Hospice -  sign for medical fitness and health care

This week I got an opportunity to speak with the staff, in particular two Registered Nurses (RNs). We had a great discussion on their job at the hospice, how friends and relatives view them working in hospice and the balancing act they need to perform at work.

They both believe their job at the hospice to be very fulfilling. While “everyone” does not want to “play team” overall there is a great amount of teamwork and support among the entire staff at the hospice. ( I can vouch for this myself, titles do not matter at this hospice, EVERYONE DOES EVERYTHING.)

While nursing is seen as an admirable job, when the nurses speak of their position as a “hospice nurse” people (friends and family members) may turn their nose up, step back or say something to the effect of “why you want to work there?”. Some people say to the nurses “It takes a ‘special person’ to work there”. A sibling of one of the nurses told her “You just need to leave that job and get out of that death and dying stuff”, The nurses response “What if I were a Mortician making all that money? You would be probably be working right alongside me!”

I surprised to know that Nurses only get a 30 minute lunch break AND it is not a paid lunch (meaning that 1/2 hour that they are not working, they are not getting paid). It does not seem to matter because of the workload, there is no time to eat anyway.

While working with the dying can be challenging (I mean these individuals are facing their own mortality everyday and like all of us, experience grief from the loss of their loved ones). (Side note: if a person who does not work in hospice experiences loss, that person is away from work for days or weeks and then returns to work; a person who works in a hospice, returns to the same grieving-like environment). But back to what I was writing: while working with the dying can be challenging, the challenge seems to be in dealing with the loved ones of the hospice patient who refuse to accept the fact that the loved one is dying. While I have never been in the room while a person died, I’ve read that dying can be a disturbing event to observe IF you are not aware of the physical shutdown that is occurring.

For example: the “Death Rattle”. According to many reference articles, but in particular the Eastern Metropolitan Region Palliative Care Consortium, terminal respiratory secretions (aka the death rattle) “is considered to be due to a pooling of respiratory secretions that occurs as a person becomes weaker, loses consciousness and the ability to cough or swallow normally… Family members often express concern
that terminal respiratory secretions may be distressing to the patient, and they require ongoing support
and education to allay their anxieties.”
Essentially the death rattle is an indicator that death is imminent. When loved one hear the death rattle, it is so disturbing that the staff is often asked to provide medication to stop the sound. Here is where the nurse has to perform a “balancing act”. The nurse, through her training and experience, knows that the patients is not in distress; the loved ones are demanding that something “be done”. This puts the nurse is a quandary: does the nurse do what they know to be right or does the nurse assuage the loved ones? Chances are, if the nurse does not do what the patient’s loved one wants, surely as the morning follows the night a complaint will be file against that nurse.

It would help all of us greatly if we became more educated on death and the process of dying. Just like a woman’s body follows a process as it prepares itself for the birth of a child, so does the body follow a process to shut itself down. It has always been amazing to me that only half of the world’s population are able to birth children,yet just about everyone in the world can contribute one fact about pregnancy or childbirth; whether it is the fact that the average pregnancy is nine months, or that most women who are pregnant gain weight. Some people can even go farther that the average facts about childbirth in telling anecdotes about Sisters, Wife of a Coworker, etc. WE ARE ALL GOING TO DIE yet, very few people can have conversations about it – it’s too morbid!!

Yet we wait until the inevitable comes and we rely on the medical staff to explain to us what we should already have knowledge about. In many cases, Physicians, Nurses, Clergy are not formally versed in death and dying*; but that is another blog post for another time.

BD.

*I am referring medical staff in hospitals not hospices; most hospice care professionals are excellent in providing education and care for the dying and bereaved.