Tahlequah Daily Press

October 29, 2013

Hospice helps patients die with dignity

Special Writer

TAHLEQUAH — Todays hospice provides care and comfort to dying patients and their families on many levels.

Time, touch and truth are the three areas we address said chaplain David Webster, with Carter Hospice/Healthcare.

"There's just something in the human touch. We will hold a hand, pat their shoulder," Webster said. "And we show patients we have time for them, and they can count on us being truthful."

Spiritual counseling, prayer and support is provided to the patient and their families in homes and facilities where the patient is placed. Bereavement counseling is provided to the families after the patient passes for 13 months.

"It's a blessing to me to see the patient go from where they are to a place where they achieve a pain-free and peaceful passing in the comfort of their home surrounded by family," Webster said.

There is much more to hospice than once thought, said, April Moore, RN-Patient Care Coordinator for Hospice of the Cherokee for four years.

"I wish people knew how much quality of life is brought about from hospice. That at some point in our lives our focus changes from quantity to quality," Moore said. "Hospice does not put someone in a bed with medications and leave them there, we want the patient to have the quality and dignity, to do the things they enjoy as long as they can, to spend time with their loved ones."

Working in Hospice can be hard at times, hospice staff have to grieve as well when a patient is lost, Moore said.

"At the end when you know you have done everything your patient wished and you allowed a comfortable dying process for you patient and their loved ones you go home with a  happy heart. Holding their hand when they take their last breath, it’s breathtaking."

Clinical Coordinator for Tahlequah, Tulsa and Bartlesville with Carter Hospice/Healthcare, Lindsey Dillard has been a nurse for nine years, with the last four years working in hospice.

"From the very first day I began training as a hospice nurse, I was impressed with the multidisciplinary  team approach to health care, and the "holistic" way hospice approached terminal illness. We meet people, not just our patient's but their families as well, where they are, and work with them side by side, to be a source of guidance and support for them until they draw their last breath," Dillard said.

Hospice is a benefit intended for the "last six months of life " Dillard said. It is most appropriate for a person who is no longer a candidate for aggressive, taxing therapy that is not  effective, and has decided to live out every day they have left with as much comfort and dignity as possible.

"It is not about "giving up" but rather taking charge of your own body and choosing comfort and quality over number of days," Dillard said.

Common fears of patients are if the actual death itself will be painful, if they will be aware of what is happening, and how long it might take, said Dillard.

"We have found that when appropriate care is initiated and support given- hospice as it is intended- that the physical act of dying can be not only without discomfort but even peaceful and can provide a sense of control over the entire situation- even though they did not choose the outcome of death, the manner in which they approached it and the way it came to pass  was, in many regards  on their own terms," Dillard said. "We understand that some things cannot and should not be medicated away, so we make a concerted effort to address all aspects of a person- physical, spiritual, emotional and psychological."

The team here at Carter has a same general philosophy regarding terminal illness, said Dillard.

"Death is a natural part of life. It does not have to be feared. When the time comes and our patient is passing we make a concerted effort to remove unnecessary medical equipment, lower the rails on the bed, ensure a favorite blanket or other item is visible to the patient- we strive to make the environment as peaceful and warm and familiar  as possible or at the very least do all we can to avoid the scene looking like a cold, sterile space invaded with modern equipment and strangers. We encourage family to sit with them, hold hands, or simply be with them for the time they have left."

Be present, be supportive but let the patient make the decisions said Vicki C Baker, MD Medical Oncologist at the Warren Oncology Clinic in Tahlequah.

"It is ok to ask the hard questions and to talk about mortality. It is a universal experience and should not be taboo. Allow the patient to talk about their fears, including fear of dying. To deny that conversation is a huge source of stress to patients who want to process through it," Baker said. "Recognize that to comfort a patient may be more meaningful than treatment, particularly if that treatment is futile."

Allowing a patient to talk about their life, their regrets and the way they want the end of their life to be will result in easing anxiety for all, Baker said.

"Patients have made lovely videos, written letters to loved ones, even future grandchildren that will mean so much," Baker said. "I had a patient who loved to hunt with his sons and he found a company to put his ashes in shotgun shells and his boys “went hunting” with their dad one last time. It was so touching to see how much that meant to him and them."

 There are no easy ways or “right” words to say, Moore said.

"Everyone grieves in their own time. Hospice allows 13 months for caregivers after their loved one has passed, so they will have the support as they grieve. Spouses and family members need to be educated and aware of the signs related to dying. They also need not be afraid to ask questions or reach out for support," Moore said. "Being surrounded by the patients family/friends and in their own environment is what makes in home hospice beautiful. Death and dying are scary facts of life but we will all be one day faced with it. Being able to hold someone's hand at the end of their journey here makes it all beautiful. To go home each day knowing you allowed for quality of life is the reason we each do hospice."