Category Archives: hospice

Heart Journey 1

Holding Hands with Elderly PatientI recently attended a one day workshop sponsored by Mary Washington Healthcare and other Virginia parent hospice organizations. Heart of the Journey is a biennial affair that is open to all hospice volunteers in Virginia. Approximately 125 volunteers were in attendance this year from around the state. The goal of the workshop is to further equip volunteers in their effort to care for their patients and patient families by having healthcare professionals present practical and helpful information that can be used by volunteers when performing their work in facilities and homes. It is wonderful to interact with experienced professionals about quality methods to better care for those at end of life. It is also uplifting to be with so many experienced volunteers. The winner of the door prize for having served the longest as a volunteer went to an elderly lady who has been doing hospice volunteer work for 29 years. Amazing.

We began at 8 in the morning and finished in the afternoon around 3:30. We enjoyed a keynote speaker and presentation, four workshop sessions, a lunch break midday, and a closing plenary session. It was a packed and busy day. I met up with my supervisor and with a co-volunteer, Amanda. Amanda and I trained and tested together. I hadn’t seen her since we took patients so it was fun and interesting to hear how things are going for her. Amanda aspires to become a hospice chaplain someday.

I enrolled in four workshops:

1. Vigil Volunteering: A Gift at the End of Life’s Journey
2. The Things That Matter Most
3. The Spiritual Journey of a Hospice Volunteer
4. How to Make Your Volunteer Visits More Meaningful

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Traveler Lodging

olddinnnMany years ago, religious orders in Europe provided places for sick travelers to stay and heal during their journeys. These places were called hospices. Fast-forward to today, then. Hospice is a place that offers comfort, safety, and compassion for those who are traveling life’s most difficult time. I am blessed to currently be caring for two elderly gentlemen. We talk about their memories. We talk about places they have been and things that they have done. Sometimes, I quietly sit during their naps, too. During the time that I am with these kind men, their families or caregivers can rest, run to the store, enjoy lunch away from the house, or spend some time however they would like to spend it to get some rest and recuperation. I’m privileged to be trusted to be with these individuals – both patients and families – during their last times together. My hope and intent is that I can bring some comfort, honor, and integrity to these during an otherwise difficult time.

I learn continuously from hospice mentors and professionals who have each been helping people through transition for many years. I’m amazed at their empathy, care, and sensitivity. The video below is about our local organization. Many in the video are ones who have had a hand in training and mentoring me. In the video, you will meet Cynthia. She is now one of our chaplains. You will also meet another one of our chaplains, Bob. I’m glad that I can spend next Mon afternoon, Veteran’s Day, with Bob at a facility in King George where we will be honoring old veterans with a pinning and prayer ceremony. I’m happy to be pinning a small flag medal to the lapels of the vets as Bob introduces and thanks each one for their service. It will be a good afternoon.

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Don’t Say It

ooooopssssA few of these statements might be said with permission or with a deeper understanding of the one hurting. Most of them are completely inappropriate. All of them are definitely on squishy ground, and, unfortunately, all of them have been said at one time or another.  I’ve had a few said to me. Of course, no one ever means to be insensitive but saying the wrong thing at the wrong time often suggests that the one saying whatever it is that is being said is nervous, uncomfortable, and skittish talking about loss and death.

This is a good list of things not to say when working with someone who has lost a loved one. Take a few moments before you try to say something thinking that you are going to fix things. Fact is, there is nothing that you can say to fix what has happened.

The better approach is to listen, listen, listen. And ask questions. “Where and when did you meet?” “What were your favorite vacation spots?” “What were his/her favorite pastimes?” “What can I do to help you right now?” “Would you like to go for some coffee?” “Can I be with you for a little bit?” “Can we look at some of your family pictures?”  All of these questions, when asked at the right times, show sensitivity, care, and patience. And most importantly, they demonstrate your desire to be in the presence of the one who is hurting. Being quietly and respectfully present is the most important help that can ever be rendered to anyone who is hurting.

From my Hospice class.

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Statements Made To People Who Are Grieving

• “I know how you feel.”
• “It’s part of God’s plan.”
• “He/she is in a better place.”
• “Look at all you have to be thankful for.”
• “This is behind you now. It’s time to move on.”
• “Be thankful. You had (fill in blank) years with him/her.”
• “He/she isn’t suffering anymore.”
• “You are young – you will meet someone.”
• “Do you have other children?”
• “Everything will be ok.”
• “He/she will always be with you.”
• “God doesn’t give us more than we can handle.”
• “You are lucky you had such a great love. Some people don’t.”
• “He/she is watching over you from heaven.”

· 2 Comments. Posted in grief, hospice.

Pressure

strasss
From my Hospice class.

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Stress Management Techniques

Eat breakfast. Food is the best source of energy for your body. Without a healthy breakfast, your body has to use some other source for energy (and it isn’t fat). If you’re not hungry in the morning, you probably ate too much and/or too late the night before.
Get 30 minutes of physical activity a day. This is a tremendous stress reliever and actually can provide more energy for you. This is not necessarily exercise; it is activity or movement – like cutting grass, raking leaves, washing the car, or cleaning up the house.
Say “no” a little more often. There are two “always” that lead to increased stress. You always can spend more money than you make, and you always can take on more tasks than you can do. Learning to say no a few times will help you avoid both of these. If you have trouble saying no, at least don’t say yes too quickly. Wait a day before you decide.
Set a realistic schedule. Know the difference between what you can do and what you would like to do.
Listen more than you talk. Enough said.
Eat well 80 percent of the time. It is not the occasional “less than healthy” snack or meal that causes problems.
Do something you enjoy.
Shut down your computer, telephone, pager, or television for a brief time. Maybe an hour or two a day.
Take a walk. Even a five or ten minute walk will help.
Worry less. “Worry is crossing bridges before you get to them and carrying a responsibility that wasn’t intended for you.” Before worrying about a matter, consider the two types of worry situations: (1) those which you have absolutely no control over; and (2) those in the past, which are the same as (1). Make sure your worry is not one of these two types.
Use humor and good things to reduce your stress. Make a list of some of the funniest people you’re around. List your favorite places to go. List some of the things that lift your spirits.

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Moving Through Grief 2

gutbeter
From my Hospice class.

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You Know You’re Getting Better When…
Part 2

The grief process is slow and is often a ‘one-step forward and two-steps backwards’ motion. It is sometimes difficult to see signs of improvement. The following are some more clues that will help you to see that you are beginning to work through your grief.

You know you are getting better when…

□ You have developed a routine or a new schedule in your daily life that does not include your loved one.
□ You can concentrate on a book or favorite television program. You can even retain information you have just read or viewed.
□ You no longer have to make daily or weekly trips to the cemetery. You now feel comfortable going once a month or only on holidays or others special occasions.
□ You can find something to appreciate. You always knew there were good things going on in your life, but they didn’t matter much before.
□ You can establish new and healthy relationships. New friends are now part of your life and you enjoy participating in activities with them.
□ You feel confident again. You are in touch with your new identity and have a stronger sense of what you are going to do with the rest of your life.
□ You can organize and plan your future.
□ You can accept things as they are and not keep trying to return things to what they were.
□ You have patience with yourself through ‘grief attacks’. You know they are becoming further apart and less frightening and painful.
□ You look forward to getting up in the morning.
□ You stop to smell the flowers along the way and enjoy experiences in life that are meant to be enjoyed.
□ The vacated roles that your loved one filled in your life are now being filled by yourself and others. When a loved one dies he or she leaves many ‘holes’ in your life. Now those holes are being filled with other people and activities, although some will remain empty. You are more at ease with these changes.
□ You can take the energy and time spent thinking about your loss and put those energies elsewhere, perhaps by helping others in similar situations or making concrete plans with your own life.
□ You acknowledge your new life and even discover personal growth from experiencing grief.

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Moving Through Grief 1

umpussible
From my Hospice class. I am not yet able to check all of these items off of the list. I still need more time. But there are some that I have accomplished. I am grateful.

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You Know You’re Getting Better When…
Part 1

The grief process is slow and is often a ‘one-step forward and two-steps backwards’ motion. It is sometimes difficult to see signs of improvement. The following are clues that will help you to see that you are beginning to work through your grief.

You know you are getting better when…

□ You are in touch with the finality of death. You now know in your heart that your loved one is truly gone and will never return to this earth.
□ You can review both pleasant and unpleasant memories. In early grief, memories are painful because they remind you of how much you have lost. Now it feels good to remember, and you look for people with whom to share memories.
□ You can enjoy time alone or look for activities to keep you occupied.
□ You can drive somewhere by yourself without crying the whole time. The automobile seems to be a place where many people cry, which can be dangerous for you and other drivers.
□ You are less sensitive to some of the comments people make. You realize that painful comments made by family or friends are made in ignorance.
□ You look forward to holidays. Once-dreaded occasions can now be anticipated with excitement, perhaps through returning to old traditions or creating new ones.
□ You can reach out to help someone else in a similar situation. It is consoling to be able to use your experience to help others.
□ You can enjoy a good joke and have a good laugh without feeling guilty.
□ The music you shared with the one you lost is no longer painful to hear. Now, you may even find it comforting.
□ You can sit through a religious service without crying.
□ Time passes and you have not thought of your loved one. When this first happens, you may panic, thinking, “I am forgetting.” This is not true. You will never forget. You are giving yourself permission to go on with your life, and your loved one would want you to do this.
□ You’re eating, sleeping, and exercise patterns return to what they were beforehand.
□ You no longer feel tired all the time.

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Grief Expectations

expuct
From my Hospice class. This list is very accurate and true.

Adapted from How To Go On Living When Someone You Love Dies by Therese A. Rando, PhD.

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Appropriate Expectations You Can Have
For Yourself in Grief

You can expect that:

• Your grief will take longer than most people think.
• Your grief will take more energy than you would have ever imagined.
• Your grief will involve many changes and be continually developing.
• Your grief will show itself in all spheres of your life: psychological, social, and physical.
• Your grief will depend upon how you perceive the loss.
• You will grieve for what you have lost directly and for what you have lost for the future.
• Your grief will entail mourning, not only for the actual person you lost, but also for all of the hopes, dreams, and unfulfilled expectations you held for and with that person, and for the needs that will go unmet because of the death.
• Your grief will involve a wide variety of feelings and reactions that are not solely those that are generally thought of as grief, such as depression and sadness.
• The loss will resurrect old issues, feelings, and unresolved conflicts from the past.
• You will have some identity confusion as a result of this major loss and the fact that you are experiencing reactions that may be quite different for you.
• You may have a combination of anger and depression, such as irritability, frustration, annoyance, or intolerance.
• You will feel anger and guilt, or at least some manifestation of these emotions.
• You may have a lack of self-concern.
• You may experience grief spasms – acute upsurges of grief that may occur suddenly without warning.
• You will have trouble thinking (memory, organization, and intellectual processing) and making decisions.
• You may feel like you are going crazy.
• You may be obsessed with death and be preoccupied with the deceased.
• You may begin a search for meaning and may question your religion and/or philosophy of life.
• You may find yourself acting socially in ways that are different than before.
• You may find yourself having a number of physical reactions.
• Society will have unrealistic expectations about your mourning and may respond inappropriately to you.
• You may find that there are certain dates, events, and stimuli that bring upsurges of grief.
• Certain experiences later in life may resurrect intense grief for you temporarily.

In general, most people underestimate the length and severity of their bereavement. Our expectations tend to be too unrealistic, and more often than not we receive insufficient assistance from friends and society. Your grief will not only be more intense than you expected but it will also be manifested in more areas and ways than you ever anticipated. You can expect to see brief upsurges of it at anniversary and holiday times, and in response to certain stimuli that remind you of what you have lost. Your grief will be very different from others and dependent upon the meaning of your loss, your own personal characteristics, and the type of death, your social support, and your physical state.

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Second Thoughts

MWHC_sqr_stackI’m into my second week of Hospice training. There is still much to me that is new and very interesting. Here are a few more thoughts on this adventure.

1. I am now an official employee volunteer at Mary Washington Hospital. Badge and all! I went through MWH’s required day-long orientation program this past Mon. All new MWH employees must attend new employee orientation prior to reporting to their first duty stations. There were about 40 of us in the orientation. This orientation takes place every two weeks for new employees. At my table was an RN who will be reporting to and working in the OR, a fellow Hospice volunteer, and a man who had recently retired from MWH as an HVAC and maintenance engineer after 28 years who is coming back as a wheelchair volunteer. At our partner table was a new RN fresh out of school who will be reporting to Snowden, an accountant who will be reporting to accounts receivable, an experienced RN who will report in to take care of new babies, and another new RN who will be working in physical therapy. So many interesting and fantastic stories.

2. Guess how many languages MWH has had and is currently having to use to conduct business with patients? 86! MWH has around ten full-time translators and access to a contracted service who provides any other language translation necessary in order to communicate with patients and/or their families. Importantly, no one can officially translate in the MWH system unless they have been trained and certified by MWH. Even staff who have a second language can’t translate. And by federal law, anyone under 18 years of age can’t translate. Trained translators have a small blue stripe on their employee badges identifying them as being certified. And around the hospital are “blue phones”. These phones immediately can put anyone in touch with someone who can translate.

3. The top languages being used now by patients come from the Middle East and from Africa. Ten years ago, the predominate languages tended to be from Central and South America. This change is due to the huge influx of refugees into Virginia and the Fredericksburg area from the Middle East and Africa. (Virginia is one of the top ten states in the US who accepts refugees.)

4. As part of Hospice, I have volunteered to work in the We Honor Veterans program. Today, one in four Americans who die is a veteran so there are a lot of vets needing attention. We Honor Veterans is an amazing program for vets and their families. The effort is a fairly new (ten years old) endeavor to bring the resources of the Veteran’s Administration and Hospice to bear in order to take care of deserving vets at their end of life. The opportunities and potential to do good for old veterans and their families is incredible. I’m very humbled and excited to be apart of this effort.

5. Fact of the day – addicts are acutely sensitive to pain. I’d never thought about this and it brings up all kinds of interesting moral, ethical, and physiological questions. It also brings up the chicken and the egg conundrum. We discussed how Hospice treats and can manage pain with medications, if necessary. Sadly, the hardest patients to treat for pain at end of life are those addicted to chemicals that were abused in order to relieve pain. I’m still having to think about this.

6. The top end of life issues dealt with by Hospice are cancer, cardiac complications, and lung complications. Cancer has always been the #1 concern for Hospice end of life patients. The average case for Hospice is, unfortunately, only eleven days.

7. The highest risk items that lead to falls in the home for the elderly are loose carpets and throw rugs, electrical cables, and pets. Yes, pets!

There is so much more. All of us are studying up for one-on-one competency tests in the coming week. These are by appointment with the director of volunteer services and others. I’m getting a bit anxious about this interview. There is lots to cover and know but each evening we do some review and discussion so I hope it won’t be too surprising and difficult.

I feel blessed, humbled, and nervous to be working with Hospice. And thanks to some of you for helping with encouragement and reference information. In several short weeks, I will be going out with a mentor and begin taking on cases.

Prayers.

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Empathy

From my Hospice class.

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Autobiography

whule
From my Hospice class.

Autobiography in Five Short Chapters

By
Portia Nelson

From
There’s A Hole In My Sidewalk

Chapter One
I walk down the street.
There is a deep hole in the sidewalk.
I fall in.
I am lost…I am helpless.
It isn’t my fault.
It takes forever to find a way out.

Chapter Two
I walk down the same street.
There is a deep hole in the sidewalk.
I pretend I don’t see it.
I fall in again.
I can’t believe I am in this same place.
But it isn’t my fault.
It still takes a long time to get out.

Chapter Three
I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in…it’s a habit…but,
my eyes are open, I know where I am.
It is my fault.
I get out immediately.

Chapter Four
I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.

Chapter Five
I walk down another street.

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