Hospice

Hospice

There is an organization that was designed for the sole purpose of giving care to the dying through their last months of life.  Hospice was a word derived from “hospitality” of all things, and now since the 1960’s, the movement to a home based end of life program has had the name.  The name is good, the program is good, and the idea that there is a gentle way to the natural end of life is a welcome change to the fate that awaits us all.  There is a question though.  Like all of life there are times when the end of life comes sooner and in ways unexpected to some of us.  What then about the function of Hospice.  The group is actually called Hospice and Palliative Care providers.  It is the Palliative in the group that I want to focus for a minute.

Palliative Care is the part that deals with the pain, the stress, the anxiety, and the symptoms of illness.  So you would be trained in the ability to observe and then treat those symptoms.  Trained to notice the hidden, the obscured, the small things of the patients so that you would have an awareness of the changes or patterns of your clients.  You would have a history of behaviors that could be tracked and then followed as a pattern so that you would be aware of a masking of real pain, or an avoidance of the next phase.  It is a history of care, but also of the trajectory of the dying.  The intractable phases of a process that only goes one way.   Hospice is a program that deals with the impending death, Palliative care deals with the path that you take to get there.  It is there for the patient, and for the family and friends.  They help in the process of grieving and the needed protection from the do-gooders that are unhealthy to the perishing.  Provider and protector depending on the need.

We get this as a society, and as those that are close go through the process of deterioration and the care of these people is begun, there is a place where we realize that we are glad they are here.  But what of those in a different group.   What about a Hospice for the hurting marriage.  What does that look like.   On the one hand there is the hope that it is only a little flu and not the shutting down of the respiration system of the marriage.  To set up a group in your church to come along side and be the Marriage Hospice group would be a little awkward if they suddenly took an interest in your life.  It might scare away some folks.  But there are some that are going to need the help, to learn to grieve their dying dreams.  To need some Palliative care for the symptoms of a broken heart, a loss of companionship, absent appetite, limping walk of faith and a hiding from others.  To go through this list, as well as a matching one for the dying, it is amazingly similar.  So are the behaviors that reveal an unhealthy grieving process.  Exaggerated behaviors from anger to hiding at home or out every night with different people, there is a pattern for hurting people that is sometimes simple immaturity and sometimes a cry for attention and a release of anger. 

The list of the needy is interesting once you start thinking about it.  It includes the struggling spouse of the addicted or other unhealthy patterns, but also the business owner that is near the end of their capable contributions to the business or near the end of their finances.  The pastor that needs to leave the church because their time there has come to an end, and the church that needs to close its doors.  The mother that will not let their child grow up, or the child that will not leave the home, both make the list.  The college student in the wrong program and cannot leave it due to the pressure from a large influence in their life.  The home-owner that cannot make the mortgage and needs to walk away.  The addicted, and those that are addicted to being needed, all make the list as well.  And suddenly you realize the pattern that you find is this, someone needs to bring the big questions to them. Is it you?  What if you are the one that needs to be asked, rather than the other way around?  Will you still call them friend? 

There is a special group of care-giver that is good at being a Hospice Nurse.  Like any vocation, some have a desire to be good at it, and some are good at it.  Not everyone should be in the business, and some in it should be told to get out, because there is a way that things are done that is healthy, and there is a way that is unhealthy, even for the dying.  They also need to be able to see those that can get better, and back to healthy.

So what would a healthy healing for the hurting look like.  What if they don’t want it? Can you walk to the edge and let them bleed?  Are they like the panicked swimmer that is dangerous to the rescuer and must be let to collapse of their own struggling so that the care-giver can finally get close?  Well, the hard answer is yes, but we don’t have to like it.  So we help the ones that can be helped.  We come along and lend guidance and counsel to the ones that will listen.  We hold a hand and help them walk to the door and then to the places that they need to go to be a functional human.  If there is a place that needs to be avoided then perhaps that is the case.  If there are places that need confronted, then the hard things must take place. 

How do you train for a task like this?  Well some is psychology, some disposition, some the Holy Spirit and then there are these two items; time on task and brokenness.  The first is simply a matter of maturity and that takes time.  The second is the genuine reality that there is a bereavement taking place and you need to embrace that or you will come off as shallow and trite, mechanical and functionary rather than grieving and sorrowful.

You will also need someone to debrief during and after the experience.  It is a draining and debilitating endeavor, and to ignore your own health during the process is a failure of observation.  Be vigilant about your own place in the process.  The next is to not preplan the process.  It will take its own path, and you need to let it.  To be accepting of the reality that there is an individuality to what is going on, and most often baggage that was unknown before hand that will come to light.  Some will be odd or uncomfortable to deal with, some simply sad. 

And what about closure?  Is there something that can be called the end?  Well kind of.  If there is support through this it is that you would teach a process of life rather than simple coping skills.  There is a difference in teaching someone to fish, and giving them fish, so keep on the teaching side of the track.  There are times that the giving of fish is needed, but not long and not often and only in the idea of a taste so that they will then be motivated to search for the equipment for themselves.  What does the end look like?  It is always different.  Some go quickly, some get stuck for a very long time on one of the stages of grief.  It is always a surprise what will move them off of stuck and onto movement.  After surgery the hospital refuses to feed you until your bowels wake up and start making noise, so too with grief.  Until the heart wakes up and starts to make noise it cannot be fed.  Don’t get in a hurry with the next meal simply because you are hungry.

So what could this ministry look like?  Quiet, hidden, behind the scenes and capable of discretion.  Trust violated is a terrible wound.  Where do you start?  When?  Not really certain about what that looks like, but I think there are plenty of candidates.  Some will get better, and some will not.  Be ready for both.  Some will wake up when you come near to the pain and then adjust and take a different treatment. They will start therapy and then with the help of a specialist make improvement.  It can be a specialist in the specific and very local nature, like the radiation “knife” that is vary narrow and controlled, or like a chemo drug that goes through out the body.  Both have different side effects and purposes.  The financial advisor is tailored to your retirement or the daily activity of your business.  The addict can have a wide range of addictions, and all will be masking an inner wound, and so the need for the withdrawal is important, and first, and then the need for the wound management comes with the diagnosis of that wound.  This person needs a group to help them.  I think you get the idea. 

So then what?   The first rule of medicine is this, “do no harm”.  But even with that you need healthy definitions of what harm is, and what it is not.  To the wounded cleaning the wound is definitely harm, to the care-giver it is harm not to clean it.  How to resolve this?  Gentle is not the same as passive.  If you have seen a good paramedic in action there is a definite structure to their behavior.  The assessment, the first care before movement, the need to care for then move to a safe area then continue care and then transport to the hospital.  For the care-giver it is the same.  How safe is it here, and what needs done first.  Always gentle, but always firmly with a purpose.  Yes it will hurt, but not as much as ignoring it.  Not as much as pretending it isn’t that bad.  The paramedic is different than the Doctor, and different than the Hospice nurse.  All are needed for different reasons and not all are there through the entire process.  If one of these is your role, then know your boundaries.  If one of these comes to you, then be accepting, you may be more hurt than you know.