It's 8 a.m. when Hannah, a nursing student in western Wisconsin, starts the day with her preceptor at a local hospice agency. This is her last day of this rotation. The day will start with an interdisciplinary team meeting, but first they must check patient assignments for the day, taking note of anyone who had complications over night or passed away.
The 8:30 team meeting starts promptly. A social worker, two chaplains, another RN, and a physician, who has called in via phone, are present. As the team discusses concerns they have with patients, Hannah notes changes that need to be made in the plan of care of the patients they will see today. "I am surprised at how much input the chaplain has made" she whispers to her preceptor. As she reflects on the time she has spent with this hospice service, she decides this is likely because there are so many psychosocial and spiritual needs with this population.
As the meeting ends, attention is turned to a bowl at the center of the table where Hannah sees three pieces of paper neatly folded ...the group is quiet as they pay respect to those whose names are written on those pieces of paper as they represent those who have passed since the meeting a week ago.
Today Hannah and her preceptor are heading to Houston County, Minnesota, which is a 10-minute drive over the Mississippi River. The river is frozen and in the distance they can see huts set up for ice fisherman. It almost looks like a small village, sprawled across what was flowing water just a few months ago. Winter is in full force, with weeks on end of freezing temperatures.
At 10 a.m. they arrive to see Harold and Lois, a married couple living in a nursing home in La Cresent. Lois, diagnosed with lung cancer, was first to be admitted to hospice several months ago. Harold, her caretaker for many years, was recently admitted to hospice when his health started to decline at a faster rate than his wife's. Lois' cancer has metastasized to her brain, and there is a noticeable bulge on her cheekbone/eye where the cancer was found. She complains of discomfort in that eye, so eye drops are ordered to hopefully relieve this pain.
Sadly, Harold looks extremely thin and has not been eating. Hannah is touched to witness the couple, each with their own fortitude remaining, trying to make the most of the end of their lives together...helping each other any way they still can. "After years of practicing in hospice, I believe Harold will go before Lois. If one of them goes, the other will go shortly after" the preceptor comments to Hannah as they are leaving.
By 11:30 am they are on their way to see Glenn, newly admitted to hospice with tongue cancer. He is young, late 60s, and a heavy smoker. Glenn is having difficulty swallowing and is in a lot of pain. Hannah's preceptor explains to him that it might take more pain medication to relieve his pain because of his past recreational drug use. Glenn is open to alternative pain management strategies but refuses nutritional supplements stating "I don't want to prolong the dying process. I have had a good life and did everything I wanted to. I am ready to die." As a student, this matter-of-fact statement takes Hannah by surprise. This is not something she had ever heard a patient say before and she finds herself unsure of how she would respond if her preceptor was not there.
It's 12:30 as they quickly eat lunch in the car on the way to the next patient. They are heading toward Caledonia, passing vast farmlands covered in snow. "Spring is coming" Hannah says. These lands will come to life again soon.
Jacob has lung cancer. As they walk into the home, they immediately notice the large skin tear he has that extends from his elbow to his wrist. Noticing their expressions Jacob states "I fell over an opened dishwasher yesterday. Mary (his wife) cut the skin that was hanging with scissors." First they dress his wound and then continue with the assessment. It was agreed upon to order Jacob a hospital bed, to avoid him climbing stairs at night for bed. As Hannah and her preceptor prepare to leave, the patient states, "You two girls are wonderful to me, thank you for everything you do." Hannah smiled at her preceptor and thought to herself, what a rewarding experience.
Before heading to the last patient, Hannah's preceptor makes a few calls to ensure the hospital bed is ordered. She also calls the nursing home to check if Lois was able to get the eye drops, as it had been a few hours since she called it in.
Back tracking toward the river, the bluffs to their front stand tall. They are on their way to Nancy, an elderly woman who lives with her husband. Both are in their 90s and still live in their home. Nancy has liver cancer. Entering the driveway, they notice that the mail has already been brought in. The nurse is supposed to get the mail when she comes, but the husband retrieves it often before they arrive. Both are very frail, so safety is a concern. "Nancy and her husband are very forgetful and often repeat themselves" Hannah's preceptor warns.
Upon entering the home, the husband is cooking in the kitchen and Nancy is sitting in her recliner. The wife begins to tell them "Well they say I have liver cancer and they don't know what causes it." Reviewing the aide's notes, they discover safety concerns with hygiene and meal prep on several occasions. After bringing these concerns up with the patient and her husband, a care conference is scheduled for next week. "Nancy is very reluctant for the aides to come more than twice a week" Hannah's preceptor states. "It will be difficult for her to accept more help."
As 3 p.m. approaches snow has begun to fall, a thin layer covering the road. Expecting 1 to 3 inches in a short amount of time will make the drive slower, but they arrive back in Wisconsin safe and sound to finish documentation.
Coming into this public health clinical rotation, Hannah expected to interact with patients struggling with the knowledge that their life expectancy was short. However, in the 7 weeks that she worked with hospice patients and families, she found the complete opposite to be true. Patients appeared ready and okay with the fact that they were dying, instead of being sad and anxious. This was an eye-opening experience for Hannah. "It was rewarding to spend those last precious moments with the patients and their families, hearing about the amazing lives each of them led. In the future, instead of being nervous to care for a dying patient, I will definitely feel prepared and privileged to care for someone in the last chapter of their life" she says to her preceptor as they part ways for the last time.