By Meg Jacobson, MD, Hospice Medical Director
Sue was a young woman ravaged by cancer. Her disease caused such severe pain that she came to the emergency room. After admission to the hospital she was treated with strong opioids, but huge doses of medication did nothing. Our inpatient Palliative Care service was consulted, and worked tirelessly to manage this excruciating and constant pain. Marshalling advice and resources from many disciplines, they ultimately brought her significant relief. With her medication dose dramatically reduced, Sue was able to interact meaningfully with her family and friends.
Freedom from pain also enabled Sue and the Palliative Care team to discuss her values and goals. Together, they anticipated her caregiving and medication requirements. Confident that Sue could continue to receive specialized palliative care that would meet all of her needs in the outpatient setting, her care was transferred to the Hospice program. Sue thrived in the supportive and caring atmosphere of Hospice House. There, she realized many of her goals before dying peacefully, surrounded by her family.
Our Palliative Care Service currently provides multidisciplinary supportive care to seriously ill patients prior to hospice referral, ensuring that they receive expert pain and symptom management much earlier in their disease process.
Sue and her family had their lives completely transformed by the specialized, seamless and coordinated care that they received from the Palliative Care and Hospice programs. To help patients like Sue, Whatcom Hospice Foundation has established a Palliative Care Fund.
Barbara slumped at the kitchen table, head in her hands. Try as she might to explain her situation to the nurse who had come to discuss hospice services, she could string no more than three words together without a horrible coughing fit. To Barb, the draining, relentless hack was by far the most debilitating symptom of her end-stage lung disease.
Living alone at 63, Barbara’s greatest wish was to spend time with her friends – to go out to lunch and enjoy one another’s company. But dining out in public was awkward, because her coughing fits were disruptive to other diners. Inviting friends to her home was also uncomfortable. Barb didn’t want her coughing to cause them more worry and concern. Barbara was weak, homebound, terribly lonely and understandably depressed. Hospice care soon improved Barbara’s life dramatically. Compassionate staff and volunteers came to her home to provide expert medical care and assistance with daily activities. With her cough controlled, Barb’s energy returned and she enjoyed several lunches out with friends. Completing her most important conversations brought peace and fulfillment to her life.
Gene, a 63-year old engineer, considered his combat service in Vietnam a defining moment in his life. But returning home to a nation that often rejected rather than embraced its Vietnam veterans was painful and sobering.
Last year, when Gene faced life-limiting cardiovascular disease, he turned to Hospice for help. Upon learning that he was a veteran, Chaplain Cheryl Smith arranged for two uniformed, active members of the National Guard to visit him, salute him, and thank him for his military service. When they presented him with an American flag pin and a framed certificate, Gene wept – so grateful for the overdue appreciation. And for the next hour, he shared stories of his own military experiences with his attentive young colleagues – finding comfort and healing in the sharing.
Whatcom Hospice is very pleased to participate in National Hospice and Palliative Care’s “We Honor Veterans” initiative. Chaplain Smith explained, “All hospices nationwide are serving veterans, but in many instances are not aware of the patient’s Armed Forces service. Our veterans have done everything asked of them in their mission to serve our country and now it’s our turn to proudly serve them.”
The “We Honor Veterans” program focuses on respectful inquiry, compassionate listening, and grateful acknowledgement, coupled with veteran-centric education of health care staff caring for veterans.
By Meg Jacobson, MD, Hospice Medical Director
Thomas had very few interactions with the medical system before he came to the PH emergency room in June. His face was painful and swollen, and he thought something was wrong with his teeth. Instead, he was stunned to learn that he had very advanced head and neck cancer. Follow-up was recommended, but Thomas left the ER feeling overwhelmed and unheard. He returned to the hospital several weeks later. After explaining to him again that he had cancer, the ER staff gave him an appointment to see a physician the next day. Thomas didn’t show up. Finally, in early July he walked into the Cancer Center and asked to be seen.
Thomas was 60 years old, homeless, and had lived in an encampment behind Walmart for many years. At the age of 32, he’d walked out of his loving and supportive family after a decade of struggle with mental illness. Once an artist and glassblower, he now bore the stigmata of untreated schizophrenia and a very aggressive malignancy.
At the Cancer Center, Thomas was immediately welcomed. Since he did not have an appointment and there was no provider available to see him, Dr. Jacobson was called. She drove across town, and began a conversation with him about palliative treatment while the rest of the amazing Cancer Center team mobilized. By the time Thomas left that day, he had health insurance and a treatment plan for palliative radiation. Most importantly, however, Thomas had shelter. He left the Center in a cab and was delivered to Whatcom Hospice House.
Once he arrived at the House, Thomas was warmly greeted and shown to his room. He was wary, withdrawn, and suspicious. In the first days, Thomas couldn’t sleep on the bed—after 17 years on the ground it was too soft for him. He was more comfortable outside than in, and could sometimes be found smoking at the end of the driveway to the House, or walking around Sehome Village. At other times he stood silently in the hallway or family room engaged in some interior dialogue. Thomas never complained, and spoke little. Gradually, over the next three months, Thomas grew to trust the Hospice House staff. He accepted the gift of a warm shirt, and it quickly became his favorite. He learned that he could eat what he wanted, and ordered grilled cheese sandwiches three times a day. He allowed help with bathing and laundry. Although he verbalized very little, he eventually was able to look directly at his caregivers, something that was impossible for him when he first arrived.
In the Hospice House, Thomas found both home and family. Ever stoic and taciturn, he nevertheless directed his own plan of care. Always, he was treated with patience and respect. His quiet dignity in the face of his suffering endeared him to the Hospice house staff. As his condition deteriorated, he was nurtured, bathed, massaged, turned, and cherished by everyone who cared for him. Thomas died in October, three months after arriving in a cab from the cancer center. After his leaving ceremony, the staff shared grilled cheese sandwiches and memories of their time with Thomas.
Several weeks after his death, Thomas’ father called the Hospice House. He had not seen or heard from his troubled son since 1988. He wanted the staff to know more about who Thomas was before his illness changed him. He was eager, in turn, to learn as much as the hospice house staff could tell him about Thomas’ life. Every caregiver sent him brief words of comfort, and they arrived in a package with Thomas’ favorite shirt. The ultimate gift to Thomas’ family, however, was the knowledge that he died in warmth and safety, with loving family around him. After years of alienation and estrangement, Whatcom Hospice House finally brought Thomas in from the cold.