Thursday, November 19, 2009

Compassion comes, but sooner

When you think of hospice care, what comes to mind? If your answer involves the final days of life, waiting for the end in a somber deathbed scene, and enduring the painful conclusion to life... then you do not understand.

I had an opportunity today to join Andy, an RN in our hospice affiliate, on a home visit. I'll admit that when I heard I was about to meet a 90 year old CHF patient who, by definition, was likely to be within her final six months of life, I formed an impression, a vision, of what I would see when I got there. Upon entering the home, we were greeted by two energetic and friendly twentysomething grandsons. They were happy to see us, and they clearly did not mark the entrance to anything resembling a deathbed scene. Proceeding through a narrow hallway, we entered a well worn kitchen and then living room where the patient and two friends were visiting. Claire (I'll call her) bounded up out of the chair and greeted Andy. She approached me and said: "Are you married?" I told her I was and she shrugged her shoulders. "That's too bad for me," was her reply. Claire then excused herself for a moment while she adjusted the television set for her guests and told them she'd be right back after her visit with the nurse. The perfect host.

I watched Andy dress a wound and tend to other tasks. All the while, Claire told me about her children and grandchildren. There was a lot of joy in the history lesson, but also suffering and disappointment, including the unexpected recent death of one of her sons. Claire was sharp and thoughtful and had I not known, I would have guessed that she is 70, not 90. Andy recited instructions and left behind various supplies and papers, plucked on his laptop for a few minutes and then we left. Given the progression of the disease and the likely course of the next several months, it struck me that Claire and her family will benefit tremendously from a well established relationship with Andy, based on familiarity and trust and respect. The kind of relationship that forms, over time.

Later in the afternoon, I had a chance to meet the talented staff of the VNA Hospice Care (website here). While there, one of the nurses mentioned that a referral had recently come from a major teaching hospital for a patient who was clearly within the final few days of life. The nurse rolled her eyes, suggesting what was clear to me based on my earlier visit with Andy and Claire. Hospice care is not for the final few days of life. By then, the ability to accompany, to teach, to care and bond and to exhibit the deepest kind of compassion is all but lost.

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