Journal: 06/03/06

Spring is here and so are the June bugs. I saw one this evening after work, it was chilly outside and the bug was on the ground, on its back and listless in the cold. I turned it over and it slowly crawled under Bill’s car, a relatively safe place, unless a cat found it. I imagine that in the morning when the air warms up it will recover and go on about its business. What surprised me was that the bug was huge, at least three inches long. Having done my good deed for the day, I returned to my evening beer.

Remembering Joann’s Home Hospice Decision

An article in today’s newspaper triggered memories of the discussions I had with Joann about her decision to go through home hospice. "Late-life chemotherapy under fire," in the Monterey County Herald, June 3, 2006, talks about the increasing tendency of patients at end-of-life to submit to radical procedures even though there is no hope left. The article discusses cancer patients as the primary group and what a waste of professional time and effort additional procedures are when death is a certainty.

One point leapt out at me in the article, that the number of cancer patients entering hospice care in the last three days of life also increased. "’That’s like a waste of the whole hospice process,’ which stresses preparing the patient emotionally and physically for death." This thought triggered a memory of Joann’s decision to do home hospice.

Before Joann came home for the last time, we discussed what she wanted to do when it came time to quit doing "recovery" things. These dialogues took place many times over the year before she came home in February and entered home hospice. Every time we talked about it, she said that she would rather be comfortable than be supported by machines. When she came home that last time, there wasn’t any thought of putting her into an actual hospice either for the "last three days," although the VNA offered it as an alternative if I couldn’t handle it. She only wanted to die at home, around those she loved and cared for.

I can understand fighting to the end, but there is a point where it is pointless. When all normal support measures fail and the patient isn’t responding to treatment, then it is time to shift gears and let it go. Joann understood that. She had a collection of doctors who were honest with her and as a former nurse; she well knew the state she was in. There wasn’t any point in fighting anymore, as she had done for three years. The choice was hers and she took the best way out she could for herself and all the rest of us.

She was also right about something else: it is tougher on those who remain than those who have moved on. I know I will make the same decisions for myself when my time comes.