By: Dowling Stough IV, M.D.
As a physician, I believed that I was quite familiar with hospice. I knew they did a wonderful job of taking care of terminally ill patients. I knew that hospice lifted the burden off the shoulders of the family and allowed time for loved ones to focus on each other. However, not having a direct connection with hospice, I had a limited amount of knowledge on the policies, procedures, and interworking of hospice as an organization.
My involvement with hospice began in 2015 when my girlfriend, Robin’s long fight with terminal cancer was nearing the end. For three years, she had battled cancer valiantly with the help of caring physicians, nurses, and staff. Despite all the treatments, the family sadly realized it was time to call in hospice.
From the first contact, I was very impressed with both their expertise and knowledge of Robin’s situation. They were extremely skillful at answering questions and making life easier for their special patient and the family members. They had knowledge on pain medications, hospital beds, nutrition, and a wide variety of concerns unique to the end of life. As doctors, we are always taught to seek a diagnosis and solve problems. Hospice workers explained to us that their goal is not to run down every lab abnormality and fix every new problem. Their goal is to provide a peaceful end of life journey for all.
The hospice staff and nurses came to my Robin’s house and would check her medications, talk to her, speak with the family, and would then relay any difficult problems up the ladder and seek solutions that fit within the hospice philosophy. Nurses were given the latitude to do this and could always confer with the hospice medical director if needed.
On a particularly difficult day, Robin was having a lot of pain and was moaning when I entered the house. She was not capable of verbalizing at that time. I did not know that another family member, who had left only minutes before, had just given her a dose of pain medication. The dose had obviously not kicked in yet. I checked the pain medication log hospice had set up for us, and there were no entries, so I gave her a half dose of pain meds and recorded it properly.
It was roughly 10 minutes later the family member returned and stated that she had also just administered a pain medication and was planning on entering in the log but had not yet done so. We both went into panic mode. Had we mistakenly given her too much? Would we be responsible for overdosing a loved one? How could something like this happen? I felt terrible, I had given this additional medication. It was during this time that the hospice worker came into the house.
We explained the situation to him. He sat down and listened carefully, then responded “Nothing to worry about here. You both gave her some pain medicines and she will do fine. No need for alarm. We will just sit with her awhile and let this pass.” Once again, he reassured us this was not a crisis, no need to call the ambulance, and we will simply observe her resting peacefully. Of course, he was right.
When dealing with the terminally ill, especially one who is a family member, it is easy to evoke intense emotion. Family members are already fearful and worried. Hospice workers are trained to calm those fears. They have the training to think clearly and advise the family accordingly. Hospice does this on so many different levels that it is beyond the scope of any short anecdotal article.
As a physician, I was grateful to see hospice in action. I don’t think all the medical education in the world is a substitute for the actual experience of having hospice in the home when a family member is dying. The physicians I know which work in hospice are absolutely first class in every regard. I thank them for their extreme devotion and their expertise. Robin left us peacefully on July 18, 2015 surrounded by her loved ones.
“This story came to me as a result of a conversation between Dr. Stough and our Patient Care Representative, Cyndi Muncrief. Both have experienced the pain of losing a loved one, however hospice was not a part of Cyndi’s story. You can read Cyndi’s story here to better understand the difference hospice can make in the lives of families seeking a peace of mind during a loved one’s final journey.” - Kelly Rice, Executive Director