I’ve gotten kind of used to it. Sometimes, when I enter a patient’s room, I notice some family members turn and whisper. It’s almost like when I tell people what I am lucky enough to do and they give me the heartbreaking face while lowering their voice to a whisper. Maybe it is because of the intensity of the situation. Maybe it’s because a hospice nurse is only present if death is lingering. In either case, a certain heaviness sometimes causes the air in the room to feel thick with unexpressed emotions.
These are the situations I have grown accustomed to. You learn how to handle them… you learn how to diffuse them… families aren’t typically malicious with their feelings. This is a rough time. Times that no one willingly wants to be a part of. Times that shape characters and often time, bring out the darkness in one’s soul.
My presence is normally very well received. If a consensus was to be taken, no one would rather a hospice nurse be there, but, since situations warrant it, typically most welcome me and the knowledge I bring. The thought process is – well, if it is happening, might as well let an expert help.
During a visit with a patient this week, a woman who has by all medical wisdoms, should have passed weeks ago, the venomous presence of a family member created an emotional pit for the immediate family. This family member was never happy the patient had chosen hospice… “Why are you just giving up?” This poor woman had searing pain that she was never able to control. After listening to the patient and evaluating her medications, the recommendation came from our pharmacists to basically triple her pain medications. When talking with the immediate family about all of this, the lingering presence of the anti hospice member was listening.. the family was fine with the changes. They just wanted me to erase the patient’s crippling pain. “Morphine in pills? What is she crazy? Is she trying to kill her earlier?” The whispers floated into the next room and my heart sunk. I had spent so much time educating this family – trying to help them not feel like were doing the wrong steps for their loved one. But, this person, was clearly on an anti hospice mission. She had been an EMT. She had a daughter that passed, she did not use hospice. That was her choice not to use hospice or any analgesic medications. Could it have been beneficial to her daughter as well as herself? Probably.
But, since that afternoon, I have heard several other whispers… “She doesn’t need a catheter… that’s just cruel to her.” What’s more cruel? A catheter or moving the almost lifeless patient who can no longer tell us when she has to urinate? Or let her urinate in the bed and have her lay in it?
“You are all starving her to death! She would live with a feeding tube. What you are doing is inhuman!” The poor patient hasn’t had solid food for months, rather surviving on nutritional shakes until she became so weak that even swallowing was too exhausting. She never wanted a tube or artificial nutrition. The patient made that clear. She knew her body was failing and just wanted to pass on without pain. It was her choice. The only choice that mattered.
“Wait?! Now you are giving her liquid Morphine because she cannot swallow her pills? That will send her into instant cardiac arrest. That’s murder!” ThAt is the one that got me. I am a hospice nurse. I see death every day. I don’t welcome it into the house. I plan my care of the patient knowing that at any moment, it can sneak through. I am still an RN bound by my oath to never hurt anyone. Hastening someone’s death could be the ultimate hurt. By the way, no cardiac episodes happened after the liquid morphine. The patient was able to relax and her respirations went from fast and chaotic to slow and relaxed.
Just like a spider weaves a web trying to make it so pretty that it will entice something to enter, so does one that is anti hospice in a situation where hospice has been chosen. It’s lack of knowledge. I don’t care if you have medical knowledge. You don’t have hospice knowledge. It’s like saying you are a mechanic but being asked to work on a bus engine. Far out of the league. But, instead of asking, judgements are made and told to an already troubled family. I wish if people had issues they would have the courage to come straight to the hospice nurse. I promise I won’t bite, nor will I load you up with lethal amounts of morphine, but rather help you come to the place where the patient and family are. I cannot and will not hasten death, but, will make the journey there a more comfortable one for the patient and family.