Transitioning

Posted April 9, 2014 by hpccr
Categories: advance directives, awareness, caregiving, education, end of life, hospice, Levine & Dickson Hospice House

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by Brenda Morales – Pico, M.D. Candidate, University of North Carolina School of Medicine

Transition-Planning-SignI attended the hospice interdisciplinary meeting on my first afternoon of the hospice experience, and one of the first nurses to report stated that her patient was transitioning.  My initial thought was that her patient was being transitioned from his home to an inpatient hospice unit.  I had learned that morning during my time with a palliative medicine team that patients can receive both palliative care and hospice care in a number of different settings, from the hospital, to skilled nursing facilities, to inpatient hospice units.  However, I soon realized that the word “transitioning” has a different and very specific meaning in the world of hospice care.  Transitioning is the beginning of the final stage of dying, the confluence of signs that indicate that a patient is approaching death within a few days.

The following day, during my time at Levine & Dickson Hospice House – Huntersville, I was able to round on several patients with one of the nurse practitioners.  Her patients were all in different stages of the hospice experience and in different phases of the dying process.  She pointed to the signs that one patient had recently begun transitioning — he had stopped eating and was now sleeping for long periods of time.  In fact, on the day that we visited him, we were unable to rouse him.  During our exam, we were only able to elicit a grimace from him.

I was not aware of all of the signs and symptoms of the transition to death before my hospice experience.  In medicine, it is very often so difficult to predict how much longer patients have before they die when their prognoses are months to years.  However, once they have entered the transition phase, the nurse practitioners are reasonably able to predict the number of days a patient will continue living, often based on the last time he or she was able to take anything by mouth.

I was surprised by how thoroughly the nurse practitioners assessed and examined each patient.  They were truly attentive to a myriad of symptoms from pain to nausea to agitation. The management of these symptoms seemed complex, especially for the patients in the inpatient hospice unit, who had been transferred there because their symptoms could not be adequately managed at home.  There truly is both a science and an art to helping patients transition – transition from their homes to skilled nursing facilities, from palliative care to hospice care, from their homes to inpatient hospice units, and finally from life to death.

There is also an art to helping the patients’ families transition.  I was able to sit in on two different family meetings during my hospice experience.  One was a discussion about goals of care with a woman who was receiving palliative care in a skilled nursing facility following a hospitalization.  The other was with the family of relatively young patient who had just been admitted to Levine & Dickson Hospice House – Huntersville the night before.  In both meetings, I was struck by the patience and openness of the providers as they answered the family members’ questions and guided them through difficult decisions.  It was clear that their roles as providers were not just to transition patients comfortably from life to death, managing their symptoms medically, but to transition patients and their families to a sort of spiritual or emotional comfort.

As I transition from medical student to physician, I am certain that I will benefit not only from the greater understanding of hospice and palliative care that I have gained through this experience, but also from the examples of truly wonderful and holistic care that I encountered during my time with palliative medicine and hospice care.

New location, same exceptional care

Posted April 4, 2014 by hpccr
Categories: awareness, end of life, hospice, Hospice & Palliative Care Lincoln County, special events

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by Andrea Powell, HPCCR Marketing Manager

HPCCR President & CEO Pete Brunnick (left) and Lincolnton mayor John O. Gilleland after the ribbon cutting on Thursday evening.

HPCCR President & CEO Pete Brunnick (left) and Lincolnton mayor John O. Gilleland after the ribbon cutting on Thursday evening.

Well, it’s official.  Enormous scissors were procured and a bright blue ribbon was ceremoniously cut.  The brand spanking new Hospice & Palliative Care Lincoln County office is open for business!

Ok, it’s actually been open for business for a few weeks, but last night we had our celebratory open house.  Lincolnton mayor John O. Gilleland and HPCCR President & CEO Pete Brunnick both said a few words and, together, they cut the ribbon in front of the door.  And the celebration began.

Over 75 attendees came to check out our spacious, new building.  Appetizers and cupcakes quickly disappeared as guests roamed the rooms and chatted with friends and neighbors.  It was a beautiful spring evening, the perfect night to debut our new home in Lincoln County.

Thanks to everyone who came to share the evening with Hospice & Palliative Care Lincoln County.  As Pete Brunnick mentioned in his remarks, “this is your hospice and we wouldn’t be here without the support of this community.”

With this new office space, we can better accommodate our growing staff and continue to offer our patients exceptional care.  Of course, we provided exceptional care when we were in smaller offices too.  Somehow, though, the big scissors and festive ribbon just make it, like I said, a little more “official”.

 

A St. Patrick’s Day blessing

Posted March 17, 2014 by hpccr
Categories: hospice

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by Andrea Powell, HPCCR Marketing Manager

Just a short and sweet blog this week.  In the honor of St. Patrick’s Day, I thought we could all appreciate this Irish blessing.  Its message is appropriate for everyone but I like the connotations it has for hospice.  May you all have the luck of the Irish this week!

happy-st-patrick39s-day39

Milestones

Posted March 12, 2014 by hpccr
Categories: awareness, blog, end of life, hospice, social networking

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by Andrea Powell, HPCCR Marketing Manager

36th anniversaryWe are patting ourselves on the back here at HPCCR.  Why you ask?  Well, because we reached a couple of milestones over the past week and we’re pretty proud.

On Saturday, March 8, we marked our 36th year of providing end-of-life care in the Charlotte region.  President and CEO Pete Brunnick pretty much sums it up, “For some of us, that seems pretty young, but what an ever-changing and dynamic life our organization has had.  To think that just 36 years ago we were literally a ‘church basement organization’ and to see what we are today really is amazing.  I have always emphasized that we are not good just because we are big.  Rather, our patients and their families choose us because of our excellence in care and our commitment to always put them first.”  Yep, we have honed our skills over the years and we know what we’re doing.  You can plan on us being around a LONG time!

On Monday, March 10, we marked the 4th year of this very blog, Hospice Matters.  I can’t tell you how gratifying it’s been to see readership grow, to see the effect our stories have on those of you who tune in week after week.  Since we started this blog, we’ve posted over 300 times and we’ve not missed a single week!  You know what that means?  It means that we’re not just dedicated to our patients and families, we are also dedicated to YOU, loyal readers!

We would be remiss if we did not thank everyone who supports this organization and what we do.  Without you, we would most certainly not be celebrating these milestones.  And for that, you have our sincere appreciation.  So I guess you can give yourselves pats on the back as well (on our behalf).  And maybe go get a cupcake.  We won’t tell.

Meet Thelma

Posted March 6, 2014 by hpccr
Categories: cancer, end of life, hospice

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by Andrea Powell, HPCCR Marketing Manager

This is Thelma.  Just look at that face!

This is Thelma. Just look at that face!

I met Thelma yesterday.  Thelma is quite possibly one of the cutest women I’ve ever seen.  Do you see that face?  I probably use the word “precious” way too much, but in this case, it’s completely justified.  Thelma is precious.

Thelma is 96 years old and she has breast cancer.  Again.

About 50 years ago, Thelma found a lump.  You know what they did back then?  They scooped it out under local anesthetic and that was that.  Luckily this procedure seemed to work because it wasn’t until about two years ago that another lump resurfaced.  This time, her family and her doctor were in agreement.  No aggressive treatments or procedures.  Keep her comfortable and let nature take its course.

But Thelma has surprised everyone with how well she’s done.  Up until last month, she was still out and about, visiting friends and going to church.  It’s just been over the past few weeks that her ability to get around has been hampered by the progression of the cancer.  But she’s never been the type to complain.  She’s not had the easiest life but, as her daughter-in-law will attest, she’s always had the disposition of an angel.

Thelma has lived in Mooresville, NC pretty much her whole life.  She met her husband, Oscar, when she was only 18.  She was a married woman with young children by the time she was 20.  A mother of two daughters and two sons, she also worked outside the home; for 22 years, she collected a paycheck from a textile mill in Cornelius.  Oscar died in 1994, but Thelma still had her family to surround her and sustain her.  Thelma has always been a very social person — to this day, she thrives in the company of others.  And she has always had an “open door” policy.  To her house and to her heart.

Lou, Thelma’s daughter-in-law, met Charles, one of Thelma’s sons, in Arizona while in the military.  After only a month of knowing each other, the two had married.  So it was with no small amount of trepidation that Lou found herself meeting her new in-laws for the first time.  Her fears were completely unfounded.  Thelma and Oscar welcomed her (and her two daughters from a previous marriage) with open arms immediately.  And  just like that, Lou found “her people” thousands of miles away from where she grew up.  Sometimes your family chooses you.

Thelma holding the hand of her son, Butch, at LDHH-H

Thelma holding the hand of her son, Butch, during his last days at LDHH-H

Throughout her long life, Thelma has had her fair share of heartbreak.  Her son, Butch, died at Levine & Dickson Hospice House – Huntersville about six weeks ago.  You’re not supposed to outlive your children, especially when you are already under hospice care.  But Thelma has.  She visited Butch for the few days he was at the hospice house and sat by his side, holding his hand.  He was mostly non-responsive, but anytime she let go of his hand, his hand hovered over the covers looking for it to come back.  A man knows when his mama is there to care for him.  Butch was no exception.

Thelma has been a caregiver her whole life.  Her mother also had breast cancer and Thelma cared for her during her last days.  Thelma has cared for her children, grandchildren, and friends.  And now it’s her turn to be on the receiving end of that kind of true love.

A long time ago, Lou made a promise to her mother-in-law that she would come take care of her if she ever needed it.  That time came.  Twelve years ago, Thelma had a nasty fall, breaking ribs (among other injuries), and ended up in a rehabilitation facility.  Lou called her from Texas (where she and Charles were living at the time) and asked if Lou wanted to stay in some type of assisted living facility.  Thelma most certainly did not.  But she didn’t want to move to Texas either.  So Lou and Charles moved back to North Carolina, back to the house that Thelma grew up in, to be her caregivers and protectors.  It’s been hard at times, but no one regrets a minute of the time they’ve had together.

And now Hospice & Palliative Care Lake Norman has entered the picture.  They’ve been a godsend to Thelma and also to Lou.  “There’s so much less for me to do now.  Hospice care is the right care for Thelma and it has been such a gift.”  For someone as social as Thelma, the additional interaction with the hospice care team has also been a huge help.  As Lou puts it, “Everyone from hospice is a family member we just hadn’t met yet.”

The thoughtful help the care team has offered Thelma and her family has been immeasurable.  But it’s help that is given freely and gladly because they adore Thelma.  Several of the homemakers on the hospice team attended Butch’s funeral so that Thelma would have extra support on such a difficult day.  The hospice volunteer who visits the family brought a clock that now hangs on the wall.  It plays music and it delights Thelma every day.  Thelma’s nursing assistant calls her “Granny”, tells her she loves her, and kisses her goodbye whenever she leaves.  The love and dedication of this team simply proves the impact that Thelma’s bright personality and never-ending positive attitude has on everyone who meets her.

Like me.  I met Thelma yesterday.  And just like everyone else who’s ever met her, I will never forget her.

Gone but never forgotten

Posted February 26, 2014 by hpccr
Categories: awareness, education, end of life, grief, hospice, spiritual care

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by Larry Dawalt, HPCCR Senior Director of Spiritual and Grief Care Services

Editor’s Note:  2014 has already been a rough year.  It seems like I learn about a heartbreaking death almost every week.  In fact, I don’t remember a time when loss has been so prevalent around me and the people I love.  That being said, I read this article from Larry Dawalt in our latest Bereavement Bulletin and thought that is was a poignantly appropriate article for what I (and others) have been experiencing as of late.  So if you have lost someone recently, I hope you take the following words to heart and rejoice in the continued relationship you can still have ‘on the inside’ with that very loved person who is no longer here. 

chasing shadowsHave you ever thought about where the idea came from that when someone dies, the purpose of the grief process is to get over them?

It has been such an accepted norm in society for many years, but lately it is being challenged more and more by a theory known as ‘continuing bonds,’ and I think that theory is closer to the actual grief experience.  While it would take pages and pages to explain the theory in detail (which has been done in the book Continuing Bonds: New Understandings of Grief), the phrase is basically a verbalization of the fact that people live on inside us long after they are physically gone.

Years ago, when asked about the death of her movie star mother Natalie Wood, Natasha Wagner stated that she “had to learn to have a relationship with someone who wasn’t there anymore.”  That task is one of the most significant parts of the grief process because even though they may be physically gone, those dear to us continue to live on inside us. And they live not just in our memory, but in our very being.

In his book The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are, author Daniel Siegel uses the term ‘neurological embedding’ to describe how our connections to others are wired within us.  That means people are a part of us to the point that they have helped shape who we are, including our beliefs, thoughts, concepts, and opinions about some of the most important matters of life.

That’s why the ‘process it and move on’ theory, which is about breaking apart a relationship, really doesn’t work.  The theory actually came from various interpretations of Sigmund Freud’s 1917 article “Mourning and Melancholia.”  Over the years we have had ‘stages of grief,’ ‘tasks of grief’, and other valuable theories that have been utilized to help understand the grief process.  And while these theories remain valuable – especially William Worden’s Tasks of Grief model – they are best understood with the realization that people live on inside us whether they are physically present or not.

The ‘reality of the loss’ is certainly that our loved one will not be physically present with us, but discovering what they left us and how they will always be a part of us is a task that can make grief more manageable.  That task will come soon enough, so please don’t try to rush this in the early days after the death of a loved one.  I agree with the saying that ‘when grief is new, words should be few’ and that includes our own internal dialogue.  But when the thoughts and feelings start to come again and as they continue into the weeks, months, and even years, I believe learning to have a relationship with someone who isn’t (physically) there anymore is the way we learn to function again and move forward.

They are inside us.  Their words, opinions, lessons, wisdom, guidance, and love are still there.  At the same time, some of the pain of relationships is there too.  This pain has to be dealt with, because just as joys are embedded in our brain, disappointments and pain are embedded there as well.

Having raised your awareness of ‘continuing bonds’, I want to encourage you to find an ongoing place for your loved one in your life.  This place will surely change over the years, but find a place where you can have a joyful, reconciled relationship where they are physically gone but never forgotten.  They walk with you, they help you, they make you smile, and when they make you cry it’s because of the way you miss their physical presence, while gratefully acknowledging the gifts they gave and the part of them that lives on inside you.

These continuing bonds will always be there, and whether you learn the theory from one of our hospice grief professionals or discover it through your own study and practice, I hope these bonds become a comfort for you and that you learn to have a relationship with your loved one ‘on the inside’ where they live as long as you live.

 


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