There 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.

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