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Facing Mortality

July 15, 2015  |  Cathy Finn

We have a gentleman who has been a patient with us since 2005. He’s had his challenges through those years; he’s battled with addiction and stretches of homelessness, as well as fairly continuous ill health. For years he has had to come into the office at least once or twice a month. The Duffy medical staff has been at his side as he went from subtle illness, depression, more severe illness, and now it is evident to the staff that he is terminally ill. 

It’s a hard thing for the staff to acknowledge; it is nearly impossible for this gentleman.

His decline is getting quicker; every time he comes in to the office someone says “He looks so much worse.” We got him Visiting Nurse to go to his house daily. It is difficult for him to get around. It is difficult to talk about what needs to be done.

Duffy is in an internal conversation about improving our end-of-life planning. Sometimes we are the last resort for finding next of kin for our patients; a call from the police or the hospital will send us to our records, hoping we have a loved one identified.

We are hoping to get an advanced directive, listing the efforts the patient wants to maintain his life and her next of kin, from most of our patients. When it becomes a normal topic of conversation during a provider’s visit, while someone is well, it is more thought out and more likely to be filled out.

I have been in with the patient on a few visits lately; the room has been a bit crowded with all the people who care for him; his physician, Dr Klein, a case manager, sometimes a nurse. When I first sat in, this man was insisting he was doing all right; things would turn around, maybe he’d get a transplant. Gently, Dr. Klein told him that would not happen, for several reasons, and he explained why. At this point, our patient would talk no further about his health.

The next time, after the medical discussion was over with, Dr Klein brought up this man’s mortality again. This time he listened a bit; he said he wasn’t ready to talk about it. He was quiet. It was difficult for Dr Klein; this middle aged gentleman, had in effect, killed himself through his hard living lifestyle; there were echoes of that thought around the room. No one had to say it, or wanted to.

A few weeks ago, Erin, our pod nurse stopped me in the hall. “He’s asked his Visiting Nurse to set him up with Hospice.” We had been seeing him suffer with the physical ailments and with the sorrow that comes with acknowledging our time on earth is short. The acknowledgement was, for us, a huge relief. Now he could get the care he needed and deserved to see the end of his life with the least amount of suffering. The end of his life will be, with loving care, on his terms, should he decide to deal with it that way. At last he won’t be seeking the cure, the unwinding of many years of poor choices and hard life.

It was a slow, gentle, caring process that Dr Klein and Erin brought him through to more peace and less pain. 

With Hospice in place we probably won’t see him in our clinic again. But like so, so many of our patients, he will always be in our hearts.

End of life issues are difficult but important to discuss. Click here for more information. Click here for more information about hospice or to become a hospice volunteer.