Thursday, June 19, 2008

What Hospice Can Accomplish

Benjamin came to us over a year and a half after he'd been diagnosed with pancreatic cancer. He was eligible for hospice the day his oncologist gave him the news -- his cancer had already spread to his liver. But Benjamin had elected aggressive treatment and even had participated in some clinical trials. He bought himself an extra year. Finally, though, the tumor had stopped responding, and he accepted his doctor's advice that he enroll with us.

A dapper gentleman of the old school, Benjamin was in his mid-sixties. He was unfailingly polite and was the sort of man who minimized his discomfort. It was only after talking with me for an hour that he admitted he had deep-seated, gnawing abdominal pain that he rated as a 7 on a 0 (no pain at all) to 10 (worst pain imaginable) scale. His appetite was off, and he was losing weight as well as hope.

Dr. Cicely Saunders, who created the modern hospice movement, used to talk about "total pain" -- physical, psychosocial, and existential. Benjamin's physical pain was signficant. But he suffered psychologically, too. He'd taken great pride in his work. He was a teacher of others in his field. His wife suffered along with him. She'd lost her first husband to cancer in his 40s. And Benjamin had left his religion a long time ago, but now with death just over the horizon he longed for some kind of return.

Hospice care is inherently interdisciplinary. Our team did its best to respond on all levels. Benjamin's pain was easily controlled with small doses of methadone and a form of cortisone. Since he and I shared the same religious background, we talked easily about it, and I was able to connect him to local clergy. Our social worker, nurse, and chaplain worked around the edges of his despair about leaving his wife behind, and with her about the dread of seeing her history repeat itself. Our combined efforts brought relief to his suffering. Benjamin worked until eight days before he died. He was able to attend a tribute at which 200 people -- coworkers, friends, and students -- honored him with their memories of how he'd made a difference in their lives. His passing was gentle and quiet, with his wife and our nurse and home health aide in attendance. The team went to his funeral, a gesture much appreciated by his widow and his children from his first marriage.

What would Benjamin's death have been like without hospice? He might well have enrolled in yet another clinical trial and come to his end in a hospital, hooked to machines with his physical pain under-treated and his other suffering scarcely noted. Instead, the totality of his pain was addressed and, hopefully, relieved. I take great pride in knowing that, but for the efforts of our team, Benjamin might not have been able to attend that tribute and certainly would have left this world with unresolved pain.

No matter what one believes about what happens when this life is over, surely a gentle and comfortable passing is to be preferred. Hospice can help make that happen.

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