Connecting to Purpose

When I tell people I work in Hospice, I often get an "Oh, how depressing!" response. People seem genuinely surprised when I tell them I don't find it depressing at all, but instead, find it very rewarding. I point out to them that short of helping to bring people into this world, I can't think of a more significant event in someone's life than when they leave this world. My goal is to help them to do so with as much dignity and comfort as possible, and to help their loved ones as well.

My first nursing experience with death and dying occurred when I was a young Army Nurse. I had been stationed at a large medical center for about three years. The first two years were spent on an orthopedic unit where I had been somewhat sheltered from death. My third year there, I was moved to a general medicine unit and my world was no longer sheltered.

We had admitted a retired officer a week before for some tests for urinary retention problems. I found myself forming a bond with him because he reminded me in so many ways of my own father with his humor and wit. His daughter was a regular visitor and we would frequently laugh and joke about our dads.

One evening, during shift report, it was noted that this gentleman's biopsy results had come back positive. He had advanced prostate cancer which had apparently metastasized. I felt awful about it. I asked if the patient had been told yet and was told no, but that his doctor would be coming in that evening to meet with the patient and his daughter to discuss the results.

All evening long, I dreaded the daughter's arrival on the unit. I found myself avoiding the patient's room because I didn't want him to see on my face that he was dying.

At the usual time, his daughter arrived, obviously eager to hear the test results. I dodged her questions by saying the doctor should be up "any minute" to talk to them, and then I ducked into the med room.

An hour went by and still no doctor. The patient's daughter came to me at the nurses' station and asked if I could try paging him to find out when he would becoming. When I reached the doctor and informed him of the daughter's request, I could tell he had been dreading the conversation as much as I had. He sighed and said something about being really busy, but he would be up when he could. I told the daughter he was tied up but would come as soon as he could. She waited another hour and then came back out to the front desk. She had small kids at home and the sitter was getting impatient. I called the doctor again and this time he told me to "just handle it."

I was terrified. How was I supposed to tell this patient he was dying? What if I screwed it up? I had just about decided I wasn't going to do it when the daughter came out to the station again and noticed I was upset. She asked me if I was okay. That was when I realized that no matter how uncomfortable I was with the situation, the patient and his family deserved better treatment than they were getting from us. I told her that no, I wasn't okay, and asked if she'd mind joining me in the lounge where we could talk.

We went in and sat down and I began by telling her how I had formed a kinship with her father and that made the news I had to give her that much more difficult. I told her what I knew of the test results and prognosis. She seemed a bit stunned and asked if there was any chance of a mistake. Then she began asking questions about treatment options. Even though I had already told her that the disease was too far advanced for curative treatment, I realized she needed to go over this information again to assimilate it. We discussed chemo, radiation, and surgery and what the likely outcomes would be.

When she began to cry, I handed her a box of tissues and grabbed a handful for myself. At first I was embarrassed to cry in front of her, but when I apologized to her she responded, "Nonsense...it just shows how much you care."

Amazingly enough, the world had not come to a screeching halt because I had mentioned the "d" word. More importantly, the family had not fallen apart because I was less than perfect in delivering bad news. We talked some more and eventually the doctor arrived on the floor to have his meeting with them. I went in to the room and held the daughter's hand during the talk.

The patient took the news much as I expected he would. He was very stoic and seemed more concerned about maintaining control and not being a burden to his family than he was about his own impending death. I think we were all relieved when he responded that way, as it made it easier on us.

I look back now and wonder if we did him a disservice by encouraging that stoicism. I can only hope that he and his family were referred to Hospice and received the right kind of support.

I realized at that point that, as healthcare professionals, we were not trained well to deal with death. Death was viewed as the enemy, something to be fought against, and to have your patient die meant you had somehow failed them. Since then, I have worked in ERs, sub-acute care ventilator units, and long term care. I have seen that there are things that can be worse than death.

During the past nine years that I've worked in Hospice, I've seen that when handled correctly, death does not have to be painful or even feared. Feeling sadness is just an indication that you care and it doesn't need to be viewed as a negative emotion.

For all the tears I've shed, there have been ten times the smiles and laughter which I've shared with my patients and their loved ones, as well. I would say I have been quite blessed.

—Submitted by Pam Edwards

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Covenant Hospice celebrates National Hospice Month
In celebration of National Hospice Month, Covenant Hospice staff and volunteers will be wearing purple and green ribbons designed to create awareness and to promote the outreach of end-of-life care. The purple and green hospice ribbon will focus attention on the special compassionate care available when people need it most.

This local ribbon campaign is part of a broader national campaign launched by the National Hospice and Palliative Care Organization (NHPCO) reminding people that hospice is not about how you die, but how you live. There will be a range of activities across the country throughout November focusing on living as fully as possible up until the end of life. 

“Far too many families who have been served by Covenant Hospice reflect back upon the experience and question why they did not seek out hospice care sooner,” commented Dale O. Knee, President and CEO of Covenant Hospice. “Many were simply unaware of hospice as a possible option, but the focus on pain and symptom control in addition to the emotional, social and spiritual support enables patients and families to make the most of every day.”

Compassion, comfort, respect, dignity and love are words commonly used to describe hospice. These sentiments are reflected in the purple and green hospice ribbon that all Americans can proudly wear to raise awareness of choices available for those facing the end of life. The use of color can strengthen, sooth and inspire. Green is most commonly associated with nature and growth; this color represents stability, endurance and peace. The green in the ribbon reflects the growing awareness of the compassionate care that hospice provides and the peace that hospice brings. Purple, the color found at the far end of the spectrum, has customarily been associated with honor, spirituality and self-esteem. It serves as a reminder that that all people have the right to live with dignity and respect, even to the last moment of life.

For more information about the hospice awareness ribbon or National Hospice Month, contact Covenant Hospice at 433-2155 or visit www.covenanthospice.org. Celebrating 25 years of keeping the promise, Covenant Hospice is a not-for-profit organization dedicated to providing comprehensive, compassionate services to patients and loved ones during times of life-limiting illnesses. 

Covenant Hospice receives NHPCO Award of Excellence in Education -
At the National Hospice and Palliative Care Organization's Management and Leadership Conference in April 2008, Covenant Hospice was selected to receive the Award of Excellence in Education for their Leadership Development Institute. The Awards of Excellence in Education recognizes hospice and palliative care programs that demonstrate outstanding achievement and excellence in the design, promotion and offering of educational programs.

Covenant's Leadership Development Institute was established in 2000 to create and hardwire a culture of leadership excellence. The program has since evolved to include two days of mandatory training for all of Covenant's 90-plus leaders each quarter, coupled with other prescriptive activities for all leaders to follow. The returns on investment for these activities have been significant. In 2006, Covenant formed a partnership with the Studer Group and became a laboratory for the introduction of Studer principles into the everyday life of hospice organizations. Then, the Studer Covenant Alliance, LLC, was formed to provide leadership development and consulting services to organizations throughout the nation, both through two-day Institutes concentrating on leadership skills development, and through contracts with other organizations, called SCA Partners. Not only is Covenant able to continue to prepare their leaders through Institute activities, but the Studer Covenant Alliance is able to share leadership best practices that work throughout the nation.