A student nurse was caring for her when the patient asked the student the same question that she had previously asked the entire medical staff, "Am I dying?"  The student, a young, compassionate, idealisitic woman, looked into her eyes and answered  in almost a whisper, "Yes, you are." 

When the patient's attending physician discovered that the patient knew her prognosis, the student nurse was immediately dismissed from the case and her instructor was chastised.  The physician didn't believe that this young mother needed time to prepare herself for her rapidly approaching death, nor did he or her family understand that she would benefit from sharing the experience of dying.  The end result was that she died in isolation, very much alone with her fears and her grief.

Times have changed.   Medical professionals no longer have the right to withhold information from a patient, even if the news might be devastating.  The dying process is now viewed as an ordinary part of life that is to be supported instead of hidden.  Hospice is the major reason for those changes.

When Doctor Elizabeth Kubler-Ross published  her book "On Death and Dying," in 1969 the medical community was suspicious and sometimes openly hostile toward her theory about the stages of dying. Nonetheless, after her book gained wider distribution a change began to occur in the way that the medical community viewed the needs of the dying patient.  It wasn't until 1974, however,  that the first Hospice was established in the United STates in New Haven, Connecticut.  Now, more than 3000 Hospice facilities exist in the United States.

What is the advantage of hospice?  When should the service be sought and who is eligible? 

To be eligible for Hospice, a person must be terminally ill and have less than six months to live.  All major efforts to sustain life, such as chemotherapy or a stipulation that the patient is to be resuscitated in the event of death, must be absent.  Hospice is a service only offered to those who are in the process of dying.

The major advantage of hospice is that it offers a better quality of life for the dying patient.  Every need is identified and addressed.  It is not uncommon, for instance, for the terminal patient to stop eating,or to be  constipated or to experience anxiety and pain.  The Hospice staff has a arsenal of knowledge and techniques that are utilized to bring comfort and peace to the patient and their family members during this difficult time.  In fact, it is not unusual for patients to actually get better.

Pain management is a first line of defense in the Hospice arsenal.  Patients who have experienced pain despite treatment in the hospital setting may finally find real relief once Hospice establishes a regimen of pain control.  Since pain is often the major reason that patients are unable to eat or sleep or relax, once the proper pain medication schedule is established, the patient finds that his/her appetite returns, that communication with family members is re-established and that peaceful slumber is restored.

A major complication of adequate pain medication is constipation so Hospice begins a bowel program at the same time as a pain treatment plan is implemented.  The patient may even receive medications to help restore appetite.

Family and patient counseling are also part of the Hospice philosophy.  Families and patients are encouraged to speak openingly about their grief, fears and pain surrounding the dying process.  A Social Worker is assigned to every family in order to facilitate open communication between the patient and family members, including children.  Hospice research has shown that the dying patient is very well aware of their state, even when families attempt to hide the information from them so a terrible burden is lifted from the patient when grief and fears can be shared with those closest to them.

A case manager RN establishes and oversees the plan of care, Nurse Aids are assigned to help with bathing and treatments and the spiritual needs of the patient and family are met through the ministers, priests and rabbis that are an integral part of the Hospice staff.

Hospice personnel are often present at the time of death in order to help both the patient and the family through the final stage of the dying process.  Since Hospice deaths frequently occur at home, hospice personnel also take care of the arrangements for removal of the body.  A social worker will carry out grief counseling for the family in the following days and months.  Special counseling for very young children of the deceased can also be arranged.

If the young mother at the beginning of this story had been afforded Hospice services, her anxiety about the fate of her children after her death would have been addressed.  She and her family would have been encouraged to discuss the reality of her dying and the grief that they shared about her terminal illness.  She would have been given medication to relieve her pain and anxiety and she would have had the support of a social worker to whom she could have expressed her deepest fears.  In the end, her family would have been encouraged to gather around her bed to say goodbye and her children would have received the necessary grief counseling to help them deal with her death.

Hospice services for the dying have brought peace and comfort to  countless families over the past several decades because it has demystified the dying process.  In the darkest time in life, the beacon that shines the brightest is the one that brings comfort and relief from pain and that beacon is Hospice.