Tom Threlkeld, Director of Communications from the National Association for Homecare & Hospice visited with Androscoggin earlier this year to highlight a unique story of six hospice mother and daughter nurses all who work for Androscoggin. While here, he also did a home visit with hospice nurse, Shanna Teague.
Being a patient or the loved one of a patient can be frightening for anyone in the health care system, but a special mystery and, for some, dread, surrounds hospice. Humans fear death and for many, hospice is closely associated with death. Enter the words “hospice is giving up” into a search engine and you will receive approximately 1.2 million results. Clearly, many people see hospice as the end of hope.
I have been on numerous home health visits as an employee of the National Association for Home Care & Hospice (NAHC) and have seen up close the incredible difference quality health care in the home makes in the lives of patients. I have seen the faces of patients and their families light up when they see their home health nurse at the front door. I have listened to them tell me how receiving care in the home has changed their lives, forever, for the better.
Until recently, however, I had never been on a home visit to see a hospice patient and I looked forward to it with some trepidation. What would it be like? Would it be sad or depressing? I know the policy case for hospice is rock solid, but what would it be like up close and personal?
As the guest of Androscoggin Home Healthcare + Hospice, a member based in Lewiston, Maine, I finally experienced a home hospice visit. I accompanied hospice nurse Shanna Teague, who discussed the patient with me as we drove to her home on a bright, cool Tuesday morning.
The patient, a 97-year-old woman with stomach cancer, rejected chemotherapy and other treatments several months before in favor of hospice care. “She might not be what you’re thinking of about hospice patients,” nurse Shanna Teague warned me.
She was right.
We arrived at the patient’s modest, clean, single-story home on a quiet suburban lane just moments after her daughter dropped by to join in the visit. The patient was small and slim, but looked healthy and younger than her 97 years. “You got your hair done!” Shanna announced admiringly after she got a look at the patient, who beamed in response. “You look beautiful,” said Shanna.
Shanna begins by taking the patient’s blood pressure (110 over 80) and examining the patient’s stomach. Shanna moves on to asking the patient questions. How is she feeling? Has her condition changed at all since the last visit? Does she have any complaints? Shanna’s speaks slowly and sweetly, listening carefully to every answer.
The patient talks about eating her favorite snack, Oreos, winning some money during a recent visit to a casino, and proudly announces she walked five laps on a local track just a few days before. Shanna continues to examine the woman as they talk, feeling her belly to detect any changes. The patient says she eats well, dresses and bathes herself, and muses about the challenge of growing vegetables in Maine during the autumn months. She mentions donating some vegetables she’s grown to a local food pantry.
Shanna asks the patient about stomach pain and she replies that it is sometimes a problem. Shanna administers some medication for pain management and tells the patient her stomach appears to be more rounded than during her previous visit. This could be a tumor or merely bowel issues, but Shanna deems it important and says she will keep an eye on it.
The patient says she eats well (including the Oreos) and does puzzles to relax and keep her mind sharp, and it clearly appears to be working. Shanna speaks to the patient’s daughter, asking her what she thinks and they briefly discuss how the family is at peace with the decision to forego further curative treatment and take advantage of hospice instead. The mood is as bright as the rays of sun shining past the kitchen curtains.
The conversation is relaxed and frequently interspersed with laughter and joking banter. The patient’s daughter looks on smiling, occasionally offering her own observations but mostly just listening and letting her mother tell her story.
Shanna sets up the next appointment, the coming Friday at 9:00 AM, and leans down to embrace her patient. The elderly woman looks up fondly at Shanna and says quietly, “Thank you, sweetie. I’ll see you then.”
The meeting ends as it began, with laughter, smiles, and an embrace. Whatever I thought a hospice was, I didn’t imagine it quite like this. It was not somber or grim and the closest anyone came to crying was when the patient wiped away a tear from laughter. Of course, not all hospice visits are like this one, but many are not dissimilar.
One of the main reasons people fear old age is the loss of freedom and independence that often accompanies serious illness. But what Shanna Teague and the other hospice nurses at Androscoggin Home Healthcare + Hospice and around the country bring into the homes of their patients is the hope of spending the rest of their lives, however long that may be, at home, in comfort, and with their independence and dignity intact.
On this hospice visit in Maine I did not witness the end of hope. Instead, I saw an elderly woman living her days just as she wanted to live them. She was not in a hospital or a nursing home, with strange people wandering past her bed. She was at home, in her kitchen, with her family, and surrounded by the fond and familiar artifacts and memories of her life. Her medical records say she is dying, but all I witnessed was a woman enjoying her life.
Isn’t that what we all hope for?