“This may be a dumb question, but…” That preface to a question is something FAIRHOPE Hospice’s staff hears frequently from family members of those on service. They might be asking about the illness, if there is more they can do to care for their loved one, or if they are “allowed” to do something in particular.

There are no dumb questions for us. We understand the family is under strain and sometimes aren’t thinking as clearly as normal. Depending upon the question we give an honest answer or reply with a, “We’ll see what we can do.”

Since our care of the person and their family deals with all facets of life, the questions asked might not necessarily be of a medical nature. Often the questions deal with last wishes. Surprisingly, questions regarding last wishes, or Bucket List type questions, most often deal with one-last-time desires. Many people on hospice service want to do something one last time. My experience has been not many people want to “See Rock City” at the end of life.

Recently, Tammy, one of our nurses, completed arrangements to transport a man on service from his home to The Pickering House. The man was born and lived most of his life in rural Perry County. He and his son loved to fish together and as the years went by, his grandson joined them. After retirement he and his wife moved to Florida.

When the man became seriously ill, he and his wife moved back to their beloved Perry County to be cared for by his son and daughter-in-law. Their plan was to stabilize his health so that they again could go fishing; at least once more. Regretfully, things didn’t work out as planned and he was admitted to FAIRHOPE Hospice.

He was bedridden when we admitted him and remained so. His wife and grown children cared for him at home. In time it became necessary that he was brought to The Pickering House, our in-patient facility. His health was deteriorating and additional nursing care could be administered there.

Arrangements were made and the next morning the transport ambulance arrived and preparations were completed. As the man was placed in the back of the ambulance, his wife joined him. She had the empty feeling that this was their last ride together. His son and teenaged grandson were to follow in their car. Our nurse Tammy, who was the man’s nurse and assisted the family prepare him for the transfer, was to follow in her car.

But before everyone got in their cars, the son asked them to wait. Hesitantly he asked Tammy, “This may be a dumb question, but…can we stop by the lake? It’s on the way and I’d like to take Dad fishing one more time.”

“Sure.” was the quick reply from Tammy. As a FAIRHOPE Hospice nurse, Tammy instinctively knew the importance of that question. Jubilant, the son exclaimed, “Dad, we’re going fishing!”

Initially, the ambulance driver was stunned by the seeming absurdity of the question. However, remembering the many hours fishing with her dad while she was growing up helped her to understand the importance of the request. This was not going to be just another patient transfer.

After notifying her dispatcher of the change in plans, the impromptu “fishing trip” began. A few miles out of town the entourage turned off US 22 and followed the narrow country road to Rush Creek Lake; the lake where they spent so many lazy days fishing. The slight sound of the gravel crunching and popping under tires broke the silence as the vehicles slowed to a stop in the parking area near the shore. I can’t imagine what was going through each person’s mind as they stared at the lake.

After a brief silence, the son asked, “Dad, do you want to try near the standing trees, or fish off the dock?” Even though his dad was semi comatose he knew his dad could hear. The son was painting a picture, reliving their many hours spent together fishing.

“Would you like to be near the water?” asked the driver.

Ever so carefully, she backed the vehicle toward the small boat dock. A tear blurred her vision as she realized that she was allowed a part in this intensely sacred event. Gingerly, everyone helped move the gurney onto the pier then stepped back. Words were not necessary. I’ve heard it said when a dad gives to his son, both laugh; when a son gives to his dad, both cry. There wasn’t a dry eye.

“This looks like a good spot, Dad.” Since childhood, how many times had he said that to his dad?

“You find a good place to sit down, Grandpa, I’ll get the tackle box.”, said his grandson.

They were creating another day at the lake. The son then cupped his hands to bring up some lake water. As he let the lake water roll over his dad’s hands, he could sense a smile on his face. For his dad, it was obvious that the frustration he experienced in his final months of not being able to go fishing was gone.

To those present, the entire Universe boiled down to just that scene on the dock; Grandpa, son, grandson fishing. Observing this his wife, almost whispering, said, “This will be forever in my heart, I will never forget this.”

What started as a simple transfer from home to The Pickering House unfolded into an event that made a lifelong, life changing impression on all of those involved. Tammy, the FAIRHOPE nurse, did not hesitate when the son asked if he could take his dad fishing one more time. She knew that fishing doesn’t just mean fish. She sensed that fishing must’ve been an important part of this father/son relationship. It was just that simple.

The patient was non-communicative, but that didn’t matter because men communicate through an activity more than they communicate by talking. This last fishing trip was a way for father and son to reminisce about their life together and to say a final good bye. The man’s son and grandson talked to him as if they were all fishing, but in reality they were communicating a life time of love and memories. Boys inherently follow their dad’s example, not their advice. And what a profound example this was for the grandson.

Although losing a husband, a Dad, a Grandpa is sad, the family had good memories of his last day. FAIRHOPE allows families to do what they feel is necessary to complete their life, and will try to assist if needed. Hospice doesn’t change what is going to happen but it changes how it is going to happen.

It is never too late to take your dad fishing, or to help him enjoy his favorite hobby.

 

 

Nursing is one of those careers that has steadily evolved. As the field expands and adds more responsibilities, what the career actually entails seems to be getting less clear-cut. I think the simplest definition of a nurse is, “A person trained to care for the sick and infirmed”. On the other side of the coin, The American Nursing Association states, “Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.”

Not too long ago the hospice where I work received a thank you card from a man whose wife had died on our service. In the card, the man thanked, “ the nurse who sat on the floor at (my wife’s) bedside with us when she had expired. (Our nurse) Tammy waited patiently and lifted our spirits while waiting for the funeral director to arrive to retrieve the body.”

The man’s wife had died at home in her bedroom. Since no one wanted to leave her alone, they sat on the floor. Tammy knew the family needed comfort, so she, too, sat on the floor with them. I’ve heard it said, ”People don’t care how much you know until they know how much you care. ”Tammy cared enough to take to take as long as was necessary to wait for the funeral director’s arrival. That simple gesture meant so much to the deceased’s family.

Absolutely, there is a need for advanced degree nurses, nursing professors, directors, leaders, etc. But at the end of life, the only need is for “a person trained to care for the sick and the infirmed”; a hospice nurse.




— American Nurses Association[36] (36) ANA Considering Nursing…Retrieved Dec 2018
(ANA website 2015) …found at acadamia.edu on 7/17/2020 and in wikepedia

     A little boy went to the cemetery with his dad on Memorial Day to visit his grandpa’s grave. His grandpa had been killed in combat. There was a flag next to the headstone. “Is this the only day we take time to remember the people who died while in the military?” he asked his dad. 

     “Every day is Memorial Day for us who lost family.” His dad replied.

     Any hospice organization has had veterans of combat on service. Most of these veterans have never been able to leave the trauma of combat behind. It is not by choice that the memories have stayed with them their entire life. And so it is with the surviving family and friends back home of someone who was killed in combat. The feeling of loss has stayed with many of them their entire life, as well. 

     Most hospice’s offer a grief service that is opened to anyone who has suffered a loss; particularly someone who has suffered a loss that they are told  they should “be over it” by now.

     Memorial Day was established to honor those who have died while serving in the United States military. It might also be a day that maybe we, who have not had a close family member die in combat, call someone who has. Where do soldier, marine, airmen, sailor, and Coast Guard combat casualties come from? They come from families. The survivors of someone being remembered on Memorial Day may carry the war with them for the rest of their lives, just as surviving combat veterans do.

     If you know of someone who lost a person during military service, call them and mentioned the deceased by name. Let them know that their loved one is remembered, and not just on Memorial Day.

 

Author Rick Schneider 

 

     It took a long time for me to realize the significance of Memorial Day. All through childhood and into midlife, Memorial Day consisted of a small parade from downtown to the veterans section of the cemetery. Then, a little while later, there was the distant boom of a 21 gun salute. And by noon it was the Indy 500 and a big cookout. But over the years as I’ve learned so much from the veterans we have on service at FAIRHOPE Hospice my way of “celebrating” Memorial Day has changed. 

     I wonder how the families who lost someone in the military, especially combat, feel about Memorial Day. It truly takes a family to defend a nation because those in the military come from families. I saved an article that was in a special issue of Newsweek magazine featuring an interview with a Vietnam veteran, who was 21 year old when the described firefight occurred. In it, he described his experience as to how combat in Vietnam occurred. It follows:

     “We were brought into La Drang on a Huey helicopter, and I had a few minutes to stand around and look at the area, which was just like every other operation in Vietnam. It was jungle. I was an assistant machine gunner that day with my friend Russ [ . . . ]. We traded off manning the weapon every other day. We barely had time to get our bearings when we came under heavy fire. And when the firing started, it wasn’t like a sniper shot or anything. It was bullets and bombs and grenades and everything going off simultaneously”.

     “And all at once, everyone around me is getting shot. My friend [ . . . ]was right in front of me and he got machine-gunned across the stomach. He dropped at my feet and was screaming for his mom. It was like something in a movie. You just can’t believe your eyes or your ears. And there were other guys just lying there dead, still in firing positions. So that scared the hell out of me. At that moment, my instincts and adrenaline just took over. I just ran, following Russ Adams, who was heading for the mountains with the machine gun. Since I had all the ammo, and the only weapon I had on me was my .45, It seemed like the place to go.”

     A friend of mine is a Civil War buff and he told me of letters he’s seen from soldiers of that war describing combat in much the same way as describe by the Vietnam veteran. Even though a mission might have been initiated exactly as scheduled, with a goal and a distinct plan of how to achieve it, once the battle erupted it was pure mayhem.

     Some of the aging spouses, and children, of those killed in combat are not able to get to the cemetery. Some may be having a difficult emotional time visiting the grave site. Maybe this year, before the cookout, feel free to thank a person who gave everything by going out to any cemetery. Find a veteran’s gravestone, or plaque, and clean around the site. That’s all.

      Such a simple gesture may have a profound effect on the surviving family, should they find out. And it may help you in that you aren’t saying, “Thanks for your service, I like tomato on my hamburger. “ but actually showing your gratitude. True gratitude is an action word.

    Every holiday has its meal for family and friends to gather around. For this Memorial Day, I’m not saying to give up the grill. I am suggesting considering making the cookout something for the end of the day, not the purpose of the day.    

 

Author Rick Schneider 

     

 

     There are a lot of articles written about the hospice philosophy, hospice care, who is eligible for hospice care, etc. But not many articles are written about humor, or laughter, in the hospice setting.  Having been a hospice patient care volunteer for over 20 years and a paid employee for over 11 years, I know that hospice is serious business. I also know that hospice, especially the one where I volunteer, celebrates life. And life may involve laughter, but hospice is no laughing matter, is it?

     Of course, we’ve all heard the overworked phrase, “Laughter is the best medicine.” It may be an overworked phrase, but it is also a well documented truth. Laughter is just as necessary in life as are tears. A friend of mine told me that laughter may be the best medicine, but if you are really sick, maybe you should call a doctor. Good advice.

     It is important to know that used correctly, humor does not disrespect the situation nor diminish its gravity. It can allow what is happening to begin to be discussed. Humor may open the door to acceptance and healing. It is up to those involved to find the humor is any given situation.

    Humor may be in the form of a funny situation or a joke. In my case I can never remember a joke so years ago I began writing them down after I heard one that I liked. I’ve kept those jokes in a binder. After I get to know a patient and it seems like the right thing to do (sometimes it is not), I will bring that binder with me when I visit them. I’ll ask the patient and family if they’d mind if I read from my binder. It has never failed when I bring the joke binder we all have a great time. They invariably tell me that they haven’t had a good laugh like that in quite a while.

     There was a particular family I visited as a patient care volunteer who requested what they called, a “groaner-type” joke when I arrived for my weekly visit. A groaner-type joke would be for example, “Why did the cowboy buy a Dachshund?” Answer, “Because he wanted to get a ‘long little doggy’” (groan). 

     When I would arrive to visit, his wife would answer the door and ask,” Do you know any groaners?” I would answer, “Yes. Did you hear about the man who was reading a book on antigravity? He just couldn’t put it down.” She’d laugh and ask me, ”Did you hear about the Siamese twins who moved to England…so the other one could drive?” Then we’d go back to the patient’s room and he couldn’t wait to hear the jokes. He’d always have one ready. For example, “The waiter asked the teddy bear, after his dinner, if he wanted dessert. ‘No thanks, I’m stuffed.’ The teddy bear replied.” The whole situation was fun to me. I remember thinking that I never thought that I would have so much fun visiting a patient. 

     Exchanging bad jokes was fun and it made the patient, his wife, and I think of a silly joke before my weekly visit. There is no doubt that he and his wife were having fun too. Yes, the patient and spouse knew he was terminally ill but we had fun in spite of it. 

     One of my hospice chaplains, Karl, tells the story of a terminally ill patient who is lying in his bed at home and smells the aroma of cookies wafting through the house.

     “Honey,” he calls out, “Those cookies smell so good, may I have one?”

     “Certainly not,” she replies, “Those are for your wake!”

     In one study of humor in the hospice setting it was determined that humor helped to maintain a sense of belonging. It helped patients to relax. It offered a feeling of warmth, lightheartedness, and delight. Humor was a life-enricher and a life enhancer. 

          A study done on nurse-based home visits found that humor was present in 85% of 132 observed home hospice visits. Of these visits, hospice patients initiated humor 70% of the time. In this study, and others as well, humor was spontaneous and frequent.

     A while back, I was accompanying one of my hospice’s nurses while she visited a patient in their home. The family pet was a cockatiel (a bird similar to a parrot). The family would leave the bird cage door open so that the bird could get out and stretch if it wanted to. While our nurse was sitting next to the patient the bird flew over and landed on the nurse’s shoulder. Without hesitation the nurse put her hand over her eye and said, “Aye, matey.” as if she were a pirate. Everyone had a good laugh.

     Instances of humorous interactions between hospice personnel and patients can be a prevalent part of everyday care giving work. According to the researcher in the study mentioned above, “Our research suggests that nurses and other healthcare professionals don’t need to suppress humor. They should trust their instincts about when it is appropriate.” 

     Humor shows the human side of hospice’s staff. It is also an important aspect of communication. Patients will observe the nurse or aide for a response to humor. An open accepting response to humor signals understanding. While a negative or no response may serve to isolate the patient.

     The hospice where I volunteer helps people to celebrate life. One way to celebrate life is to enjoy the moment, regardless of the circumstance. Laughter is a very effective way to do that. I’m often asked, “How can you work in hospice? Isn’t it sad?” It’s hard to believe that not only is it very rewarding to volunteer with hospice, but sometimes it can also be fun. Yes, laughing matters.

 

Author Rick Schneider