Ruth Williams

My belief about life in general is that we’re all here to learn and grow and share with others in their own journey of learning and growing.

That works in the grief arena as well. I was a psychotherapist in private practice before joining the Alive Hospice team. I learned from my clients with whom I worked then as I learn from the clients with whom I work now.  We all experience grief in our lives. None of us usually makes it “out of here” without losing someone we love.

By virtue of our being human beings, we have (or will have) the privilege of accompanying others on their path toward the end of life as well as having others accompany us! That may sound like a gloomy way to look at it, but it doesn’t feel at all gloomy to me. We all are here, alive, granted each new day to make the most of it.

Some of us are clearly facing death right in the eye. Others are being their midwives, guiding them as they transition out of this life into the next, either sitting at their bedside or nursing their wounds and easing their pain. Most (if not all!) of us simply have no idea of what tomorrow may bring for us or our loved ones.

A friend of mine, who has raised more four-legged “children” than most of us, once said something to the effect that our pets are often our greatest teachers about death. I’d never thought of it that way. However, our pets do tend to live fewer years than humans do, so we usually do have to face their death with them. Another lesson with an unsuspecting teacher, perhaps –- but hopefully, a valuable one.

Ruth Williams is a counselor with Alive Grief Support Services, the bereavement support program of Alive Hospice.

The Alive Hospice Blog received an Award of Merit at the 24th annual Parthenon Awards on April 28. The Parthenon Awards are given in recognition of excellence in communications by the Nashville Chapter of the Public Relations Society of America.

The Alive Hospice Blog was launched in January 2009 and features thoughtful commentary on end-of-life matters from Alive Hospice staff and volunteers. In its first year, the Alive Hospice Blog covered a variety of topics, including how caregivers help hospice patients and their families; misconceptions about hospice and answers to frequently asked questions; lessons hospice caregivers have learned from patients and families; hospice advocacy; coping with grief and loss; commentary on hospice research and relevant news items; charitable giving; special events and program offerings; volunteerism; advance care-planning; self-care; and health-care reform.

In addition to this award, the Alive Hospice Blog was spotlighted in a March 23 National Hospice and Palliative Care Organization webinar, “Marketing Hospice in the Digital Age.” It also was featured at a Center for Nonprofit Management (Nashville, TN) seminar as a best-practices example of how nonprofits can utilize blogging (in 2009, the blog’s first year).

Congratulations to all of the winners at theis year’s Parthenon Awards, and thanks to our readers!

Nanette Mathe

I love this quote:

“Anyone can carry his burden, however hard, until nightfall. Anyone can do his work, however hard, for one day. Anyone can live sweetly, patiently, lovingly, purely, till the sun goes down. And this is all life really means.” ~Robert Louis Stevenson

Many times, when I visit a patient, we talk about living life each day to the fullest. My patients have taught me that I can do anything for a day, even the hard stuff, especially when I approach the day full of thankfulness that I am alive. I often end my visit with a prayer of thankfulness: for the day, for enough to eat, for pain medicine, for the beauty of the earth, and for God’s presence.

Nanette Mathe is an Alive Hospice chaplain who serves on the agency’s Murfreesboro team.

Dr. David Tribble

There has been much discussion regarding the recent New York Times article regarding Dr. Desiree Pardi, a palliative care physician who chose to pursue disease-modifying treatment until she died, as if this were somehow contradictory, an abandonment of the principles she espoused in practice.  I have been privileged to read the response from her husband as posted by the Pallimed blog’s Christian Sinclair as well as a thoughtful response by Brad Stuart on Geri-Pal.

The salient point in both these excellent discussions is that the decision of how to conduct the end of one’s life lies with the patient, regardless of how we as hospice people think they should decide. As Brad so eloquently points out, we are obliged to meet them where they are and support them there, not to try to force them to agree with us. True palliative care provides informed choice.

Rob Pardi’s description of his wife’s final days shows her to have been faithful to that which she always espoused, that patients deserve good information and the right to choose their own direction.

I encourage us, therefore, to rid ourselves of the condescension that causes us to label anyone who does not follow the course that we, as hospice professionals, believe they should take as being in denial. It is possible that they do understand the poor statistics and choose to try anyway. It is possible that they are in denial because that is the only way they can deal with their situation.

As a final thought, however, I would pose that the medical community at large has the responsibility to distiguish between that which has a small chance to meet the patient’s goals from that which has no chance to meet the patient’s goals. There is a reason these treatments require a physician’s prescription: it is up to the physician to determine whether a given treatment is indicated for a given patient, and not to provide treatments which offer the patient no benefit.

It all comes down to honest discussion of possibilities and the willingness to be quiet and listen.

Dr. David Tribble is Alive Hospice’s chief medical officer.

Jan Jones

April is the month in which we have the privilege of honoring our trusted, dedicated volunteers. These amazing individuals work all year long to ensure that our patients and families are loved and comforted in a variety of ways. Some of them answer the phones and get people connected; others stuff envelopes with valuable information about what to expect in the grieving process; still others bring their beloved cats, dogs, and even ponies to visit those in our Residence or inpatient facilities.

We have people who are gifted in playing an instrument and/or singing who share that wonderful talent with our patients and families. Others do hair and nails or provide a massage or healing touch. I certainly would be remiss not to mention all the incredible volunteers who sit with patients for numerous hours just to be present so they know that they are loved. These volunteers might provide relief for the family who need a much deserved break or just be there to read or pray with patients, fix a light meal, write a letter — whatever the need may be.

Almost any talent can be shared with those whom we are privileged to serve. Most importantly, EVERY volunteer shares their loving spirit.

We have seen a very unique reaction to the difficulties with our economy over the past year: more people wanting to volunteer! Our statistics are staggering when we measure the impact of this service. In 2009, our 269 volunteers gave more than 15,000 hours of service.

So let this blog be a huge salute to the spirit of volunteerism and to our Alive Hospice volunteers in particular. Thank you! We would not be the premier program that we are without you!!!

Jan Jones is president and CEO of Alive Hospice.

In the days leading up to the third annual National Healthcare Decisions Day (April 16) Alive Hospice will provide helpful information about advance care planning to help Alive Hospice Blog readers get started. If you’ve already completed your advance directives, we hope you’ll encourage others to do so and forward this information to friends and family!

Click here to forward this information to a friend!

Dr. David Tribble

As health care reform (in whatever form it will actually take) begins to develop under our eyes, there is more attention paid now to the issue of thinking about, discussing, and then making known what each of us wants for ourselves.

A prominent news anchor spoke with no degree of charity about the narrowness of mind that refers to such conversations as “death panels.” In a recent blog at The Human Condition, the blogger developed an argument familiar to those of us who are already believers, that sober consideration of these issues in advance leads to fewer painful, intrusive, expensive, and ultimately unsuccessful interventions at the end of life. A salient point in this age of health care reform is that those who had the end-of-life converstations not only had earlier hospice care, better quality of life, and fewer futile hi-tech interventions. They also survived just as long as those who did have those interventions!

Those who fail to learn from history are condemned to repeat it. It is with that thought that we remember the last months of the life and dying of Terri Schiavo, in which two sides of her family waged a bitter and nationally televised legal battle, each side certain that it knew what she would have wanted, and neither side with possession of any firm information that they did, in fact, know. Tragically, there was also no way for either side to actually find out.

While most families do not achieve the degree of press coverage that this family did, the fighting and division can be just as bitter, all for the absence of each of us making some statement to someone who matters to us what we would want in such circumstances. It doesn’t matter what you choose for yourself, even whether it is realistic or not. It matters first and foremost that you make a statement about your wishes so that others don’t have the burden of making a decision on the basis of too little information.

It is also true that once is not enough. The decisions you make for yourself when you are 25 may look very different from the ones you make when you are 55. Even a week may make a difference, if, in that week, you have experienced something that changes the way you think of everything. There is no limit to the number of times you are allowed to change your mind, tweak your decision, or reconsider the whole thing.

None of that will matter, however, if you never tell anyone.

Dr. David Tribble is Alive Hospice’s chief medical officer.

The April 2010 edition of Palliative Care Grand Rounds, hosted this month by Tim Cousinis at Palliative Care Success, has been posted. Palliative Care Grand Rounds is a monthly round-up of compelling blog entries focusing on hospice, palliative care and grief matters. Check it out!