Today a student asked my feelings regarding hospice care. We had a patient that was in the process of being discharged from the ICU to hospice. He asked if that would be a hard decision for me to make. Without hesitation I answered "No."
The greatest gift you can give a person in their last days is dignity. I would much rather be in my home surrounded by family and friends, eating cake and drinking Diet Pepsi than in a hospital setting. A hospital is the last place on earth you can find peace. We have a job to do and we do it around the clock; regardless. We must keep to our schedule, get those treatments done, get those vents checked, stay on schedule, pass meds, look forward to what must be done next, keep moving, stay on schedule, see the next patient, run a code, do a trauma, stay on schedule. I was never really THERE for my patients and really never much thought about it. That was just the way it was. Until I had a patient that had been a nurse. She told me, "I know I wasn't a very good nurse in my early days starting out. I did not know what it meant to be sick then, I was too healthy. I wish I had listened more and talked less and not worried about the schedule." She died later that week at home in hospice care. The lesson she taught me that day was more valuable than any lesson I learned in two years of school.
I told the student about another patient that is forever ingrained in my memory. My patient told the night nurse that she knew that she would die the next day. She asked that we arrange for the priest to come and take her last confession. We did just that. After the priest left she was so calm and peaceful, I knew that she would be alright. Several hours later she asked me to tell John, who was standing behind me, to speak up. There was no man behind me. I knew that someone had come to take her home. We called her power of attorney to come right away. When I told her the story she said John was her deceased father and he had passed 18 years earlier. By this time my patient's vitals and respiratory status were in decline. She did not wish to have any other measures taken, but was convince by her family to be put back on life support. I had a very frank conversation with the family prior to this. I told them "These are the last moments. Moments that she is lucid and able to talk. Take this time to be with her and let her go home in peace. Her body is tired and the cancer has taken over. She will not be healed, love her and let her go." Unable to let her go, we "did everything" . She never regained consciousness. She was not able to say goodbye to her sisters and friends that came later and she passed early the next morning. I continue to be extremely saddened by everything that took place that day, even though it was more than a year ago. Those last days are infinitely precious. I would without hesitation choose hospice care over the care we gave that woman. I am still haunted by it. Families are only doing the best they can in situations they are not equipped to manage. We as professionals should have known and done better. The lesson I learned that day is to be a louder, stronger voice for those that have none.
I told the student that everything he thought he knew about living, dying and illness would be forever changed when he started doing this job. I know it has for me. Even though the lessons I have learned are hard, they are invaluable. And, I am a better person for it.