if she walks slowly. Catherine lives alone with plans on moving to a retirement community in two months where there are higher levels of care available as needed.

Catherine is divorced and has lived alone for years. She has two adult children who are very close to her. Her daughter, “Lisa”, moved in a few months ago to help out. Lisa works during the day, but is available weekends and nights. Catherine’s son, “Jay”, works nearby and can take off work whenever he needs to help his mother.

Catherine has a very independent personality and is very determined to live her life to the fullest. She pushes herself to keep going in order to live her life her way. She loves to eat out and lives near many restaurants within walking distance. Many days one will find her slowly walking up the street with her walker toward her restaurant of choice for that day.

Catherine has been on hospice for over six months. Whenever the nurse or I visit, we spend most of the time talking about food and the local restaurants. Catherine is a delight and so full of life.

Her one issue, though, is severe back pain. The hospice nurse offered morphine which Catherine quickly declined. She had the understanding that taking morphine would either mean you would become addicted or that you were dying. Roxanol is the same drug and, quite often, when presented that way, patients are more willing to accept the option.

Catherine’s son Jay was worried about his mom’s pain issues and offered to get her some marijuana. Catherine quickly said no as she felt she didn’t want to smoke it. When Jay offered getting it in a brownie, she again quickly declined as she didn‘t want to digest any marijuana. Jay discovered a lotion at a local marijuana dispensary that Catherine was willing to try. She is now happily using it as it is very effective in relieving her back pain.

Catherine said she is from the old school where values were such that one didn’t take certain drugs. She now is a big fan of her marijuana cream and will quickly praise its graces.



PAIN


She is from the old school
where beliefs were firmly set.
Certain values were acceptable
while many others were not.

She didn’t want to take morphine
even though her pain was often severe.
It would mean she’d become addicted.
It must mean the end of her life.

Roxanol is the official name for morphine
and she was willing to it a try.
She didn’t know it was the same as morphine.
She just liked how it helped with her pain.

Marijuana is sold legally in her state.
One just needs a special card.
Her son offered to get her some.
He hoped it would help her pain

She didn‘t want to smoke it.
She did not want to consume it.
She was willing though, to try the lotion
with the creative name of “Cannabliss”.

The lotion was instantly effective.
Her pain a steady decline.
She quickly amended her lifelong beliefs.
She only had to give it a try.