An unusual event occurred in the Pickering House only a few years after it opened. The event was a Thanksgiving story that I don’t think will be made into a movie on the Hallmark Channel. It was, however, a nice illustration of how the importance of the Thanksgiving Holiday brings out the best in everyone.

When someone staying for a few days in the Pickering House has an unusual request, we will address it. What adds a little color to this particular event is that it occurred in the late afternoon on Thanksgiving Day.

The woman on service, “Kay”, was spending a few days at the Pickering House. She was depressed due to being alone on Thanksgiving. Her family was celebrating the holiday as they always did at her sister’s house several States away. Being alone in her room Kay just wasn’t in the holiday mood.

In the late afternoon of that particular Thanksgiving evening, one of our STNAs walked into her room and almost gleefully asked her if she was ready for a nice plate of turkey, dressing and mashed potatoes. Kay turned and looked out the window at the dark grey sky and said that she wasn’t the mood for “that type of food”, as she called it. Our kitchen staff had prepared a holiday banquet for all of the staff, visitors and people who were staying at the Pickering House on Thanksgiving.

“Well, what would you like? Our kitchen staff will prepare anything you’d want.”

“They can’t fix what I want.” After a pause and with a sarcastic tone of voice she said, “All I want is a pizza and a beer.” After a sympathetic conversation with our STNA, Kay decided upon some vegetable soup.

Leaving Kay’s room our STNA got to thinking that maybe this is one of those we’ll-see-what-we-can-do situations. She knew that beer was out of the question because of the medication the woman was taking….but….we can order pizza for her!

“Well, why not?” she thought.

The staff also thought it was a great idea and they all pitched in. They ordered several pizzas and a couple of six packs of root beer. When it arrived, the staff brought in extra chairs placing them around the woman’s bed. They began the “feast” by bowing their heads and giving thanks for the food they were about to receive.

What a Thanksgiving dinner that turned out to be! One of the staff members who attended said it was probably the most profound, meaningful prayer before a meal she had ever said. One of the nice things about this Thanksgiving dinner was that when done, no one had to do the dishes or clean the kitchen.

FAIRHOPE celebrates life up to the very end and this Thanksgiving “banquet” of pizza and root beer was a good example. In the gathering of our staff around the bed of someone in the last stage of life, there was joy, there was love and there was life. Yes, life with joy and giving thanks for each other’s presence in that room.

In the words of Charlie Brown’s friend, Marci, “Thanksgiving is more than eating, Chuck. You heard what Linus was saying out there. Those Pilgrims were thankful for what had happened to them, and we should be thankful, too. We should just be thankful for being together. I think that’s what they mean by Thanksgiving, Charlie Brown.” (– A Charlie Brown Thanksgiving, Charles M. Schultz)

Thanksgiving can be the nicest of the three holidays because it takes the littlest preparation. It can be celebrated extravagantly or it can be celebrated simply. The day’s festivities can be loaded with tradition or planned as painlessly as, “Well, why not?”

Happy Thanksgiving!!

One late afternoon a woman entered the Pickering House carrying two grocery bags filled with a variety of items. She told me she was returning the left over supplies we had given her to care for her mother whom she had been caring for at home. As she walked across the reception area she glanced to her left, looking out the window and stopped without saying a word. She was quiet for a moment, staring out the window at the bird feeder in front of Room 1.

Breaking her stare, she approached me at the reception desk. She told me that before she passed, her mom had stayed at the Pickering House in Room 1 for a short respite stay. She told me how important the bird feeder was to her mom, saying that her mom watched the birds every day from morning until after dinner.

“Then the deer would come over and clean the feeders out.” She added smiling.

Her mom said that watching the birds gave her peace and helped her sleep at night. It became obvious that bird feeder was calming the daughter even now as she watched the birds flutter around the feeder waiting for their turn.

When the Pickering House opened in the Spring of 2007 there was one bird feeder in the front yard. That single bird feeder became a focal point almost immediately. Those temporarily being cared for at the Pickering House, as well as the visitors and even our staff enjoyed watching them. And I think that it was more than enjoying it, as there seemed to be a need to watch them. So many commented on the feeders with the overriding theme being that after only a few minutes of gazing their stress seemed to fly way. Sometimes people would sit in the lobby of the Pickering House and just gaze at the birds; Deep in thought.

Realizing the obvious importance of the feeder to everyone at the Pickering House, one of our volunteers, Jason, brought up the idea of a bird feeder outside of every room. Soon, they were bought and set up within a few feet of each window in the 12 room facility. Each bird feeder is in easy sight of the person lying in bed and close enough so that chirping can be heard.

It can’t be emphasized enough that the natural conclusion of someone’s life involves peace. It involves silence. And it involves spirituality. Mother Teresa said, “God cannot be found in noise and restlessness. God is the friend of silence. See how nature – trees, flowers, grass grows in silence; see the stars, the moon and the sun, how they move in silence…”

Who would have thought that, those many years ago, when Jason’s idea of putting a bird feeder in front of each window was accepted that it would have such a positive effect on so many people for such a long time? After all, it’s just a bird feeder.

 

 

Sharon met the four volunteers at the door of her father’s hospital room one April afternoon. Her father, Len, was in one of the Palliative Care rooms of the hospital. The volunteers had been requested to honor her father, a veteran, for his military service with a brief military pinning ceremony.

While in the hall outside of her father’s room, Sharon told one of the volunteers that the room was packed and that there wasn’t any more space for even one person to stand in his room. She said if they’d wait for a minute she’d ask a few people to stand in the hall and watch the ceremony from there.

Soon, with a little bit of confusion and a lot of, “Pardon me”, “Excuse me.”, “I’m sorry.” and one “Oops”, the four volunteers threaded their way through the crowd of family members to get near Len’s bedside and begin the ceremony. Even though Len was in a deep sleep the facilitator introduced himself and explained what he and his cohorts were going to do.

Before beginning, the facilitator asked if any of the family members would want to perform the actual fastening of the pins to Len’s garment. This is a significant gesture because when someone enlists, the family is left behind and most likely experiences separation anxiety. And the same is most likely experienced by the one who enlisted. By fastening the pins to the garment the family experiences the joy of honoring their loved one just as the loved is experiencing the joy of being honored.

Len’s grandson, Chris, serving in the Air Force stationed at Grand Forks Air Force Base, had flown in to be able to witness the ceremony honoring his grandpa. Sharon said Chris idolized his grandpa and always said when he grew up he was going to enlist in the Air Force.

The family insisted that his grandson, Chris, should be given the honor of fastening the pins.

The ceremony began and soon it was time for Chris to fasten the pins. He crouched down at his grandpa’s bedside so that he was eye to eye with his hero and carefully fastened the American Flag pin to his garment above the heart. Then the Branch of Service pin was fastened below the flag. After he finished, he hesitated then put his head down on his grandpa’s chest and softly said, “I love you, Grandpa.” He stood up and took a half step back. Visibly holding back tears he stood at attention. There was a stillness, a deep sense of oneness prevailed in the room for those few moments.

The ceremony continued as one of the volunteers read the certificate and presented it to Len’s wife. The volunteers then individually crouched down to be at eye level to Len and thanked him for his sacrifice to our country.

Five family members in Len’s family were veterans. The facilitator asked if the veterans present would want to join our volunteers in saluting their dad/grandpa/brother to conclude the ceremony. All agreed. They unanimously voted Chris to command the salute since he was active duty.

All of the veterans formed around the foot of Len’s bed. Chris stared at his grandpa, took a deep breath and barked, “A-ten-shun!” The men snapped to attention.

“Present Arms!”

They brought up their right hand and held their salute. Five seconds later Chris commanded, “Order Arms” and their hands came down to end the salute. Chris returned to his grandpa and again crouched down and laid his head on his grandpa’s chest saying, “I love you, Grandpa……I love you.” There were sniffles, and tears were wiped. The salute concluded the ceremony.

There is no calendar and no clock at the end of life. So for FAIRHOPE Hospice, every holiday is celebrated when appropriate. Celebrating a holiday brings a sense of normalcy to a family in crisis. The volunteers were part of FAIRHOPE’s “We Honor Veterans” program and in this case they singularly celebrated Veterans Day in a hospital room on a nice April afternoon with one veteran and his family. It was good.

FAIRHOPE is grateful to all veterans for their sacrifice and we will celebrate their service and their life regardless of the hour, the day, or the month.

 

I have been a patient-contact volunteer for over twenty-four years. During so many of my visits, when the spouse is preparing to leave, she will give her husband (who is on our hospice) the shortlist of hospice staff who may be stopping by. Experience has shown me the most important person expected to visit is no surprise. It is the man or woman who is the nursing assistant. 

Being in the forefront as a somewhat passive observer to hospice, I have learned much about everyday hospice care. A good percentage of what I have learned is not so much what is in the books and brochures about amazing care by amazing staff; rather it is about what is most important to the person receiving the care. Not only is the person receiving a great deal of attention, but so is the family. To see so much attention focused on a loved one gives the family assurance that they are not alone. 

Each hospice generally assigns a registered nurse (RN); possibly a licensed practical nurse (LPN), also known as a licensed vocational nurse (LVN); a nursing assistant (aide, CNA, STNA); a social worker; and the offer of a chaplain and a volunteer to be of assistance. The one who makes the most favorable impression, by my unscientific study, is the nursing assistant. Theirs is a title that varies by region: nurse aide, certified nurse aide (CNA), nursing assistant, certified nurse assistant (CNA), patient care assistant (PCA), and state-tested nursing assistant (STNA). I’m sure that I have left a few titles out, but at the core they are the angels of hospice care. Probably the easiest way to describe what they do is to use the short version of the Prayer of St. Francis. It follows:

Lord, make me an instrument of Your Peace: where there is hatred, let me sow love. Where there is doubt, faith, where there is despair, hope. Where there is darkness, light. Where there is sadness, joy.

O Divine Master, grant that I may not so much seek to be consoled as to console; to be understood as to understand; to be loved, as to love; for it is in giving that we receive, it is in pardoning that we are pardoned, and it is in dying that we are born to eternal life.

Let’s take a look at that prayer line by line, from the perspective of a nursing assistant:

Where there is hatred, let me sow love. Since the late 1990s, I am aware of only two people with AIDS who have been under the care of my hospice’s service. Both of the people, by their own admission, had become infected with AIDS as a result of their lifestyle. And they felt they were now paying the price.

However, their parents were also paying the price, although they had done nothing to deserve it. The parents heard derogatory comments about AIDS patients wherever they went. They hurt because their sons were suffering and because no one seemed to care about them.

No one cared until the families called my hospice and our staff entered their lives. I remember when one of our STNAs gently, tenderly put salve on one of the men’s sores. I felt as if I was watching Mother Teresa doing it. The STNA told me she only sees the need, not the cause.

Where there is injury, pardon. Our home-side nursing assistants visit the people on hospice wherever they live. In one particular setting, a newly hired nurse assistant had a difficult person she was caring for. After a few months, when the dying process started, the man reached for her arm and, in a barely audible voice, said, “Thank you. I love you.” The nursing assistant had taken the brunt of his anger over her previous visits with him. She endured much but understood where it came from. Those five words confirmed that this was where she belonged.

Where there is doubt, faith. People always think of the future, perhaps thinking of an upcoming vacation, a special outing with friends, or simply a day to enjoy one of life’s pleasures. When someone becomes terminal, everything changes because the person runs out of future. Doubt begins to settle in rather than looking forward to what lies ahead. Our nurse assistants remove a person’s doubt and fear by looking at the individuals with the eyes of faith. By their presence, nurse assistants bring emotional and spiritual comfort to those at the end of their life.

Where there is despair, hope. Often, terminally ill people have been lying in bed for an extended period. Often they may experience depression. The anticipation of the nurse assistant’s arrival gives them something to look forward to as a ray of hope.

Where there is darkness, light. I was talking to one of our nurse assistants, Stephanie, and she said that whenever she tells someone she works in hospice, she gets admonished in some fashion. “That’s so depressing.” “How can you work there? Can’t you find something better?” Truth is, Stephanie has been with us for quite a few years, and she told me she wouldn’t want to be anywhere else. She lights up the lives of the people on service with her unconditional and empathetic love.

Where there is sadness, joy. A woman was brought to the Pickering House for symptom management. She seemed depressed. Talking to her, one of the nurse assistants discerned that she had been engaged for quite a while, and now it looked like she and her fiancé would never get married. Hearing this, our STNA initiated plans that were quickly carried out by the staff of the Pickering House, the in-patient facility of my hospice. And the couple was married that evening. While the ceremony was taking place in the Sun Room, the staff eagerly made the new bride’s room into a “honeymoon suite.” Through tears of joy, the woman said, “Now I am complete.”

Grant that I may not so much seek to be consoled as to console. Patsy, one of our nurse assistants, walked into a person’s room to give her a massage. The lady was curled up in a ball, not from pain, but from fear. Over the next hour, as Patsy gave her a slow, gentle massage, she sang and prayed for her. The lady relaxed to the point that Patsy said she would lift the woman’s arm a tiny bit, and it would “plop” down on the bed. The woman went to sleep as Patsy was shampooing her hair. When Patsy told me about this, she said it had been a rough day up to that point, but the ill person came first, and Patty came second.

To be understood, as to understand. Near the end of her shift, Carla, a Pickering House nurse assistant, was pushing a man on service in a wheelchair. He had been restless, and she was hopeful this would relax him. The man noticed a woman carrying her purse, a floral arrangement, and a shopping bag. He asked if he could take them to the door for her. “Sure, I could use the help. I hope my purse isn’t too big,” she said with a laugh. He placed the three items on his lap, and Carla pushed him to the front door, where the woman thanked him. Earlier the man felt that he was “wastin’ away,” as he put it. Intuitively, Carla understood his need to be needed.

To be loved, as to love. I was talking to a woman whose mother had been on hospice. She mentioned that she had never forgotten how tenderly Kelly, the nurse assistant, would touch her mother. She also mentioned that when her mother wanted to talk, Kelly would pull up a chair and sit next to the bed so that she would be at eye level. “Where do you find people with so much love?” she asked.

It is in giving that we receive. Every nurse assistant I have talked to has told me they receive much more than they give. A family member told me that she was “almost startled” by the cheerfulness of our aides.

It is in pardoning that we are pardoned. Our nurse assistants sometimes may deal with difficult people. It is a part of the job. They understand the emotion of a person losing control of his or her life. They easily pardon any negative emotion because it is not aimed at them.

And it is in dying that we are born to eternal life. Angela, a longtime nurse assistant, told me about a woman she was tending to at an assisted living community. When Angela visited one afternoon, she noticed that the dying process had started.

The woman always had a two-bulb lamp lit next to her bed, but as Angela approached the woman’s bed, one of the lights went out. She didn’t think too much about it at the time. Sensing that the woman’s final hour was approaching, Angela sat at the woman’s bedside. At almost the same instant that the woman took her last breath, the second bulb went out. The room was now dim, and Angela was enveloped by the spirituality of the moment. She was there at the most important moment in the woman’s life, as she entered eternal life.

What does a nurse assistant do? I think the quickest way to find out is to listen to the words of St. Francis.

 

     One of the misconceptions, or myths, of hospice is that it’s a place; some sort of medical building. The notion is that if you sign on to hospice service you will have to go somewhere. With many hospices, you don’t go anywhere. In fact, you stay where you live whether it is your home, a family member’s home, a friend’s home, a nursing home or an assisted living facility.

   However, not to muddy the waters, there are some hospices in America that do operate care facilities for those on their patients. When the famous Washington Post columnist, Art Buchwald, admitted himself into a Washington D.C. area hospice he moved into their facility. That particular hospice didn’t visit people in their home, as the hospice where I volunteer does. Our hospice facility is, at its core, a short term respite facility.

   And when we care for people who live in their house, we understand that it is their house and not ours. Therefore, they may have their bed set up where ever they want. As a hospice volunteer, several of the people I visited preferred to sleep in their living room recliners because they were more comfortable. It’s their home, after all.

   In your home, the feeling of who is in control is brought back to you. In a hospital, or in any type of institution, you are not in control. In your home you are in control and can stay in any room you prefer. During this stage of your life, being in control is one of the most important aspects of life.

Every hospice is blessed to have a wonderful group of volunteers. All hospice volunteers are vital to ensure that hospice fulfills its mission of helping those under their care. Hospice came into existence through the efforts of volunteers, but they aren’t just a luxury. Medicare requires at least 5% of all hospice patient care hours are provided by volunteers.

Hospice volunteers fulfill many roles. Sometimes they assist in the business office, some help with fundraising, while many are patient-contact volunteers or reach out to families through bereavement support calls. A volunteer chooses what area in which they want to serve. At my hospice, it may be all four.

Of the four areas of volunteering, the patient-contact volunteer is offered several unique privileges. The patient-contact volunteer is given the privilege of entering into someone’s life to help them complete goals and relive special delights in their personal history.

Will Rogers said, “We all can’t be heroes, someone has to sit on the curb and clap as they go by.” The volunteer allows the person on service to be the star of the show by allowing them recount their successes, failures, funny stories, regrets, accomplishments, and goals.

Supporting someone on our hospice with their goals may involve helping them reunite with an estranged child. It may be connecting them with people to help them complete a train layout as a final gift to a grandson. Or it may be lending a hand to a Marine veteran whose goal is to put his fishing boat away for the winter so that everything is in order and he can die in peace. Completing personal goals are an important part of the final stage of life. Patient-contact volunteers are often involved in helping make these final requests possible.

Along those lines, the patient-contact volunteer is in the position to help people relive a favorite activity one final time. For example, one of our volunteers, Margie, was talking to a woman, Kay, who was staying for a few days at our hospice facility, Pickering House. She was lamenting about how all her life she loved going on picnics. Sadly, now that she was ill and bedridden Kay knew she would never go on another picnic.

On her way home Margie thought, “Why not bring a picnic to Kay?”

The next day the two of them shared a lovely picnic on the woman’s bed in the Pickering House. It was that simple. The woman said the only thing missing was the ants.

As with Margie, many of the activities in which patient-contact volunteers are involved consists of a one-last-time event. Over twenty years ago, as a patient-contact volunteer, I was visiting with a man while his wife went shopping. When I arrived, he was sitting in his favorite chair, a recliner. After his wife left, he decided he wanted to nap so he slowly got up out of the recliner. His bed was a mere five feet away. I helped him get out of his recliner and waited while he steadied his feet. I assisted him by holding his arm as he took the short walk to his bed.

As it turned out, I walked with him during the last steps he ever took. The volunteer coordinator called me the next day and said the man’s kidneys began to shut down. He died two days later. I got to thinking that over eighty years ago he took his first step with, most likely, a lot of fanfare from his parents. I had the honor to be with him when he took his last steps after all of those millions of steps throughout his life.

I frequently hear comments about how sad it must be to volunteer for a hospice. Whether at a hospice in-patient facility or in the home of someone on hospice, our volunteers help them celebrate and complete their life. As far as I am concerned, there is nothing more enjoyable and satisfying than that.

 

Taxi cabs were still an important part of the cityscape in 1972. In an effort to pay my way through college, I drove a Yellow Cab in Dayton, Ohio during part of that year. My cab was #30 and that has been my lucky number ever since. Those seven months behind the wheel of a taxi exposed me to every facet of life. And as I look back on my cab driving career, one fare that took 20 minutes from start to finish eventually brought me to my last career position; volunteering and working for a local hospice.

On a very drizzly, dreary, dark evening in late February, I was dispatched to the Emergency Room of Miami Valley Hospital to pick up a fare. Since the location of a hospital’s Emergency Room is familiar to everyone that was where most taxi related hospital pick-ups were. Emergency Room fares were always interesting because I never knew if the fare would be a banged up Emergency Room patient being released, a staff member needing a ride home, or any of a myriad of reasons someone needed a ride.

As I pulled up, a small, frail woman probably in her 80’s approached my cab. I got out and assisted her into the back seat. Her address was on Xenia Avenue, just east of downtown. Since we were heading to an older part of the city I asked her about the neighborhood, how long she lived there, etc. I always enjoy hearing about the “good ‘ol days”. She talked for a bit about the neighborhood then gently turned the conversation towards me. I told her that I was recently married and my wife had been a nurse for about a year.

“Oh, you two have your whole life in front of you.” She sounded so happy and excited.

Then, as she gazed out the side window of the cab, said that she had been at the hospital visiting her husband of 63 years and that he was very sick. I wasn’t sure how to respond. But after a few seconds of quiet, she continued talking, almost wistfully, about her husband and their life together. Being newly married, I found it fascinating.

“His nurse said that he wasn’t doing very well and that he needed his rest. Someone came in and said that visiting hours are over and that maybe I should go home and get some rest, too.” Talking softly, as if to herself, she said, “He is going to die tonight, I know it. They wouldn’t let me stay.” I thought to myself, “After an entire life together, on a day that was just as important as their wedding day, why did the hospital staff send her home? Why separate them when their need for each other is so intense?”

I pulled up to their house, the house they moved into as young-marrieds over 55 years ago. Low clouds and drizzle muffled the sounds of the city and dimly reflected the lights of downtown onto the small front yard. Hurrying around the cab, I opened the taxi’s rear door for her and she slowly got out. I instinctively put my arm around her and walked her up to the front porch.

She gave me the house key and I let her in. She wished me and my wife a happy life together and as I turned to leave she embraced me, pressed her head in my shoulder and started to sob. “He was such a good man. I’m going to miss him…I’m so scared.” Caught off guard, I held her for a bit. I did not want to leave her.

Again she said, “He’s going to die tonight. I know it. Why wouldn’t they let me stay?” Again, I had no reply. She turned, went in, and I stood there as the door closed. After a moment I turned and took a few steps toward my cab. I stopped. My bottom lip started to quiver and my eyes moistened. Gazing back at the dark silhouette of her house I realized her life was ending, mine was beginning. It was as if she passed the baton of life to me.

A lot has changed in the medical field since 1972, but the change in the medical field has not just been in technology or pharmaceuticals. There has also been a change, albeit a small one, in the thinking on the part that the family plays when dealing with a serious illness. Through the hospice philosophy, we are turning back from medical invincibility to reality.

When I think of that woman I picked up from Miami Valley Hospital, I think how different it would have been had hospice come to America by that time. Hospice care has brought some common sense into what modern thinking had turned into a clinical event: the end of life. Common sense, or maybe I should say “hospice sense”, tells me that the woman’s husband did not need rest. Rest for what? He needed his wife and she needed him. She needed to be with him and to comfort him. Couldn’t the hospital staff have bent the rules just a little for her? All these years later, I still think of her. Little did I know that that short fare would eventually bring me to hospice.

Twenty five years later, in January of 1997, I saw an ad in the paper about hospice seeking volunteers and instinctively knew that I had to do it. I didn’t know much about hospice then but I did know that hospice care focused on people. That it encouraged family and friends to gather when someone was approaching the end of their life, and not send family home to “get some rest”. In fact, many times at the hospice where I now volunteer, our staff has helped a spouse get in bed with their dying partner so that the one could comfort the other.

When I got back in my taxi that night the dispatcher was calling my number. He had a pick up for me at the Galaxy Club on Linden Avenue….It was a “go-go joint”…. And life went on.