Help with the Transition from Life into Death
The touching story of one man's short stay in hospice
I first saw Sam, an elderly Jewish man, as he was being wheeled into a room at the Hospice Center for Caring. Although he was weak, pale, and short of breath, he tried hard to smile when I introduced myself as his nurse.
Sam had been a hospice patient for just about two months, and one of our hospice nurses was caring for him in his own home, where he wanted to stay. He also had two personal caregivers, Susan and Connie, with him 24/7, one of whom accompanied him on admission into the Hospice Center. His hospice nurse arrived shortly after with a full report on how he had been doing in the home setting. If you are looking for God’s face in everyday life, you have only to look at the hospice nurses who cared for Sam and the caregivers who never left his side.
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At 90 years of age, Sam was in the end stages of congestive heart failure, with all its accompanying discomforts and anxieties. More often than not, patients with congestive heart failure are very weak, tired, and shaky, and therefore unable to take a deep breath. They fear not getting enough oxygen into their lungs. Caring for them requires a great deal of know-how—and patience and compassion as well. Their inability to breathe deeply causes increased anxiety, which in turn causes them not to be able to breathe as easily.
Although Sam had around-the-clock, hands-on caregivers, as well as the hospice nurses coming to his house, his 86-six-year-old wife, Martha, had grown increasingly fearful of the idea of Sam dying in their home. By now, she was very weary herself (and many older people have strong feelings about being alone with a loved one when they are dying). We understood Martha’s fears and tried to reassure her as best we could. Sam very much wanted to remain at home to die and was sad at the possibility of doing otherwise. But as his dying time drew closer, Martha became even more fearful and anxious.
After much discussion with the medical director, primary nurse, and social worker, we decided to move Sam to the Hospice Center just a few minutes away. His wife and caregivers were in full agreement. The hospice team caring for him at home and the Hospice Center staff worked together to make the transfer as comfortable and seamless as possible for both Sam and Martha.
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Serving the needs of terminally ill and dying patients in a hospice facility is different from caring for them in their own homes. The hospice nurse is a guest in the home of the dying patient—a caring visitor, so to speak. In that setting, the patient is able to maintain some control over what is going on around them and what is happening to them.
At this stage in the patient’s life, so many responsibilities of personal care have been taken over by others, and often the patient’s sense of self is greatly altered. However, when the nurse and patient are on equal footing, friends in a way, a patient can maintain at least some sense of control. Once these patients move into the Hospice Center setting, they fear they have lost their “home-field advantage,” and it takes great skill and compassion on the part of the nurse to help them feel otherwise.
This is when you lean heavily on the Holy Spirit to guide your every word and deed, as there is no way humanly possible to know the patient as you would like to. The staff in a facility often enters the patient’s and family’s life when everyone and everything seems to be in crisis. Fear, anxiety, pain, shortness of breath, weakness, and sadness all roll into one and are often the reason for the admission in the first place. It is the nurse’s primary responsibility to look past all the chaos regarding the family dynamics, putting the patient first and addressing every one of their needs as soon as possible, all the while appearing calm, tender, and in charge.
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Thus it was with Sam on the day of admission. I believed one of the most important things I could do for Sam was to immediately make him feel safe and comfortable. Once I was able to address his symptoms and alleviate his fear and anxiety, Sam realized it was better for him to be in the Hospice Center than at home. That alone made life better for him and for Martha, who was feeling guilty about wanting him to be at the Hospice Center rather than at home while he was dying.