‘Death smiles at us all; all we can do is smile back.’ — Marcus Aurelius (121 AD-180 AD)
Editor-In-Chief, Chester “Trip” Buckenmaier III, MD, COL (ret.), MC, USA
The word hospice is derived from the Latin hospitum, meaning “a place of rest and shelter for the ill and weary.” As I have aged, the reality of death and dying has occupied more of my time as aging parents and friends enter the twilight of their lives. At times, as with my father, this process can be excruciatingly sudden and swift. The undisputed reality that we are all in the process of dying from the moment of our birth does not ease the shock of a loved one lost unexpectedly. When my father died suddenly, he had a brand-new car in the driveway and a new suit hanging on the bedroom door for my first daughter’s wedding. The shock of his loss still reverberates in my life today. I do recognize that the sharp edge of my father’s passing spared him the realities of a slow, plodding demise. He would not have been a model citizen within a nursing home (enough said).
For most of us, we must face the slow, always surprising, deterioration of our bodies and the loss of function performing tasks we take for granted as younger individuals. My knees, for example, have been sacrificed to the Army. While I still love cycling, I now only run when chased. My dad often said, “Getting old is not for the weak-willed (he used a different word, but for the sake of decorum, we will leave it there).” My point is that the warranties on our bodies expire, and as we did as children, we will require care again if we are blessed to live long enough.
In my opinion, far too many older people spend the last days of their lives in a hospital. Having spent a significant portion of my life in these institutions, I can testify that hospitals are not ideal places to complete one’s cycle of existence. Hospitals are not designed to ease a person’s passing, and the mindset of those who work in these institutions sees death as failure, not the flipside of the coin of life that death actually is. I am not being critical of these folks; I was one of them. I want my doctors and nurses in the hospital to fight for my life when I am ill or injured. There will be a time when the fight is hopeless, and the reality of the journey we all must take is clearly defined. When that time comes, as I advise my friends and relatives, I want to be in the comfort of my own home, surrounded by loved ones, with my pain aggressively managed.
My wife and I have enjoyed many successes during our fulfilling careers as healthcare professionals. Perhaps one of our most meaningful roles now is to be willing to advise and discuss death and dying issues with friends and family. We are also both huge proponents of hospice services (https://hospicefoundation.org/what-is-hospice/) in caring for those needing palliative care. Pam and I have been dealing for years with aging parents and friends from tragic injuries or falls, to the scourge of malignancies. We are unique as medical providers in our families, and as such, we are the medical advocates for our loved ones. When those close to us face a “storm of life” that may (or may not) lead to their demise, we recommend the involvement of hospice early and often. The resources provided are unique within our healthcare system.
Sadly, too often, when we suggest that a patient consider Hospice services, their healthcare providers will discourage the idea as “premature” or “foolish.” Other folks will hear our recommendation of hospice care and comment, “So you are giving up,” or “I didn’t realize they were dying.” News flash, we are all dying.
Hospice is not about giving up; it is about obtaining the resources needed to die with dignity or, quite possibly, recover in the comfort of your own home. It is a gift you give a family member as they prepare for the journey we all must inevitably take.
Regrettably, like everything in the American health system, Hospice is a business. There are good and bad businesses. In my experience, I have found hospice providers to be some of the most compassionate and exemplary caregivers in this country. I find the profit motive of American medicine extremely unpalatable, but I am enthusiastic about the success and expansion of hospice services. As an aside, I also support integrating anesthesiologists into hospice services, since that profession is steeped in the art and science of pain management.
As federal medicine providers, we are in the business of preserving life. That said, we must not allow the pride we all take in that mission to result in the hubris that we can (or even want) to deny the reality of death. We should be as aggressive in assisting our patients in need of end-of-life care as we are in enhancing their lives when they are injured or ill. As a clinician, hospice care should not be perceived as a bitter pill of failure but rather a solution and an incredible act of compassion for patients entering the last phase of existence, no matter how long that period may last.
In the end, death will come for us all. As healthcare providers, we are the educators of our patients in maximizing their body’s potential. Since death is inseparable from life, we need to be a resource for our patients who will become candidates for palliative care services. Hospice is an enlightened organization that supports this noble goal.
