The nursing care facility I worked at had a contract with Hospice to wrap palliative care services around residents of the facility as an option for families, so that end of life care could be provided in the same place their family member lived. It may seem unusual to some people to want to stay in a nursing home, but to many residents, this is preferable to a transfer to an inpatient unit or hospital. Occasionally, we admitted someone for the express purpose of providing hospice care in a long-term care setting. We preferred to admit people to a quiet, private room. But sometimes we would offer an available room up to a family even if the circumstances weren’t ideal. And, so it was for Charles and his family.
Charles had been a well respected lawyer, and had successful children who lived and worked mostly out of town. His wife had died several years ago and he had lived alone until recently, when the onset of advanced, metastatic cancer was detected after numerous falls and an eventual broken hip. He couldn’t go home, and he didn’t want to leave town. He had months or weeks to live and wanted to stay in his community so friends and family could visit. We offered Charles the one room we had available, a lovely private room, although it was located on a wing of the unit mostly occupied by people with Alzheimer’s disease and other dementia.
Charles and his family were lovely people, and were kind and compassionate to confused neighbors who may occasionally wander into his room accidentally. We had him on a room relocation waiting list, but Charles condition was rapidly declining and he and his family settled in to his surroundings and made the best of it.
As social worker for the unit, I had gone over all advanced care planning and end of life wishes with Charles and his family. He wanted no life sustaining measures, no feeding tubes or other artificial nutrition/hydration, no hospital transfer. Only pain medication for comfort. We worked with Hospice staff and the pharmacy to be sure pain medications were available in alternative delivery forms since his swallowing was affected. Charles and his family had made plans for a peaceful death, a good death with choices respected. But, death did not come as quickly as they thought or hoped.
Days went on and it was hard to manage the pain without medications that would affect his breathing. It was a fine line, and we worked with this resident and family to respect their wishes but have no regrets, either. Too much pain medication can hasten death and that was not what he or his family wanted. His children began keeping around the clock vigil to be sure that he remained pain free. Nursing staff worked hard to keep wandering residents out of that wing, to give Charles and his family space.
One morning, I was visiting with Charles and his daughter and one of the residents with Alzheimer’s followed me into Charles’ room. I tried to redirect him, but he was insistent. This resident, I knew, had been a doctor and was having a moment where he was confused and thought this was his patient. Charles’ daughter seemed to understand and patiently allowed the other resident to enter. We both watched in amazement as this resident strode gently over with perfect bedside manner and listened to his pulse, stroked his hand, and told him that they were taking good care of him, to simply rest now and know he was in good hands. The Good Doctor then shuffled out. According to Charles’ daughter, he continued these periodic visits all throughout the day and evening. He gave “orders” to the nurses and solace to the family. Every visitor was moved to tears. Charles died, peacefully, the following day.
I made sure to visit my resident…the former physician…in the morning to check in on him. I asked how he was doing and told him how grateful Charles’ family had been for his care and concern. “That’s my job…” he said while he shuffled off down the hallway. He resumed a card game with a staff member and didn’t ever seem to recall his brief return to duty. I was sure to pass on the loveliness of this story to his own family, though.
The Good Doctor, making his rounds and checking on his patients left a lasting impression and created comfort for more people than he ever realized. Charles’ family spoke of it both in his eulogy and the card and flowers they sent to the unit staff. He had played a pivotal role in this situation becoming a good and peaceful death.
Sometimes light and love and comfort come from unexpected places at exactly the times we need them most.