Addition and Subtraction

“I know you hospice types”, he looked over at me as I jotted down notes, “you are going to admit me now and just start taking away all my medications.” I looked up at him and thought about his words for a second. His eyes glimmered with a bit of mischief but, also reflected his fear and worry. His statement was just like that of a child – tossing out words to see what will land where. The sad reality was that there was truth to his fears. What was I there to take away?

He worked his whole life. He had only retired a few years ago and not because he had just become eligible but because being in his late 70s, his body was fighting a losing battle with Father Time. A few months after formally retiring, he started to feel a fatigue that seemed to appear from nowhere and intensified daily. A trip to the doctor, after serious encouragement from his wife and all his plans for retirement changed. The first sign of subtraction.

I sat back in the chair and fiddled with my pen. “Well, I don’t think you understand exactly what hospice is all about.” He chuckled – the deep, gruff and throaty laugh of a lifelong smoker. “Sure, I get it. You take away my meds. Who needs vitamins when you are dying? Then, you start me on Morphine until I die.” I sensed his worry and hesitation. “Hospice isn’t about subtracting things from your life. It’s about adding.”

Hospice gets a bad rap. We are the take away folks. What we add gets lost in the smoke of death. No one actually ever wants the addition of a hospice nurse, aide or social worker, but, arguably that inevitable journey would be much more difficult without them. We add another set of eyes, we add care without question, we add compassion and empathy. We give space and time for your family to breathe for a few moments in the midst of it all.

As a nurse, I explained, all of my time is spent on securing continued comfort for my patient. Patients and families are at the epicenter of my care. Not having to worry about doctors and appointments yet being able to remain at home is often the final goal most terminal patients want.

The reality is that while I cannot take away what will happen, I can make that journey one filled with comfort, dignity and understanding. Allowing the patient to live their final days on their terms while doing things they did not imagine possible because their symptoms are controlled is often the priceless gift of hospice. Addition, not subtraction.

We sat talking for a good while. His nervous laugh relaxed and the more I explained, the more his weathered face softened. He understood how we might ditch vitamins at some point, what we were adding to his life would be far more profound. As I gathered my things to go, he reached over and grabbed my hand. “Thanks”, he said holding on. “You made it all so clear and so simple. Just like arithmetic, what you will add to my life will be so much more than anything you might take away. So, even in my simple mind, that sounds like a big positive!” Yes, my dear patient, hospice is a positive amidst the negative.

We add and enhance life. That’s what hospice as all about.

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