Have a Good Death

used with permission

Have a GOOD Death

People keep dying on me. Don’t get me wrong, I’m not second-guessing my career. I love being a hospice counselor. But there are good deaths and there are bad deaths. I believe the problem lies with people’s misunderstanding of what hospice is. They hear it and think, hospice = death. Which is not necessarily true. Some people actually get better and graduate out of hospice care. But instead of trying to convince you that hospice is good, let me tell you about some good and bad deaths I’ve observed.

Here are some examples of good deaths:

Last week I lost three of my favorite patients. They were all sharp, warm, loving people with a great sense of humor and I loved hearing their stories. Their families called hospice early in their diagnosis. When they decided they didn’t want to go back to the hospital any more, they called us. I work for a small, community-based hospice so I can’t really speak about the big chains. As my boss if fond of saying, “When you’ve seen one hospice, you’ve seen one hospice.”

When we come in, this is what you can expect: our nurses with take a list of all of your medications and show them to our Doctor, to see if they are all necessary. People come in with twenty-seven medications and many interact with each other in bad ways. Having our nurse and doctor sort out, and take care of, medications is a huge relief for the family. Most of the medications that are considered appropriate are paid for by Medicaid and delivered right to the doorstep.

The nurses come at least 1 to 3 times per week to check vitals, check-in with the patient’s progress, and to care for any wounds or other physical ailments. They are also available 24/7 for last-minute concerns. The Certified Nursing Assistants (CNAs) come 2 to 5 times per week to bathe and care for the patient’s hygiene and comfort. Both nurses and CNAs train family members in on-going care.

The social worker comes in to assess the family’s needs. They help the family make “end of life” decisions and work through the difficult “who to call when their loved one dies” questions. Social workers are great at finding resources for companionship and increased quality of life for the patient, like books on tape and volunteer companions, and for assisting the family with financial and legal concerns, like energy assistance. They also access the potential bereavement issues in advance and help the family prepare for the death.

And I come in as a Spiritual Care person, to assess any connection to the family’s religious needs. But after I help them connect to their religious community, if they wish to, I keep coming in to sit and talk, listen, pray or just be present.

So, when you call hospice, you get a team of people on your side, to help you care for you loved one. I’m not even mentioning the volunteers, office staff, medical equipment and other support we have access to. Plus, bereavement care for the family goes a full thirteen months after a death.

This team becomes part of the family: caring for, loving and serving during one of the most difficult times in a family’s history. The three people that died last week left a hole in my agency’s heart. We grieved alongside the families and we grieved corporately at our staff meeting. We lit a candle and said our favorite things about each person. We continue to meet with and care for each family. THAT is good death. Good deaths happen in long-term care facilities too. Our hospice comes into those with the exact same services.

A BAD Death

A bad death is simply this: family members don’t want to admit that someone they love is dying. Obviously, I understand this. So they want to “try everything” to get that person well. Which generally means the person is in the hospital, they have a tube in their throat or a feeding tube, they have needles in their arms, they are continually awakened by the nurses monitoring their vitals, they are away from home, away from loved ones, and they die in this sterile, rather impersonal environment. I’m not putting down the care they get in hospitals. Thank God for wonderful nurses and doctors! But let’s all be honest, if you had a choice of where and how to die, like that, or at home surrounded by your loved ones, which would you prefer?

And, we get a lot of those people too. Family’s that wait too long to call us. We rush in, try to help, but their loved one is gone in two or three days and we can’t really do much. Those are the deaths I’m talking about when I say: People Keep Dying On Me. I can only have remorse about that. I don’t have a relationship with the family so they usually choose not to access our post-mortem bereavement program. I don’t usually get time to know the patient, so there is less to grieve, and less to celebrate.

What do you think?

I’d love to hear about your experience with hospice. Or your experience with good and bad death. America needs to learn to #DoDeathBetter. #Hospice is one way to start that, but there are so many others. Let’s talk!

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