Wednesday, March 12, 2014

Hospice Thoughts

I have two hospice patients right now, a man and a woman, both quite old (mid-90s) and in nursing facilities.  I'll visit them every other week.  In only one visit each, they've gotten me to thinking.
You know the saying, "You can't take it with you!"  I realized talking to my gentleman that not taking it with you begins before death for so many.  Regardless of their station in life, I come to my hospice patients pretty much all in the same place:  alone, with very few belongings (and that's counting clothes, some pictures, a rosary, a blanket--pretty much it, even for the woman in her daughter's home.)  Even if they have large families or a living spouse, they are rarely accompanied even most of the time, even when living at home.  Even the finances don't seem to have much of an effect, though perhaps the food is better and the care more attentive at some places than others.  Still, I generally find them all alone, in rooms overwhelmed by loud tvs next door and beeping machines, with the same institutional smell, whether they are paying (large sums of) cash or covered by Medicare or Medicaid.   But things like Harvard degrees or law practices or many languages or baking skills or WWII vet status or lots of travel or church membership (even my most religious person hold little sway, except perhaps as the memories keep them company.  I'm not saying those experiences and accomplishments have no value, only that they seem to recede in importance towards the end.

What is important, then?  I would say the patient's outlook, almost more than anything else, has the most influence over their lives in the end.  We have a saying in hospice, "patients die as they live, only more so." The content ones seem to adjust; the angry ones lash out.   Same with the joyful, the anxious, the chatty, the quiet, each in his or her own way.  My woman now has two mantras that she repeated to me today:  "I mind my own business" and "What are you gonna do?" in the vein of "it is what it is" (which was the mantra of one of my other patients.)  So, perhaps all of those experiences and accomplishments do, in the end, go with you, insofar as they perhaps influence and affect your outlook at the end (or do they reflect the outlook?  A little of both I suspect.)

I hope that my hospice experiences will be something I take with me to the end.

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