Hospice , twice this year.

[RNERHOUSESUPOR]

I'm not a Hospice Nurse, but unfortunately will need to have them again in my life. My Father passed away this spring and my younger brother had a visit with the local Hospice on Thursday of last week. Although I have been a nurse for 20 plus years, I had not lost someone "before their time" (in my opinion) die until this year. I have lost Grand Parents , Aunts and Uncles but all sort of finished with life at the time. My Brother was diagnosed with stage 4 Lung cancer coming up on three years ago, and has done much better than I expected. My Dad was diagnosed earlier this spring with the same but didn't do as well. He died in April. Last week a couple of my Brothers Dr's said he had from 2 weeks to 2 months left. I have tried to prepare myself for the inevitable but don't know how it will really be. Was able to be present for Dad, but am not sure I did everything I could. It took me a while to sort of get aggressive with the nurses to ensure an absence of suffering. Looking back, I think I should have acted sooner to prevent some obvious (now) suffering for my Father. I really don't want to do this again, but I don't have a choice. Twice in a year is asking a bit much, isn't it???????

I have been able to spend some extra time with my Mother this summer. Was able to get a Travel Assignment close to home and have been spending every weekend at home with Mom. Today I helped my brother move 6 ton of Gravel in a patio he wants to finish before he dies. He let me drive the truck and run the tractor, so I know he is not feeling well and is sort of winding down. I will be OK, I think. I am really worried about Mom and my youngest Brother, they are "lay" people and don't really understand some of the medical issues. Mom was there for Dad, but has commented on how hard it's going to be with my other brother. It's one of the reasons that Dad seemed to go so quickly. He didn't want a son to go before him. When I started this I thought there would be a question at the end, but right now there doesn't seem to be one. If you have a comment, I will appreciate it, and maybe it will elicit an edit with a question. If not it does feel better letting some of this out.

Rod

[DelanaRN, MSN, APRN, NP]

Dear Rod,

I am so sorry that you are going through another loss so suddenly after the passing of your father. I can't even imagine the grief you must be feeling. I certainly imagine your heart and mind flit back and forth between all the stages of grief (Denial, Anger, Bargaining, Depression, and Acceptance) and I don't doubt you will continue to feel and experience all of these emotions as you move towards final acceptance. Hopefully, your brother is already signed onto Hospice and as a family you have accepted Social Work, Spiritual Care, Bereavement Care, etc as the psychosocial aspect will be a very big component for all of you. Verbalizing your wishes, thoughts, and fears to your Hospice Nurse Case Manager will help to alleviate your concerns and put both your mind and the mind of your brother at ease. For instance, I have a patient with Lung Cancer who is not as fearful of actual death as he is of the dying process. He has expressed that he wishes to feel no pain and that when his time comes, he be kept as comfortable and comatose as possible until he passes. I will do my best to accomodate his wishes and have made our medical director aware of his concerns. We have discussed palliative sedation, but I don't feel that will be necessary. Additionally, he and his wife get regular visits from our bereavement care coordinator and spiritual care. His biggest ailment at this time is depression and anxiety, and we work through it together, as a team.

Try to enjoy the time you have with your brother, albeit, a potentially short amount of time. If possible, act as a care provider and be there as often as possible during his nursing visits so that your questions can be addressed and you can be taught different aspects of palliative care. This precious time at the end of life is so very special, and it can not be regained once it is lost. You will likely treasure the coming days, weeks, and months greatly. Do things with your brother he enjoys. Talk, reconnect...engrain the lines of his smile into your memory. Hold his hand and tell him you love him. Reminesce. Most of all, remember that your separation is temporary, his suffering will cease, and one day, you will be reunited. It is not "goodbye" but "until we meet again".

God bless.

[RNERHOUSESUPOR]

Thank you Delana,

I was lucky to get a travel assignment close enough that I can spend every weekend at "home". Have been working 3 to 11 for the past 11 weeks and will be able to start 12 hour shifts in a couple weeks. Will still have every weekend off but one will be a 5 day weekend. I'm sure my brother will have several projects he will need assistance with. My first week home we dug out a space for a "patio" and are slowly getting it completed. I help with his yard work and what ever I can.

The past few weeks he has been getting a bit worse. Having dizzy spells and has loss quite a bit of feeling in his left hand and arm. Is still walking well (if he isn't dizzy). He had been on steroids and has ballooned up to 265 lbs. Has stopped the steroids, tapering over the last 3 weeks and should be completely off any day now. Don't know if that will have any effect right now. He likes to eat and isn't able to be too active. It bothers him a bit, not being able to do what he wants. He watched our Dad sort of get the diagnosis and then become suddenly unable to even get out of his chair. Dad suffered with bone pain for several weeks before finding out it was from Lung Cancer that metastasized to the bone. I keep telling myself that I need to have a talk with him to find out what he wants. Just don't seem to be able to do it yet. Tried this past weekend by asking how the visit went with the Hospice intake person and he said 'maybe I'm getting a little ahead of myself'. I told him he was in charge and could use them or not. I did say it's not too early if you want to discuss things before you may not be able to. That's sort of where it ended. I'll just be there as much as I can.

Thanks again for the response and advice.

Rod