I've been in Hospice nursing for just under a year now and find the most difficult patients, physically and emotionally, are ALS (Amyotropic Lateral Sclerosis or Lou Gehrigs Disease or Motor Neuron Degeneration) patients. The common prognosis from diagnosis is 5 years. People know from the beginning that it is terminal. They are faced with having their entire world close in on them, becoming completely paralyzed with loss of communication and respiratory ability but their minds remain active. I would like to hear any comments, suggestions, stories etc...on how other hospice nurses deal with this frightening disease process in their patients who have it.