Thursday, January 27, 2011

The Hardest Cold Call: Dispatch from the Hospice Front

Coming Home Hospice at 115 Diamond in San Francisco's Castro neighborhood.

You think that cold-calling a potential employer during a recession is hard?  Then try this on for comparison: the first day working at a hospice.

Firstly, I'll clarify exactly what hospice is.  A hospice is a facility for the care of terminally ill patients who have been diagnosed with six months or less to live.  The average stay at hospice is 35 days.  Besides the length of stay, hospice differs from a nursing home in that hospice medicine – medical care for people who are at the ends of their lives – is geared towards patients who don't have much time left.  Pain medication may be given in higher doses, treatments can be specified for end-of-life symptoms, and, at the decision of the patient, family, and doctors, no aggressive curative treatments will be undertaken (commonly chemotherapy, surgery, or antibiotics).

A hospice is a a place where dying people live.  And I'll tell you about my first day volunteering at one of them.

The staff at Coming Home Hospice in San Francisco, a quaint former convent in the Castro, consists of nurses, social workers, and doctors, as well as cooks and housekeeping staff.  Then there are patient-care volunteers whose job it is to make the rounds and talk to any residents who are lonely.  Last week, that was me. 

I showed up for my first shift knowing that I wouldn't receive many instructions, as the staff are busy and so volunteers are left on their own.  However, the head nurse informed me, with a sympathetic wrinkle to her forehead, that one resident was "actively dying" (systematic organ failure, analogous to a computer shutting down its programs) and although he wouldn't be responsive to a visitor, I should sit with him.  I walked into his room.  The blinds were pulled so the morning sun only came in faintly through the slats.  A very thin man was sleeping, breathing  heavily in a hospital bed where his willlowy arms and legs were virtually lost in the folds of the blanket.  I said his name, to which he didn't respond, and sat in a chair next to him.  There was nothing to do but be with him and listen to his rattling breath.  I was waiting for the grass to grow, and he was waiting for death to come.

One hour past.  I left his room to walk around the residence.  Breakfast had just been served, and through the doorways of the single-occupancy rooms, I could see that tray tables with the remains of eggs, oatmeal, and coffee stood beside the patients' beds.  The rooms are arranged such that the patients have a view of the window, meaning that I couldn't see their faces from the doorway. 

But from where I stood, it seemed like they were all asleep, maybe taking a post-breakfast nap.  Most of the residents were older, and all were thin.  None of them looked like they wanted to talk to me. 

I returned to the first floor, where I encountered Rich, the hospice director.  He asked how I was doing.  I told him that the residents all appeared to be sleeping.  He nodded, curled one side of his mouth upward and said, "You never know, you just never know."

Never know what?  It took me a while to understand.  But then I realized that he meant we never know if a dying patient, who is restricted to a hospital bed, is sleeping or could indeed use some company.  Imagine the following scenario and you will also understand:  you are given the prognosis of having less than six months to live.  Your body is failing you, you can't stay at home anymore, and so you move (or are moved, by your family) into a residence where nurses can tend to you around the clock.  Not many people come to visit, and within a very short amount of time – even a week – the monotonous passage of days eludes you until it is impossible to say how long you've been there.

So, the best you can do is close your eyes.  And hope that you sleep.

A hospice resident who appears to be "resting", therefore, could be seen like a telephone receiver in its cradle.  I had to learn – gently – to pick up the phone and see if anyone was there who wanted to talk.  I'd have to learn to walk into a room, pull up a chair, introduce myself to the closed eyes of a patient, and be ready for a grateful response, or a grumpy answer, or no answer at all.  It was like a cold call to the spirit of a dying person.

I will periodically report on my volunteer service at Coming Home Hospice.