The Inpatient Hospice

Hospice works to provide caring, compassionate care while death occurs naturally.

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There are many patients who I will never forget.  Some died in my arms.  Some had amazing families.  Some lived in abusive conditions, extravagant homes, or on the streets.  What I’ve learned in my adventures is that everyone has a story, and I am honored and humbled to be a part of and to witness a few moments at the end of their story.

One of the first nights I worked at the inpatient unit I admitted a young man.  He was in his twenties, over 400 pounds, and trached (this is when a tube is placed through the throat in order for you to breathe, sometimes with a ventilator).  The ambulance bought him in after his family called; they could not care for him and they wanted him transferred out of their home right away.  He was dying.

Hospice transfers patients from home to the inpatient unit during periods of crisis, uncontrolled pain, new onset of seizures, or other medical reasons.  Transfers were not uncommon, even during night shift. It was the middle of the night and he arrived alone, no one but uniformed paramedics accompanied him.  This was a young man who required a lot of help – he couldn’t move himself, clean himself, or communicate easily.  He was alert; he was having difficulty breathing, and he seemed to be in pain.  Did I mention he was actively dying?

I assured him I would do everything to help get him comfortable.  He tried so hard to say something to me, but the tube in his throat that kept him breathing also prevented his vocal cords from working.  I got closer, listened as best I could, and was shocked.  “Kill me,” whispered through his trach.  I pulled back with wide eyes, not sure if I’d heard correctly.  That’s not how hospice works!  Hospice provides caring, compassionate care while death occurs naturally, but we do not euthanize patients.  He grabbed my wrist, using every bit of energy to repeat “kill me, please.”  It was clear that time, said with his pleading eyes and his trembling body.

His breathing was labored and he grimaced when moved, so I said “I’ll get you some pain medication.”  His eyes squeezed shut, tears rolling to his side.  He was in pain and I could treat that, but I couldn’t kill him… that’s not what hospice does!  But he was saying it, no doubt in my mind.  It seemed he’d been through so much and a young man in his condition was not what someone would think of as dignified.  He was in pain, so the Dilaudid and Ativan I gave helped him relax.  I was still at a loss.

Thank goodness the other nurses on duty where experienced and I asked them to take a look, curious to see what they thought.  “He’s still in pain,” the charge nurse said, “give him another dose of Dilaudid with Ativan.”  I gave the maximum the doctor ordered three more times before my shift ended.  The next night I worked, he was gone.  No one mentioned him, but I had to ask.

“The doctor came in and increased his medications.  He died peaceful around noon.”  The nurse told me she was with him when he took his last breath.  No family came; no one at their home even pick up the phone when she called so a message was left that his remains were sent to the mortuary.  They still hadn’t called back when I arrived that night.

I was appalled at how the family treated this young man during his last days.  Thank God they had the decency to send him to hospice and allow the loving, compassionate nurses there to take care of him.  No one should be in pain – physical, emotional, or spiritual.  The hospice nurses, including myself, made sure this young man was cared for, comfortable, and died with as much dignity as possible.