Focus 580; Hospice Care

Good morning this is focused 580 our morning telephone talk show. My name is Jack Brighton sitting in for David Inge glad you could listen today. You may have seen the recent Bill Moyers programs on PBS on our own terms Moyers on dying. BILL MOYERS notes that modern medicine and social changes have prolonged life but also transformed the experience of dying. Ninety percent of Americans say they want to die at home but in reality four out of five of us will die in a hospital or other health care facility. During this our focus 580 will talk about the work of hospices and the ways in which the dying their families and their caregivers can cooperate to balance medical intervention with comfort and humanity at the end of life. We have to guess with this in the studio with matter which is a registered nurse and associate director of community care and hospice at Privia Medical Center and Viera Duncanson is the chaplain at previa Medical Center. We'll talk with them about the work of the hospice there at Ravinia and in general about the general issue of. How to manage. As I say medicine and quality of life and family and relationships at the end of life. During this hour of the show if you would like to

join us. Questions and comments your own experiences are welcome. You can call surround Champaign-Urbana 3 3 3 9 4 5 5. That's also 3 3 3 W I L L. It's easier to think of that way. We also have a toll free line anywhere you hear us that is 800 to 2 2 9 4 5 5 again around Champaign-Urbana 3 3 3 W I L L toll free anywhere 800 1:58 oil. Well both of you good morning good morning good morning. Thanks for being here just to start. Maybe with magic I could ask you to talk about the hospital both of you and chime in about the hospice program that provided it's the oldest in the area. Yes it was one of the first downstate hospices and we opened 20 years ago so we just celebrated our 20th anniversary this summer and 20 years ago hospice was something sort of revolutionary. Because a lot of people did die in the hospitals. Death wasn't really talked a lot

about and it really started kind of a movement of what is it that people want and looking at how can you make end of life care better. And I think those are still some of the promises that hospice is based on today. Probably one of the keys are pain management and symptom control because that's one of the things people say that they fear almost more than dying is pain. And then also looking at the pain can be defined in lots of different ways but a holistic approach looks at the spiritual emotional psychological financial and that's one of the strengths of the hospice team is that we have nurses social work physician chaplain home health aide volunteers pharmacist. My forgotten dietician dietician because that impacts not only the patient but their family member as well especially if their caring for them at home. So we don't try to tell

people what to do but to be able to provide them with options and then support them in their choices far's the care that they want at home given that they have a limited time left to live. That people try to do that in comfortable surroundings. I sometimes give the example have you ever traveled. Tell me about the hotel bed would you. Well there's nothing quite as good as getting back home and you sleep better in your bed and there is something to that for people who you know just the comfort of your own bed is it's a lot different than being in somebody's else's bed. And just being at home the surroundings it is more comfortable for families. There's more space. The dogs neighbors people can drop in and out and people can look out and see their garden and other sorts of things that are what people tell us are meaningful. And I think that's the other thing is we try to learn from each person and in what they tell us is important. We don't come in and say this is

what's important end of life right and we really need to take that direction from people. Well originally the word hospice was used in the Middle Ages and it was a resting place for weary travelers and travelers would stop by there and people would care for their body and their spirit so this is really just a modern version of that. Well it's interesting that there has been such a change in the ways in which the end of life play out in the locations as as I mentioned at the beginning you know most people still say they want to die at home but most people don't. Most people you know are in a health care facility. You can you think of any reason why it has to be that way. I mean is that is that a better way to manage things. I mean obviously you have all the resources that you can bring to bear there but. I think sometimes it depends on people being given information with choices yeah. I think sometimes what's happened in health care is if people don't say what they want we presume that

they want intensive care and tubes and lots of things. And maybe it isn't what they wanted but a lot of people haven't had discussions with family members about what they want. Just because medicine can do something doesn't necessarily mean that that's what a person would want to do however if they haven't left something in writing haven't told their family member when they're presented with a crisis in the emergency room or something happens. Think you know you know we go off on a track because it's a crisis. And somebody ends up dying in the hospital where maybe had they had the discussion earlier maybe called in hospice maybe had a home health agency other sorts of things if truly that's where the person wanted to die. But you have to have the discussion about where you want to die in order to be able to have that play out and for a lot of people that still very very uncomfortable.

Yes certainly I was just thinking that because I'm at the age now where a lot of my friends their parents are at the end of life over there I mean they may still be healthy in many cases but that's not going to be the case forever. We all know that but yet we don't like to talk about we don't like to imagine it much less talk about it. And I think sometimes the older people are more willing to talk about it than the younger folks. It's incredible That's when I hear people say you know sometimes elderly people give us opportunities to do that. You know I can remember my mother's wanting to talk about it and myself saying Oh my that's a long way off from now. And really she was just wanting you know opening for the discussion. So we need to give them that opening and enter into it which is interesting because I have I've seen and perhaps even done this myself. Oh I don't want to talk about that let's not talk we don't have to talk about that. But that's that's probably not the right thing to do. While the comfort level is different for everybody and we have to acknowledge that in ourselves also so I

wouldn't to be too hard on it. We've spent a whole century sort of denying this whole subject and not talking about it so introducing it now is going to be a slow process but it's happening and I think a Bill Moyers special was really helpful in that as a hospice. We've been trying to whittle away at that conversation for the past 30 years in this country. But getting others to enter into the conversation it's really helpful for a good. I think sometimes just acknowledging this is this is a tough subject. Is it OK. Is it ok sometimes an asking permission. Is it OK. I saw this and would it be OK if we talked about this a little bit. I'm kind of uncomfortable and sometimes just in saying that you can both acknowledge that it's uncomfortable. It doesn't mean that you have to sit and talk and get every detail right. You know for three hours now we're locked in. But sometimes you don't know what families want for end of life issues organ donation is another part of that

discussion not necessarily related to hospice but do people want to be donors or don't they and some of Michael Jordan's publicity has helped to get that word out. It's a little more. It's still the same. Topic just a little different focus. And so maybe you find out oh yes they'd like to be a donor if they could. And next time they'd really like to die at home or different treatment options were things that people really don't want. Promise me. Who would have the. Sometimes those are difficult promises that we find so sometimes it's it's I don't know the promises are difficult because none of us know what the future holds but at least it begins the discussion for what people's choices would be. Right. I think it's important just to take advantage of those times where you can talk about it for some people it may be at family gatherings. You know Thanksgiving is a time to you know look at your blessings and to

give thanks and maybe it's a time to talk about what matters most to us in our lives and what we want to have carried on after we die and so forth. For others it may be watching a movie on television where the subject brought up and you say we've never talked about that. I would hate to be in a position of having to speak for you when I don't know what you want. So really take advantage of any opportunity that comes along. Let's talk about the things that one might discuss. We mentioned a couple of things. You know I guess in the way that Bill Moyers put it I think was in terms of making plans for the end of life essentially coming up with an idea of what you want to have happen and making sure that the legal details are taken care of as well because those are also issues it seems like it's a pretty complicated thing or it can be if you don't pay attention to you know power of attorney and you know just things like living wills and

how you feel about medication and where you want to where you want to be when you die. I mean just all these things perhaps need to be discussed ahead of time. I think sometimes we think that well hopefully I'll just go in my sleep you know be a car accident. But that's usually 10 percent or less of the population. So most of us are going to have a debilitating illness or a chronic illness or something that will that will live with for some time. And I think sometimes it may be more difficult for people who are living with a life threatening illness because sometimes for them to have a discussion about what they want they think in their own mind it means giving up or if I have that discussion with mom I think it means she's not going to make it. And so. We may avert some of the the kinds of discussions you bring up the point about living will. I think that was one of the first legal documents that came out and a lot of people had living wills.

The living will is only effective if a doctor says you have a terminal condition. So if you're in a if you have a chronic heart disease lung disease ongoing maybe even cancer the Living Will doesn't become effective until you actually have a limited time left. And the doctor says that the person is terminal. So if you're in a car accident and something happens to you a living will probably isn't going to be helpful. So that's where the power of attorney comes in. And usually they call it a durable power of attorney for health care. There's also a durable power of attorney for property and for financial things somebody who can sign your checking account and but that's not to be confused with the health care. So that's something just for people to be aware of that it's different if you can sign on your parents talking about your your friends and their parents getting older. If you can sign for your your parents on their checking account it doesn't mean that you can sign for their health care.

OK so that would be something separate which is then different than someone's last will and testament. So the health care which is what we would focus on the durable power of attorney for health care. Basically says if I can't make decisions for myself this is someone that I would designate to make my decisions. And then there is the opportunity to put in writing the specific things you would want or not want and also to have the discussion hopefully with the person that you would name to be to make the person who would make the decisions for you. If you couldn't make your own decisions so. If someone had a stroke or if their disease progressed and they were unresponsive and they were brought to the emergency room or something. Who makes the decision. So usually the family and next of kin. If there is nothing in writing then they are the ones who are our next

approached. If it's a parent and there are multiple children siblings and they can't agree then that becomes difficult because health care can't quite you know pick Well we like these will go with them and what. So then people can get into more legal and difficult situations in. In that sense. So the power of attorneys help people to have the discussion and at least have something in writing to be able to present to healthcare providers about what the person's wishes were and who is the person that they want to make their decisions. Let me reintroduce our guest this morning. During this hour focus 580 We're talking with Ruth matter what she's a registered nurse and associate director of community care and hospice at Vienna Medical Center. And Vera Duncanson is the chaplain at previa Medical Center. We're talking about the work of the privy in a hospice and in general issues of death and dying and what one might think about when making plans for the end of life. And if you would like to join the conversation you can call us around

Champaign-Urbana at 3 3 3 9 4 5 5 toll free anywhere else 800 to 2 2 9 4 5 5. Well Ruth following up on on your last point what happens when someone is say in an accident or has a stroke and they're brought to the emergency room. What is one of the first things you ask is do you have a Living Will Power of Attorney to me these are these are things that are important to determine so that you can make good decisions. It's one of the many things that the emergency room staff and physicians would look at or or try to to find out what is it. If it's a car accident the chances are that general things like people see on E.R. and other things those those kind of measures are going to be taken. The presumption is in our society that's why we have 9 1 1 that's why we have the emergency system that we do. If you're in a car accident something happens our presumption is you want us to do as much as medicine can do to help your

life because you are to live along OK and then you had this traumatic accident. So in that sense that would be the general thought unless that would be the general trend unless a family member or somebody stepped up and said there something else please we need to evaluate. But usually in the critical moments they're going to presume to save life and do what they can in emergency room. Sometimes I think people don't understand when they say I would never want a ventilator or respirator I don't want life support they sometimes don't understand that you may be in a situation where that life support may get you through the next eight hours and then you can you can have a fairly good quality of life. So that has to be taken into consideration to when you do make your plans. Very good. We have three callers waiting. Let's go ahead and include them in our conversation and we'll go first to a listener in Urbana online number one. Good morning you're in-focus 580. I really enjoyed the film Warners program I thought it went into a

lot of different circumstances in detail and I liked liked all that. What I thought was interesting was they think it was the doctor who decided to not go with the details in his documents but to give his wife what he called the naked power of attorney and talk with her about his preferences but to leave it up to her to evaluate the situation and not be hampered by their guesstimates ahead of time about what things would be like. And I haven't heard about the naked power of attorney before but it seems to me to make her make a lot of what do you think. I'm not sure what state that was and sometimes different states have slightly different legal ramifications. The Basically you could do the same thing here. The important thing I think is to have the conversation and obviously he had with his wife in discussing the different alternatives and basically naming her to make the decisions. And

that's that's sort of the key to this. I would think you would also need to have backup people. If you're I mean he was he was looking at death coming up. For those of us who don't see that obviously on the. Rise and I'm wondering if it might also make sense to have backup people with the power of attorney so that you can. I think you can cover more bases. I would think it would be very helpful if you can. It's also something that when you have a power of attorney it's not a document that. That can't be amended which means that at some point in time in the next 10 years your life may change and you you may want to amend it. So I think one of the the topics of this is is sort of it's an ongoing conversation because a conversation you have with a family member today your life 10 or 15 years from now baby may be different and what we can do

in medicine may be different. And your wishes may have changed and so it's sort of an ongoing periodic conversation. And I think the important thing is that each person needs to customize it and personalize it so that their wishes and how they best feel. And if you'd like to name two or three successors that's possible. First I want so-and-so if they're not available then check with the next one and then somebody else so you know for her. A good phrase that I try to keep in mind. Death is not optional. Yeah they good effect. We all are going to die. And question. The thing is we just don't know when. Even you know somebody who's young and healthy could be as you said in an automobile accident could have some expected quick medical catastrophe that might leave them hanging. Well need to deal with this and not think of it as giving up. But I can see where that would

be something that would be difficult for poets. Thanks very much for being there. Thank you. We will go next to a listener in St. Joseph on line number two. Good morning on focus 580 high. I have a question. I have a durable power of attorney over my body or whatever you call it. And I would like to know is it necessary or is it a good thing to keep it on file with your doctor. Yes it's a very good thing to have it on file with your doctor also if you have a copy or your the person who is your agent also has a copy. So if at some time you would need it. Some people also leave copies with their attorneys O'Kane it with their other legal documents. I think probably not only having your physician so that your physician has a copy but having a conversation with the physician because what we

find is that life presents us with situations that are quite as clean cut as it might say on paper right. And having that discussion with your doctor so that you feel like Oh good we're on the same page this is good. I actually talked with physician this week who heads had many patients come in and have the discussion this week after having seen the Bill Moyers and going away feeling very relieved that they felt that the doctor was on the same page with them and sort of They'd been carrying the burden but they didn't realize they'd have this burden. So I think that I think it's been helpful. I have another question and that is I have for example I'm just going to use myself because I know myself best but I'm sure this refers to a number of other people. I have no one no member of my family living close to me. What do you do in that situation. I have nominated one of my sons but he lives in New Jersey.

I would think you would have a back up plan here also in case they are not able to reach your son if you have a friend who is close by. For some people it might be a clergy person who has you know you've had this conversation with. Right. OK thank you very much. Thank you for the call. We're about our mid points in our conversation with Ruth amount of work and a very Duncanson from the Peruvian a medical center talking about the hospice program there. We have one caller waiting and would welcome others and to the number again around Champaign-Urbana 3 3 3 9 4 5 5 toll free anywhere you hear is 800 to 2 2 9 4 5 5. We'll go next to a listener in Champaign on line number three. Good morning unfocussed 580. Hi this is Dan Sharpe. To Ruth in the heart of Europe. Hi Joanne I have three things that I love the bill for the show. One of the points that you made I don't know which one of you about the conversation but it's very important to talk to

talk and to understand. And the second thing I want to say somebody called in the death of the last is true but mystery is not optional I'll hang up and listen to what you have to say. And thanks for being there and perk being you by thinking by Jan Shepherdson for those of you who don't know started the conversation in this community she was one of those who is the founder the founders of our program and it's her philosophy that really has guided us for the past 20 years that this is a subject that has been neglected and she has brought this subject out with a great deal of grace and dignity into our community so I want to say thank you to her for that and thanks for calling Jan.. Well the point that she made there at the end in terms of suffering it being something that obviously people don't want to to go

through for a long period of time. But it but it is also something that obviously that you know modern medicine is extending our life span a great deal and change the circumstances of our of the end of our lives but also giving us perhaps better tools to deal with you know the suffering aspect from a technology standpoint and pain medication that has been the case we now have medications people can take sustained release medicine so that they take it twice a day instead of having to take something every two or four hours. That helps people's quality they remember it. It provides a sustained pain level release. Otherwise your blood levels are going up and down and up and down and up and down and people are experiencing pain so from from that point technology's been available and helpful. There are pain pumps implantable devices things that we can do for the physiology and the biological components to

pain. I think we're also making strides some of them are. Things from from ancient days like being there with someone touch holding the hand. You don't have to be a massage therapist door although that's very helpful. But some of those things that are also in looking at how people suffer are how that is perceived by different people. Relieving suffering can come in a lot of different ways. But we've come from this period where we haven't talked about it and I think even just being able to talk with each other relieves a lot of suffering for people they don't have to keep it to themselves. But from the spiritual aspect we've learned an awful lot in the past 30 years that suffering can be addressed through through prayer through touch through music through. We help people

to take a look at their own spiritual resources and they may or may not be religious. But for some folks it's having visits from people from their church or listening to him in prayer or laying on of hands. It's a really holistic approach that cares for the body mind and spirit and together I think we've come a long way in in relieving suffering but you can't relieve suffering totally and I think that sometimes our frustration. But but it's reality and sometimes people need to hang on to some of that also. We've got a call to talk with in Bloomington Indiana one member for Good morning Ron focus 580. Hi I am in this discussion of the right to die. I'm glad I'm glad you just you just mentioned pain pumps and some palliative devices because it seems to me the emphasis has been too much. I'm controlling death rather than controlling pain. Now that there's a there's a medical specialty called palliative care. And

nowadays and it's it's a very sophisticated specialty. In fact the first episode in Bill Moyers series was on palliative care. And the the advantage of palliative care is that it we can control pain. It it appears I've heard I've heard professionals talk that there isn't any pain they can't control. I know that there are that there are some that there are some. People in the medical profession that will tell you that there are certain certain types of pain that they simply can't control. Well in the palliative specialty they will tell you they can control any kind of pain. And the reason that's so important is because if there's an there's a danger in in controlling in this death the idea of controlling death rather than controlling pain that we have already seen in places like the Netherlands where people are afraid to go to a hospital because they're afraid they will never get in there or they're afraid the doctor will take the initiative and kill them. I know a

nurse who broke her arm and would not go to a hospital. And this is a nurse and she's a sophisticated. She's a sophisticated elderly woman. She would not go to a hospital to get her arm set because she was afraid they would kill her. And that's right here in the United States. So the is the medical specialty called palliative care I think is the answer rather than attempting to control death did this and this attempt to control death puts us on a slippery slope where people are especially elderly people are afraid to go to the hospital and they shouldn't be. You bring up the topic of palliative care which is actually an outgrowth of hospice care. It is now looked at as a specialty there are actually some medical schools here that are providing rotations for physicians to be trained in palliative care. Yeah its focus is to alleviate pain. And they've done a wonderful job. I think that the point about alleviating pain

is the focus and I think that all patients regardless of whether it's surgical pain or pain from. Something else that the focus for pain relief should should be beyond just those that may be dying or at end of life. So I think that palliative care has helped to bridge that gap beyond the pain expertise that's happened for people at end of life care and hospice and bridge that further for others. And I think that. Excellent. The caller raises a point that we really weren't discussing. You know in terms of the decisions to end life that is the reason I want to follow up on that though is I think that there's a tendency for folks to hear something like that and maybe respond in a way a sort of a urban legend about you know someone who went to the

hospital you know for a tummy ache and you know was you know euthanized or something. This is not something that hospices practices. This is not the purpose of a hospice whatsoever just a want. That's the question. But also a statement it is correct that the tenets of hospice and the National Organization for hospice and movement throughout the United States clearly states that we do not hasten death nor do we prolong dying. So that is the focus and the tenets of hospice. We do look to provide quality care for people regardless of the the the time that's left in that short time. OK well very good. Just make that point and then we also have another call I will get right to let me mention that we have just about maybe 12 minutes left with our guests Ruth Matt awake and Farah Duncanson from the hospice program actually from the Privia Medical Center and the hospice program there were discussing issues of death and dying and hospice care. We

have a few more minutes if you'd like to join us. 3 3 3 9 4 5 5. Anywhere you hear is 800 to 2 2 9 4 5 5. Next up Alison champagne on line number one. Good morning unfocussed 580. Hello. Yes I'm on my car phone I hope you can hear me. I have pulled off. OK great. Actually I'm doing a luncheon but I think it's that we've just been through the death of my mother in another nearby city and she was in the hospice program near the end I just wanted to share my experience. I was part of the volunteer program when it started to mercy and we were separate and our experience with my mother who I was nearly had to demand you know and so all of the operates the health care operative that we had were put into effect. My experience was of course that has made a great difference in

keeping her comfortable. There was one problem and I was on the air. Hostis has the course and we were surprised to find that there was such a thing as a contract with Medicare and the nursing home where he was living and so when her doctor thought it was necessary that he would meet the guidelines for an assisted care under those situations he went onto our program and it made quite a difference. And he had been an assisted living for two years and we had caregivers around the clock for two years and we continue them in the nursing home. Because of course they don't have enough help and she became we had to use a lawyer to lift and move her and so forth. You never had a dispute with this. He was able to get up for a long time after he'd been on hospice for perhaps six

weeks. He showed enough improvement that they suddenly suddenly told him that he would have to be terminated from the CR. Graham and I was a little shocked at this but I didn't protest because I understand there are guidelines that you must follow them. But he obviously was in a early terminal situation and so within about a week he needed to be back on and I didn't quite know what to do. I kind of waited and finally the nursing home staff suggested that she go back on the program and so he did. But it took quite a while. And after he was back all the concerts maistres were operative and obviously he was more comfortable but then you know only live about another week a very long slow demise. And in that time the spacers the last 3 days were very helpful. But I just raise

this is I'm still struggling with this in my mind. Hospice makes it great. But I I wish they hadn't terminated there because we had a period of about three weeks where it would have made it. Do you have any comments that would help me. Any time we have a doctor certifies that they think that a patient has less than six months to live which those are the guidelines that we operate under. Those are best guestimate in a sense of where where a patient is. We have on occasion had people who have actually done much better and improved. Sometimes it may be due to the increasing pain control pain does interfere with lots of things in people's lives. And if their pain is not out of

control they can't do very many things to get the pain under control and many times they can do lots of things that they weren't doing so they may appear to be getting better. Well and you said it had improved and that's what they were going by. Indeed sometimes they people do. We've had people who have. Ben we say sort of graduated from hospice and many of them have some of them have lived on for months maybe years sometimes with them we've had people who sort of their condition deteriorated again. I think the thing that's difficult is is none of us at the times that we make a decision know what the future holds. And so at that one point in time trying to make the best decision not knowing that maybe three weeks later her condition was going to deteriorate again as you described him prove was not dramatic when they took her off it was

she was well within a six month prognosis of course I understand. Yeah it's tentative but oh I just wish you know we could have kept her on it. I still am struggling with that period in which she she needed the hospice program. You know it just makes sense to you. It really does. And I was just grateful to them. But has the system changed. You know it to me it almost has become a business. And I had to adjust my thinking to fast. But I'm all for the program. Well I just wanted to share this. I don't know whether there would ever be. And the attempt to try to deal with this type of situation we have had are not. But there are some potential legislative changes one of the things that the hospice has and many of the different agencies that try to discuss things at congressional hearings

in looking at extending the criteria for longer than six months. We know on the one hand want to have better end of life care. But then there are the criteria that sort of box things in. Yes we're dealing with I realized. And so from a legislative perspective that has been put forward as far as. Expanding some sort of hospice care so that it's longer than six months what they've found is that many times. For that for the most part patients under hospice care. Most of them do not exceed that time limit. It's not really a time limit it's sort of a guideline. I know I understand I think total He was in the program last spring.

More like who altogether was it Mitch and and that seems to be the national trend. Which also creates a problem of people are only in hospice for a couple days or a week. Yeah because you're not really able to connect with the family and really able to do the kind of pain management and end of life care that allows people to have the discussions and to say goodbye and to really sort of get things in place it's kind of a last minute crisis. And in our situation my mother was not able to communicate with us. A long time so it was difficult to try and interpret her restlessness. It sure was or not and and you know it took some of the relieve me of some of the risk a sense of responsibility. OK well I appreciate very much your program and I too enjoyed more your show it just spoke to me I'm struggling with why she had to go

through this long period you know suffering and I'm dealing with a lot of emotional aspect and the elastics and I felt very comfortable with people and I really support her. Thank you so much I'm do it a lot. OK well thank you thank you for calling it by all right. The whole area of grief is another huge aspect of hospice and I think especially when people look back and and think What if Or could this have been differently. Makes grief a little more complicated. But hospice provides grief support following the death of our patients for 13 months and also through our center for grief loss and hope we provide support and resources for everybody in the community so I really what that's a that's a huge area in addition to the pain control and caring for patients as they're dying is the aftercare that we provide we have groups for children for

teen for infant and perinatal death family member that may have had a death by suicide and adult groups. So there's a lot when you look at grief that's that's beyond just hospice. When you focus it truly end of life because that may that may come in lots of different ways. We may have time to follow up on that have a couple of questions but we also have a listener. I've been making weight will conclude them in a conversation. This is someone an auto on line number four. Good morning unfocussed 580 Good morning. My question is for your staff what I'm really interested in her activities and what she sees as her priorities if that's happening. And maybe contrast first a little bit with. What really. Well actually I do both but primarily I do hospice. My role really varies. Again our program is tailored from

individual to individual as and that's the way spiritual care is for. For some people even the word chaplain is a little scary because it comes with a lot of religious baggage sometimes if people have had a difficult experience. So I'm the chaplain or I'm the spiritual caregiver I'm somebody who listens my role is to assess the needs of individual patients and families and then to really go from there. A lot of what I do is being present with people listening to people sometimes helping people to sort through what matters most in their life how they want to spend the time that they do have sometimes issues like forgiveness come up or how do we celebrate together. Sometimes it may be helping people plan their funerals or actually doing their funeral for them. Another part of my role is I coordinate the grief support groups for the children. So it's that ongoing kind of care also but the role is varied

and interesting and. I think any of us who work with Hospice would say what what a blessing it is for us to be a part of people's lives at this time. Are you working. No I'm not I'm a lay chaplain. Oh yeah. Well thank you very much. Okay thanks for the question. You mentioned issues of forgiveness and you know that the family it seems like there would be I imagine a large challenge in in essence coordinating or maybe facilitating a way of people communicating around what may be a crisis or maybe a prolonged crisis but I mean is this one of the challenges that that you do that you try to fulfill is sort of facilitating or you know bridging or trying to get people talking to deal with this and perhaps come to some sort of closure. Right I think that's a challenge for all of us on the hospice team. Sometimes I'm not the one in there but it may be the nurse or maybe the nurse's aide or the volunteer. So all of us look

for opportunities to be able to help build those kinds of bridges with families. Sometimes it gets done and sometimes it doesn't get done. You know we see families for a very short period of their life and there are in some families forgiveness issues that go way way way back and sometimes we are able to help facilitate that. But that is that is a huge challenge. We just have about three minutes left and there are a whole bunch of things we could talk about. It just strikes me that in looking at this and thinking about it and I note some some figures that came with the Bill Moyers special that show the change over the past hundred years in the way things play out at the at the end of our lives in 1900 the age death average was forty six years. Now at seventy eight that's thirty two years longer in one century a century ago the leading causes were infection accident and

childbirth now it's cancer heart disease and stroke and whereas disability before death was very unusual and brief a century ago. Now it's on average more than four years. This is a major change in our society and the way that we're experiencing the end of life. And it seems only perhaps not surprising that we're having some adjustments to make about how we go about dealing with that. Dying is taking a lot longer than it did at the beginning of the century. Or I guess at the beginning of the last century I should say when illnesses took people very quickly and I think that that is a huge issue for all of us is to help people to deal with the fact that illnesses are much longer and chronic today and how to provide that kind of palliative care along the whole process. Just to sort of wrap up in talking about the hospice program itself

what would you perhaps I'll direct this to Ruth Madoff. What would you suggest for people if they want to learn more and maybe start thinking about the kinds of conversations they want to have some of the resources that perhaps they should be aware of. They could call our hospice office if they want to which is 3 3 7 2 2 7 3. And depending on their question it could be diverted if someone is interested in volunteering volunteer coordinator if it was something from the Center for grief loss and hope. If it were more of a medical question one of the nurses could answer so depending on their specific question they might get a different team member. The other thing is that we're going to be having community conversation meetings they'll be three of them. The first one will be next Monday September 20 5th all three will be we're doing this in conjunction with the public library and champagne from 6:30 to 8:30 talking about how to

have a conversation and how to talk about dying. Also what kind of advance directives you might need then. On October 16th we're going to have a discussion about controlling pain. What are the losses that people experience in family members. And then how people are dying at home how people can be helped in order to help a family member to do that. Then the next want to Tober twenty third is about having hope and celebrating a life. And that will be something. Looking at sort of individual things and spirituality and what that means for people. And then the next week November 6th will be. November is hospice Month National Hospice month celebrating that will have Doug Smith will come and he's a divinity graduate I believe and he's going to talk about patient stories what the

dying people want to tell those of us that are living. And I think we learn a lot from them. OK. So if people want to find out more about that they can call the hospice right 3 3 7 2 2 7 3. OK. I'd also like to say that our children's grief support group starts September 20 8th and anybody who is interested can call at 3 3 7 2 4 7 0. OK. I wrote those numbers down in case anybody wants to call after the program. We're going to stop since we're here at the end of our time. And I just want to say thank you very much for being here. Thanks for thank you for having me with Madam wick and your Duncanson from the hospice program at Vienna Medical Center.