The mindset and milieu in a nursing home are quite different from those on my new unit. The nursing home environment is often very noisy and busy; the focus is usually on subacute conditions and rehabilitation. There are activities, therapies, lab and diagnostic tests, consults, rounds, and meetings.
On the hospice and palliative care unit, it is much quieter, and the pace is slower. We do quality-of-life meetings daily, spend time with families, and educate everyone involved on how to help the hospice patients achieve a more dignified and peaceful death.
One way to encourage this is by providing the patients and families with the pamphlet “Live and Die Healed.” It encourages the family to consider the following statements: Forgive me, I forgive you, I love you, Thank you, Goodbye, Let go, and Open up to what comes next. (The first five were written by Ira Byock, MD, former president of the American Academy of Hospice and Palliative Medicine. The last two were added by our hospice director, Deborah Grassman, ARNP.)
Death, I realize now, is a sacred event, and I am very happy that I decided to make this change in my nursing career. Not only is my mind more open, but my heart and soul are open as well. “If you don’t love yourself, then how can you love others?” is a question you’ve undoubtedly heard before. My new question is “If you don’t heal your own heart, then how can you help others heal their hearts?”
My heart was broken. Seven years ago, my sister died tragically, a victim of domestic violence. She was murdered—strangled in her bed by a jealous boyfriend—leaving behind four beautiful children. My hospice experience has helped me heal some of those wounds, and that is helping me heal others.
It has only been about 10 months since I started on this unit, but already I am no longer the rehab NP who would say “You’re a diabetic or cardiac patient—put that doughnut down” or “You’re an alcoholic. If you go out on pass and drink, we will do drug and alcohol testing when you return, and if the results are positive, we will discharge you.”
I now say instead, “I know you’re a diabetic and have heart disease, but you can have that doughnut” or “I know you’re an alcoholic, but would you like a beer or a glass of wine or anything else? You can have anything you want.”
It is very fulfilling to give people what they desire and need in their last days. I have never had so many people say “Thank you” and “God bless you.”
I still laugh and smile. I am still alive—and I actually feel more alive in this place. I treasure my life, my family, and my health much more now. I cry, too. There is no holding back. As a result of my expert-to-novice experience, I see and feel the human condition in a new light.
Ellen Thatcher is a Geriatric Nurse Practitioner on the Inpatient Hospice and Palliative Care Unit at Bay Pines VA Healthcare System in Bay Pines, Florida.