Report

It never ceases to amaze me the condition my transfer patients arrive in from other hospitals or units.

Some healthcare providers on other units or in other hospitals are perfectly diligent and follow protocols and really look at the big picture.

Others send patients and stress the main problems are weakness and oral thrush and in comes a febrile, emancipated-looking man with no white blood cell count.

An accurate report is really, really important. Just so you know.

Quip

"I see you and your husband have been married for 65 years."
"You think that's a GOOD thing? Take my advice - get out while you still can!"

The Meaning of Hospice

At the end of October, I had an elderly woman who was truly ready to go to hospice. She had been accepted and was just waiting on a bed to open up. After years with her cancer, treatments no longer worked and physicians had nothing more to offer.

I had her for two consecutive nights and one of her sons never left her side. It was obvious that he had his mother's best interests in mind and no matter what she needed, every single time, he just said "Anything for Mama," and did whatever it was. The combination of all the treatments she had been through and being an older person in general made her very weak. She was barely able to move. She was incontinent but could tell us when she needed to be changed and her son helped me re-position her, slowly, because it hurt her to move.

I left to go home in the morning, being told the hospice center had a bed and would be taking her later that day. Overall, I was relieved. Her son made one comment to me toward the end of my shift about how he was hoping to get her out of hospice very soon but I thought that either the physicians or the hospice center would explain to him the goal of hospice.

I returned a few days ago to find a familiar name in my assignment. I knew who it was immediately but I was puzzled as to why she was still here.

I went in the room early on and that same son was with her. He asked me to help change her, so I did, and then started my rounds on my other patients.

A little later, she needed to be changed again. This time, her other children were there. My tech and I started cleaning her up. Suddenly, her other son began screaming that we were too rough, cursing at us and ordered us to leave the room. When a patient hurts just to move at all, there isn't much you can do about that but I can see how a distraught family member may not see it that way.

When the evening quieted down, I asked my charge nurse what happened with hospice. I looked through the previous documentation. Apparently, she had been doing quite well from the palliative chemotherapy they were giving her in hospice and her children took her out of hospice and back to the hospital.

Cancer is hard on the body. Chemotherapy and radiation are hard on the body. Sometimes it works and patients leave cancer-free and that's amazing. But sometimes the cancer spreads. Sometimes the treatments don't work or stop working. In this woman's case and many others, we know what the outcome will be and the only thing left to determine is how and when it reaches that point.

It's incredibly difficult watching someone you love die in front of you. Even when that person is in hospice care being kept comfortable, you may not understand. You might feel that hospice is cruelly starving your loved one when in reality, it's difficult for many patients who qualify for hospice to eat and they're usually getting some kind of drip so as not to feel the hunger. It's important to understand that hospice is not a step in between hospital and going home. Your loved one is dying, likely from something very painful. Even as a nurse, I can't imagine seeing a loved one in hospice wouldn't elicit some very powerful emotions. I'd want this person to stay with me as long as possible. I wouldn't think it's fair that they're dying, not now, not from "this," whatever "this" may be. But it's important to try your best to take yourself out of the equation. Your loved one probably doesn't want to leave you, either, and also may not think it's fair that they're dying now and from "this." They don't want to suffer as much as you don't want them to suffer, which is why it's so important for family members to understand hospice.

The fact is that this person is dying. It can't be stopped. The best that we can do is let the person die comfortably and with dignity. As healthcare providers, we truly do want to do what we think is best for your loved one, and what's best for you, too. But your loved one comes first. If you don't understand why we are doing whatever we may be doing or why we think your loved one should go to hospice or what will happen there, ask us!

Yes, as a nurse I've had thousands of patients. But please don't think even for a moment that I don't care what happens to your loved one. I became a nurse because I WANTED to care about all of these people and each and every one of my patients matters to me.