A wise saying: There is nothing new under the sun.  Suffering is our human condition; we all have some experience Scream Parody (1)with it.  Though it seems of late there is just too much.  A recent visit to a nursing home reminded me of how much silent suffering exists in our world, especially among our most weak and vulnerable inhabitants.  An elderly gentleman was labeled by staff as “resistant to care” for flailing his arms and pushing away caregivers in his final days of life.  He lay in his bed, having lost the ability to talk in order to express his needs, or turn himself in bed to relieve the pressure on his bony prominences, or quench his thirst with small sips of fluids.  Sadly, this is not an isolated situation in places where our vulnerable reside. 

We still do not provide the kind of care most of us would like to have as we become increasingly dependent and eventually lay dying.  COVID-19 has seemingly targeted the elderly, with nearly 40% of COVID-19 deaths being nursing home related.  This current crisis has created extra burden in caregiving (and also innovative ways for delivery).  The “essential” workers in these settings are true heroes dedicated to diminishing suffering while often working within a vast lack of resources.   I have witnessed firsthand how difficult it is to properly staff these facilities.  Though plenty of data is being collected, we actually don’t know how many people are dying without the level of care that was needed, without loved ones at their bedside, without facility staff who were adequately trained to alleviate pain and suffering.

Our elderly are again being short-changed and marginalized in a society that has a poor track record for providing the financial and societal supports that are necessary to ensure dignity and appropriate care towards the end of life.  So when I read about another funded study—this one for 3.5 million dollars— to implement a palliative care program in a number of select nursing homes, I do wonder what it is that we still need to study? (A large number of previously performed research studies have indicated the benefits of palliative care, and the training inadequacies among those who care for elderly and seriously ill populations.) I should make the distinction here, regarding palliative care and not hospice care per se, because we are talking about care that lessons difficult symptoms and increases quality of life, not just end-of-life care.   I’m happy for the palliative care focus, but perhaps Maslow’s hierarchy of needs warrants closer examination and provision of funding sources to ensure that needed care gets delivered?  I believe in research, and in the societal change that comes from deeply understanding the issues and ensuring solutions are reality-based.  We must begin by having adequate staff for meeting the basic needs of keeping residents clean and comfortable, having time to feed them, moisten their dry mouths, and ensure staff have adequate training to know, recognize and alleviate symptoms of distress.

I am indeed validated in my concerns, when I read another study (McGarry, Grabowski, & Barnett), indicating more than 20% of US nursing homes across the country have reported severe staffing and PPE shortages during this pandemic, (the most common staff shortages were reported among nurses and nurses’ aides).   How do we provide this palliative care, when our nursing homes are plagued with staffing issues, with ongoing lack of trained staff who can provide it?  A report from over a decade ago from the recognized leaders of palliative care in the US (CAPC-Center to Advance Palliative Care), recognized the need for, but also the limitations of, palliative care in nursing homes:  “The tight financial constraints of nursing home management provide challenges for delivering palliative care. Many homes know what they need to do to improve the quality of life and care for their residents, but don’t have the necessary resources for service enhancement.”  Additionally, this report outlines a number of models that are being used, and can be replicated, to ensure palliative care is provided to nursing home residents by partnering with outside agencies to deliver palliative care, and training of nursing home staff in the basics of palliative care delivery.  Well over a decade later, there still has not been a standard federal response to the acknowledged needs of palliative care training and care delivery in nursing facilities.  Now we see the devastation of COVID-19 amid our elderly.  In August the CARES Act will finally distribute funding for nursing homes for improved access to PPE, infection control and testing, however much of the funds are connected to “performance-based distribution” to ensure federal government pays for “better outcomes” (I can’t begin to know how an equitable funding allotment will be assured).

So, we know it is needed, we know how to deliver it…WHAT’S THE HOLD-UP?  How much is related to financial constraints that drive staffing metrics, along with profit margins (70% of nursing homes are for-profit institutions)? And limitations including  the education and training opportunities for facility staff, with high rates of turnover for minimum wage jobs in these facilities?  As a country, we have not deemed providing palliative care to every resident who needs it in a nursing home as a federal spending priority.   I know (as so many of us do) the lack of practical caregiving resources available, even when COVID deaths occurring in nursing facilities didn’t highlight this lack or create an even greater need.

I just wonder…When will our country begin to spend the money necessary to provide the needed resources to right this wrong?

“Excellence is not a gift, but a skill that takes practice.  We do not act ‘rightly’ because we are ‘excellent’, in fact we achieve ‘excellence’ by acting ‘rightly’”.  Plato

UPLIFT trial National Institutes of Health’s National Institute on Aging, grant R01AG066922.

McGarry, B.E., Grabowski, D.C., & Barnett, M.L. (2020). Severe staffing and personal protective equipment shortages faced by nursing homes during the COVID-19 pandemic.  Health Affairs, 39 (10),1-5

Nursing Home Data- retrieved from:

Center to Advance Palliative Care. (2007). Improving palliative care in nursing homes. New York: Meier, D.E. & Sieger, C.E.

CARES Act Funding- retrieved from:

Posted in end of life care | 1 Comment


As I thought about who and what have been my greatest teachers in life, I considered the quote: He who can, does; He who cannot, teaches*.  Though this quote is considered disparaging to teachers, I like to think of it this way:  as we age, and perhaps no longer have the ability todo” some of the things we used to do, those experiences of doing lend a depth to what we are able to hand down to the next generation, a kind of legacy.  You might argue that this is not at all what is meant by the quote.  I choose to be contrary.

Another year goes by and I am one of many aging workers who have experienced and can share some wisdom about listening.  As I accompanied a novice palliative care worker on a visit, I realized the lessons I have learned about listening came through living in many moments, and I can share this.   Though I may no longer “do” (I am not daily caring for dying patients), I can teach because I have been a doer. (These are lessons I hope the next generation of doers learn also.)  For me,  my mentors and teachers have been those who have had a depth of knowledge through their own personal growth, and like them, I believe what I know firsthand lends credence to what I teach.  

The lesson today was:  listen with your whole heart.  I  had three teachers of this lesson who could be considered gurus.  My counseling professor, who taught me that being curious was one of the best attributes of any counselor—and lived this advice.  My mother, who taught me that giving time to listen to each other was part of loving well, providing a means of preventing squabbles and misunderstanding—always stopping to give her full attention to any concern expressed.  My first dying patient, and countless others who followed, who taught me that the many things unsaid had great importance and could be heard— if hearts are open and listening well.

As I accompanied this new worker, I thought about being curious— which means don’t settle for a simple answer; giving full attention— which means stop focusing on filling in the blanks on the computer screen; and listening deeply to hear the unsaid words— which means take time to really hear.   I realized that the listening lessons must be taught by those who know: those who have shared quiet moments and not hastened to fill the speech gaps during hard conversations;  those who know that a question is simply an open door, and the opportunity to hear much more than the quick answer comes only if time is allowed before the next question is hurriedly asked;  those who hear a concern, and can also hear the deeper unspoken words of existential suffering and aren’t afraid to delve a little deeper; those who can listen to another’s story even when their own story might feel mutual, yet recognize this time is not about them, or sharing what they know, but about stopping the flow of words in their own head, and being emptied of lists, agendas and necessary questions.  

So, though I may do less, I want to teach this:  Stop doing, and begin listening with empty hands, open hearts and caring presence. 

(*from collection of quotes by George Bernard Shaw in Maxims for Revolutionists)

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Don’t call me morbid because I’ve spent the past few days preparing obituary examples.  I’ll be using these for a class of young people to demonstrate a bit of what “legacy” means: something left behind when you are gone.  This is how I happened upon the opportunity to read about “Pink”.  I did not know Mary A. “Pink” Mullaney, and she’s been dead since 2013, but I cried a little reading her obituary and only wished I had met her. (I have been lucky enough, though,  to know a couple of people as unique as “Pink”).

This is an excerpt from what her family wrote about her:  “We were blessed to learn many valuable lessons from Pink during her 85 years, among them: Never throw away old pantyhose. Use the old ones to tie gutters, child-proof cabinets, tie toilet flappers, or hang Christmas ornaments. Also: If a possum takes up residence in your shed, grab a barbecue brush to coax him out. If he doesn’t leave, brush him for twenty minutes and let him stay. Let a dog (or two or three) share your bed. Say the rosary while you walk them. Go to church with a chicken sandwich in your purse. Cry at the consecration, every time. Give the chicken sandwich to your homeless friend after mass. Go to a nursing home and kiss everyone. When you learn someone’s name, share their patron saint’s story, and their feast day, so they can celebrate. Invite new friends to Thanksgiving dinner. If they are from another country and you have trouble understanding them, learn to ‘listen with an accent.’ Never say mean things about anybody; they are ‘poor souls to pray for.’ Put picky-eating children in the box at the bottom of the laundry chute, tell them they are hungry lions in a cage, and feed them veggies through the slats. Correspond with the imprisoned and have lunch with the cognitively challenged. Do the Jumble every morning. Keep the car keys under the front seat so they don’t get lost. Make the car dance by lightly tapping the brakes to the beat of songs on the radio. Offer rides to people carrying a big load or caught in the rain or summer heat. Believe the hitchhiker you pick up who says he is a landscaper and his name is ‘Peat Moss.’  Help anyone struggling to get their kids into a car or shopping cart or across a parking lot. Give to every charity that asks. Choose to believe the best about what they do with your money, no matter what your children say they discovered online. Allow the homeless to keep warm in your car while you are at Mass. Take magazines you’ve already read to your doctors’ office for others to enjoy. Do not tear off the mailing label, ‘Because if someone wants to contact me, that would be nice.’ ”  

In a world full of madness and meanness, this is what looking at the world through “rose colored glasses”, remaining an optimist, and practicing random acts of kindness looks like. Legacies come in all shapes and sizes, rather material or something intangible—but the impact is a little piece of immortality.  

Posted in end of life care, legacy | Tagged , | 1 Comment


How many of us, as nurses, have had the experience of speaking to an “enflamed” family member, and practiced all our communication skills to bring calm and rational judgment into play?   Recently, in the midst of a friend’s pain crisis and a families’ sense of being overwhelmed and powerless in a hospital’s decision to discharge without effective treatment rendered, I had the opportunity to use some of these skills—with the hospital staff.  be-511555_1920

I had a “run-in” with a nurse manager at a regional hospital.  Though this was only a phone conversation, this person’s irritation, even anger, with me was a palpable sense through the radio waves.  She had been given an order.  She had already applied her decisive approach to the patient and family and spoke as though there were no options available.  She was orchestrating the discharge.  She really did not want to talk to me.

It makes me wonder:  Are we listening, when family express great concern about symptoms that medical staff seem to downplay?  (Remember, who decides what “pain” is…us or the patient?)

Are we listening, when the stoic patient is making statements like “I just want to die” with pain totally out of control, and the treatment furnished is not effective?

Here is the dilemma: It is a weekend, the specialist is not available until the following week, and the hospital has limited beds.  Here is the answer: Send him home, and perhaps hurry up the appointment with the specialist?   Not acceptable.

One statement is never the right answer:  There is nothing more that can be done.  There is ALWAYS something that can be done.  For one, ADVOCATE.  Every nurse needs to have this role.  We are the “eyes and ears”, we are the ones the family is depending on, to listen and see what is happening, using our refined clinical expertise and judgement, to defend the patient from a system that does not always see the individual, does not necessarily care if the home situation is adequate, if the symptoms are controlled, or if the cause of symptoms has been deduced.  This is not a coding problem, or a patient-bed management solution, or an insurance issue…this is first and foremost, really seeing the patient. I can’t help but wonder, with all our technology and streamlined productivity and effectiveness, are we missing the most important aspect of providing medical care…LISTENING WELL?

In the business of the day, in the overworked staff’s experience, and in the power that rests in the hands of the decision makers, we must first and foremost advocate for the patient and family, and truly demonstrate what most medical establishments’ mission statements claim: The patient/family unit is at the CENTER of all the care received from the entire medical team.

Posted in advocacy; patient rights; hospice nurse, palliative care | 5 Comments


I am concerned about a new mantra afoot: that palliative care–unlike hospice care– is not “giving up” but irivers addressing improved symptom management and quality of life (QOL) for all patients with advanced disease.  I  am disappointed as I read opinions of many champions of early palliative care in the perpetuation of this myth— both outspoken views, or by sheer inference— that palliative care is increasing QOL while hospice care is requiring “giving up” (also synonymous with the very end of life).  Making such a distinct difference between palliative care and hospice IS NOT helping the average person understand either palliative or hospice care.

As physicians consider the benefits of early concomitant therapy, recognizing the value of a palliative care referral at the time of a patient’s serious disease diagnosis, they have also hopefully acquired an understanding of hospice philosophy demonstrated over the last 40 plus years in the US. Hospice is not about “giving up”.  Anyone who has provided hospice care can describe numerous conversations with patients at the time they signed up to use hospice services, clarifying that deciding on hospice did not require “giving up”—hospice services would contribute to needed support and encouragement to live fully, all their remaining days, weeks and months, with quality of life as a focus.  Because someone no longer seeks curative treatment does not equal “giving up”.  And because someone does not want to continue with multiple medical interventions, regardless of the benefits versus risks, they too have not “given up”.  And because someone’s physician makes the deplorable statement, “There’s nothing left to do” does not mean one should “give up”.   Treatment choices should be determined by the person whose life is being lived with a serious, even terminal illness (since as I have mentioned in the past, being human is indeed a terminal diagnosis, we all might consider our decisions and complete that advance directive!).  

Please, palliative care advocates, do not refocus the public on palliative care versus hospice care, as though these two entities are the anthesis of one another, with the caveat that palliative care is not about “giving up”.  We will be going back decades if this is how the medical community now sells palliative care services.  The entirety of palliative care services is a continuum, a means of recognizing serious illness and demonstrating the right care at the right time, according to a person’s self determination.  Honest and multiple conversations are needed.  Palliative care providers can actually help people in a sometimes long journey of debility and illness: to have symptoms better managed; futile care perhaps less frequently sought; adjustments made easier to the ongoing losses incurred with serious illness; and care focused on the quality of every day that is lived. 

We are often the light bearers in a culture that denies death will happen to all of us.  Medical professionals who are having honest conversations regarding palliative care earlier on in the continuum of life threatening disease —whether this leads to the determination to use hospice services or not—must include fair sharing of all treatment options, thereby assisting in decision processes without their personal bias.  Please, please don’t compare hospice to “giving up” and for “the very end of life”, thereby relegating it to only those who believe they are soon dying and palliative care another direction to take altogether.

Posted in end of life care, palliative care | Tagged | 1 Comment


I finally read something, in the NY Times, about The Zen Hospice Guest Home* in San Francisco, which closed down last summer.  Though The Zen Home was known to many workers in end-of-life care, others may not consider this significant news. It seemed incredibly sad to those of us who understand the immeasurable value of a home-like setting in the non-profit sector for dying persons unable to remain in their homes, with excellent care provided by staff experienced in end-of-life care.  The Zen Home closure represented just another demise of a wonderful option for the dying.  Financial difficulties were cited in funding the day to day care for residents at the guest home.  This is becoming a common scenario in other communities across the country.  Options for non-institutional end-of-life caregiving in places other than home are often dependent on philanthropic donations.  Increasing funding dilemmas for smaller and more intimate hospice settings have become common, while these settings are also being affected by a more fettered and complicated Medicare hospice regulatory and reimbursement system.  

For many of us, if asked where we hope to die, “in my own home” is the answer.  But the reality is, many of us will not have this option.  Some research predicts nursing homes will indeed be the place of death for nearly half of us by 2030, even though not preferred by most of us. Deaths in assisted living facilities are often considered and reported as “community deaths”, (versus more “institutional” places of death), though some of us would argue that these facilities’ end-of-life care provision is not synonymous with hands-on care received in a person’s home by family members.

Sadly, many of the aggregate living settings, whether considered institutional or not,  are too often places plagued by staffing shortages, a revolving door of new and minimally trained workers, and profits paid to stockholders and owners, rather than shared with the minimum-wage-paid-workers who are actually doing the care-giving.

Regardless of the claims that progress is being made in hospice and palliative care accessibility and improving end-of-life care, I believe we will face an ever-increasing crisis in this country as our growing numbers of frail elderly impact both the place and the persons who will provide care for the dying.  We ship people out of hospital beds as they are dying, often to avoid penalization and receive adequate reimbursement from the Medicare system, and we have overwhelmed facility staff who simply cannot provide the hourly care needed when one lies dying. (At best, an average of 4 out of 24 hours represent the total patient care hours in most nursing home staffing ratios and will never meet all the care needs of the dying). 

What I will need, when my dying becomes a reality, is someone who will be the gentle hands and give the loving care in the middle of the night, when in a confused state I try to get out of bed; and someone who will clean my mouth, all dry and crusted from the “mouth breathing” common in the dying; and someone willing to turn me side to side and change my soaked sheets, from the recurring episodes of incontinence.  Who will provide regular drops of medication in my mouth, when I can no longer tell someone that my pain is worsening, and I have lost the ability to both talk and swallow?  A physical presence is needed, and it may not be my loving family member, but an underpaid caregiver in an institution that is severely understaffed and whose staff is overwhelmed.  How do we intend to find and train and retain the workers in the future who will actually do the physical care needed for the dying?

Dying well needs more than an educational focus for the upcoming generations of medical providers and academicians.  Trained caregivers must be available in order to provide excellent hands-on end-of-life care in these institutional settings where many of the dying will reside.  Currently, across the US, nearly all the day to day care in our institutions is provided by aides who are mostly high school graduates making slightly above minimum wage, many who worked as baristas last week and an aide the next. This has not changed in the last 40 years, since I began my own nursing career as a nurses’ aide. Chronic staffing shortages and high turnover rates plague the institutional settings that provide care to the aging population with advancing disease, many of whom will die in these institutions. We need a new plan and allotted funding, freed from the greed of increasing profit margins and corporate agendas, to improve these conditions in the future.  

We may be dying in places not of our choosing with care provided by too few hands at the time of our greatest need.   We will need more than education and research to change how we die.  We will need adequate staffing ratios in facilities, with accountability. We will need vastly improved monetary compensation, increased recognition, and genuine support for those who actually do the physical day to day care of the dying (those same minimally educated employees, also minimally compensated, who are doing the bulk of the care in facilities across the US).  We will need social change that demands a shift from profit-motivated health care to prioritizing the day-to-day delivery of excellent end-of-life care for all.  

Posted in aging, caregiving, dying at home | 1 Comment


As 2018 comes to a close, I am remembering a friend who died this year.  Over a period of many months, we had these wonderful talks that seemed a lot like Tuesdays with Morrie,* with moments of her insight shared during our conversations over coffee breaks and lunches.  Being a medical professional herself provided it’s own special challenge, along with the sense that this was happening way too soon.

Her peaceful exit followed a couple of years of really “living” and making the days count, in spite of cancer.  Below are some highlights of her learned wisdom.

On having a “Bucket List”:

“I don’t have a lot left to do, not that I didn’t want another twenty or thirty years, but I don’t have a ‘bucket list’, or a lot of things I need to get done. I’ve had a great life.” 

On having the hard conversations:

“I’ve had all those dinners and hard conversations with my family, even though they rolled their eyes and didn’t want to, they now are pretty ok with talking about this…”

“When I asked her (my doctor) to be real with me, and give me all the information without holding back, you know, ‘none of the bullshit, I want to know everything’— She did just that, she talked in-depth, in medical jargon (knowing I understood this) and about every possibility and treatment option, until my eyes glazed over.  I didn’t mean all that information! Talk about doctors not listening to the real message!”

On options, self-advocating and DWD:

“Speaking of options, She (the doctor) said I could retire— like that is an option! 

With regards to chemotherapy treatment: “She (my doctor) thought I might get two years, but what would that take, to buy two years?  I think I have a few months.”

(I ask, ‘What makes you think you only have a few months?’)

“Well, I don’t want to financially, emotionally and physically bankrupt my family.  It’s why I’m glad I live in a state like Oregon, where I have some say about that. I’m glad to have options.” 

We talk a little more about DWD in the state of Oregon, though she is not totally certain this is what she will do.  (She is just happy to have a choice, she tells me.  And ultimately she decides not to go that route.)

On continuing treatment:

“I was kind of convinced (by my doctor) that this new treatment might give me a couple of years, instead of only a couple of months.  So I did a handful of treatments, and I was so sick, and the tumors grew, and I said I didn’t want to do anymore chemo even though she was a little upset with me.  I know this is something everyone does differently.  For me, I get as much benefit from the other approaches I’ve taken.”  

(In addition to living many months past the predicted time, even without continuing treatment, she has used things like massage, meditation, acupuncture and imagery and successfully reduced the need for significant amounts of pain medication in the midst of a very aggressive cancer with metastasis.)

“I’ve taught them (the hospice team) some things about palliative care, and I am directing my own care, even though I know I’m not in control…” and she punctuates this statement with a deep, gusty laugh.

On grief and guilt:

“I’ll tell you a story.  When my daughter died, I carried grief around with me for 20 years.  It was a burden that I could not put down, only a monster would lay down that grief!  I knew it was my burden to carry.  I didn’t want to be a monster… 

Then, when I was on vacation in the islands, I went to a healer for a facial and massage, and she told me I could have a ‘reading’ for free.  I don’t know if you’re into that kind of stuff, and I am not sure if its real or not, I just know what happened.  She told me in the middle of things that I didn’t have to keep burdening myself with my grief, that it was ok to lay it down.  I realized how much a part of my body that grief had become, how guilty I would feel without it, and what a monster I would be to let it go.  And then it dawned on me how ridiculous that was, that I didn’t have to continue to carry it with me, that in fact my daughter if she were here would be so upset with me that I had carried it for the past 20 years.  I learned from that very day to begin living without that heavy guilt of grief, and I have continued to experience this sense of freedom every day since.”

On writing her legacy:

“I know that we don’t always share the dark things, the parts of us that we aren’t proud of, our mistakes, the things that in fact form us to be who we are as humans.  I need to tell the story of my dark places, my mistakes that are a big part of me.”

On lessons learned:

“It’s hard to say what has been the greatest lesson.  I realized I was not in control of anything.  I am not in charge.  And I learned to let go…I will have to let go of everything.  But even though I say I’ve learned the lesson, you know how that goes…everyday this is a lesson I must repeat! (She chuckles, and smiles knowingly.)

On living:

“So much to do, so many projects to get done, and I worry I won’t get it all done.  But then I realize I will get done what I am supposed to.”

My last visit, as we sat quietly on a not-so-good day, she told me she had finally finished her projects, completed the family gifts of mementos to remind them all of her… later on.  She looked a little forlorn as she whispered “I don’t know why I’m still here.  I was supposed to die a long time ago”.  But some of us know how blessed we were to have her stay, even a little while longer.

(*Tuesdays With Morrie, by Mitch Albom)

Posted in end of life care | 1 Comment


father-1837457_640I will be happy if I never hear or read of another palliative or hospice-trained person saying something like, “she should just be the wife (or whatever the role is) and let us be the caregivers”.  “Should’s” are often not a helpful stance in anyone’s end-of-life journey.

Like others, my first glimpse of hospice care was the team who came to help my mom care for my dad the last 3 months of his life.  At the time, I was a newer nurse working in critical care, and lived a couple hours away from my folks.  I had watched the dying process many times as we valiantly attempted to stave off death from our critically ill patients. But seeing patients dying in the hospital was a very different experience.

Dad’s diagnosis of two separate cancers, both colon and lung, had initially been treated with a brief run of chemotherapy, then the lung cancer was complicated by brain metastasis, followed by a few radiation treatments that took the stuffing right out of him.  I remember when dad said he was done.  He wanted to stay out of the hospital, and mom called in hospice.

I came down every week to help care for dad.  The hospice crew would come and go, giving mom a much needed break and also help everyone understand what was happening.  Though I knew death as the enemy in the hospital world, I had also had opportunities to watch many families provide a loving presence even if they were not the ones providing the physical care.  Sometimes, only that presence was the antidote for an anxious and confused patient.  I learned to value this—perhaps more than all the technology we could offer in the hospital.  Eventually, I sought hospice nursing as a means of providing a different way to approaching caring for the dying.

A decade after dad’s death, as a hospice nurse, I was traveling that 1-5 corridor again, this time to help care for my mother.  As both a nurse and a daughter, I learned another way to see the family, the care, and the hospice team.  I recognized the value of each person’s experience and also how the different roles we all juggled could add depth to the shared experience.  I could understand a daughter caring for her mom at home, because I had experienced that.  I could know the trepidation of a nurse who was also the daughter caring for her father while he lay dying, because I had experienced that, too.  I knew what it was to feel helpless, both as a daughter and as a nurse.  I understood, from my experience, how hard it is to separate these different roles that make up who we are.  Nor is it necessary.  I believe I can be a daughter, a nurse, an advocate, and a caregiver, without the need to separate these roles into tidily bound boxes.

Families do end of life care in all kinds of ways, from all sorts of perspectives.  Though I have participated in many hundreds of other’s journeys, I know I am not an expert in how things should go.  I’m not sure “should” is part of the vocabulary.  There really is no right way.  It is simply a journey that all of us will make.  Most of us hope when it is our own that it is upheld with kindness, imbued with dignity and encircled with love.

Posted in caregiving, daughter, end of life care, family of the dying | 5 Comments


diamond-158431_640What will you do with your one wild and precious life?  Mary Oliver.

I was thinking about legacy, and how the world shapes us.  There have been so many lives shared with me over the years: some people I have known only briefly, others for longer times.  I am always cognizant of the diverse and sometimes terrible ways their legacies were made.  So often, what was truly harsh in this life became refined before their lives were done (like the heat and pressure that creates the beauty in diamonds).

I have some vivid mental vignettes of their shared experiences that shaped their lives: The purplish stamped numbers on an old woman’s forearm, and the losses she suffered in this life that moulded her into a person who quietly survived— teaching her children to never let life beat them down;  The serene age-lined face of a man whose students hung on the cherished words he spoke, himself saved from an abusive and brutal life through his dedication to inspiring literature— still quoting and teaching wisdom as he left life behind;  The gentlest man who had overcome his own demons and continued to bring support and light to others in the clutches of addiction— remaining a mentor until his last breath; The pale faced little girl whose inherent limitations in this physical life created total dependency—and whose happy demeanour brought laughter and joy to her family throughout her short lifespan; The man whose livelihood and family had been torn apart during a government-led internment— who spent the remainder of his days lovingly growing plants and enhancing lives around him with beauty.

For many, these stories will go unnoticed in the world, their accomplishments will not be heralded after they are gone and their obituaries forgotten… though a few will remember.  When all things are taken into account, it may seem insignificant.  It may seem as though they just happened to have been in a certain place, and the experience just befell them.  It may seem as though none of it really mattered in the end, since all of us will only be remembered for a time.  Yet they made a difference in their small corner of the globe.  The events in their life shaped them, and they in fact did something wonderful with their wild and precious life.

I’m taking a moment today to remember and thank each of them; it was the sharing of their lives, their legacies, that made their precious life even more precious to me.

Posted in end of life care | 1 Comment


vintage-1354642_640-2There is a question suggested for hospice staff to consider when they talk with people about hospice services.  “Why hospice, why now?”  Ask yourself, what makes this moment in time the reason someone might decide on hospice; what about this time is the right time; how might this person’s goals for their life, and death, be served best now?

It’s a question we thought about, we two nurses, as we gingerly stepped through an obstacle course of a yard, ignoring the no trespassing signs, and entered a particular place, at a particular time, to speak with an emaciated “houseless” man about his goals for care.

I counted 12 people who came and went during our brief time there.  We sat in a 5 foot  x 5 foot space, our knees nearly touching, in the middle of a ramshackle, dilapidated hoarding home open to local folks who had no home.  We talked together, amidst large black garbage bags of trash and rusted tools and paint cans and stacks of plastic containers and obsolete papers.

His story was like most of the others’ who lived in this place, where the battle with drugs and alcohol had direct implications for the loss of family, job, and sense of belonging.  Except strangely he had found a kind of belonging. His friend was sitting next to him, who cared for him and hoped that the last part of his life could be lived the way he wanted.

As we sat, our potential patient talked of his picture, what death might look like at the end, and how he visualised his ability to “call the shots” continuing for a lot longer.  We listened, as he explained he wasn’t quite “ready for hospice”.

We two nurses observed his yellow coloring, his enlarged belly, his swollen legs, and his waning strength, and we knew it might indeed be time, much sooner than he realised.  But the question, “Why hospice?” doesn’t always have a quick and ready answer.  The why now? part requires someone’s acceptance of approaching the later part of a disease process; a realisation that this short life is nearly done; their desire to finalise plans for death without a lot of medical intervention; and the desire to have hospice help.

He let us know that he wasn’t in that space yet.  Maybe he would arrive there later. Maybe not.  We told him we could be available when and if he decided that hospice now was what he wanted.  As we headed out the door with our hospice agenda unfulfilled, his friend of many years assured us he would be there to make sure this man didn’t die alone.

Many of us who work in end of life care might share a particular and rather defined view of what constitutes a “good death”.  But the plan and how each person arrives there is never as straightforward or simple as answering that question, “Why hospice, why now?” 

It might not be hospice time just now.  Yet the question, and the time that is right for each person… “a time to every purpose… a time to be born and a time to die” (Ecc. 3: 1-2)….will end up answered, one way or another.

I always hope for each and every person I encounter, that it will be in their own way, in their own time.


Posted in advocacy; patient rights; hospice nurse, end of life care | Tagged , | 3 Comments