The Final Ascent

By RN, CHPN Rochester, NY

Hospice is a concept that means hope, comfort, and tender loving care to many. However, hospice is a very discomforting option to some people. To them it means giving up.

The difficulty of accepting hospice care was illustrated by a family whose elder father was declining in health. The son and his wife wanted the patient to receive extra care, but did not want him to know he was dying. During my initial visit, the patient asked, “What is wrong? I know something is different.” I shared this with the family and encouraged them to allow their father to be honest about his feelings. However, the daughter-in-law stated, “You hospice people are a depressing group. When the patient has his faculties, you don’t bring in the funeral director!” As I thought about this conversation, I recognized that many people probably have similar feelings about hospice, but few are as straight forward in expressing their discomfort.

All of us will approach the end of our life at some time. Some receive no warning and have no time to prepare. Others have decisions to make: choices about treatments, how long to continue aggressive therapy, where they will spend their last days.

Hospice is a route that can be chosen as one travels to the summit of the mountain of life on this earth. It is an option that allows the patient to go on, free from carrying the burden of denial. Admitting that the end of the journey is near will not make it happen sooner. Withholding information from the patient can isolate him.

Sometimes when we hike up a hill, we keep our eyes on the ground for periods Of time, watching for rocks and roots that might trip us. However, the joy of the journey is diminished if we never raise our eyes and look around. When reality is faced, plans can be made, relationships can receive attention, and memories can be made.

The sorrow of knowing life on this earth is coming to an end can be somewhat mitigated by sharing feelings. The traveler will benefit from honest support from his friends and family. The pain of the anticipated loss can be shared with tears and hugs. The regret of unexpressed love and appreciation can be avoided when there is openness about the destination.

The hospice team members are some mountain climbers choose to use oxygen in the thin air near the top. Others feel a greater sense of accomplishment if they ascend without it. The patient does not need to carry the burdens of diagnostic testing, aggressive, cure-oriented treatment if it is no longer contributing to the length and quality of life. The hospice staff will use its skill to keep the sojourner as comfortable and alert as possible. The hospice guides walk alongside the climber assessing needs, interpreting signs and symptoms, and assuring the traveler and his companions that all will be well.

Just as mountain climbers discard more and more items as they approach the summit, the person who is dying narrows his focus. He may show interest in fewer people and things. His desire to eat will diminish. He may be content to sleep much of the time.

As the traveler nears the end of his ascent, he understands that he must crest the mountain alone. He may withdraw from those to whom he is closest. He may pull his hand away when those he loves want to hold it. These actions can be anticipated because each of us attains this pinnacle alone.

Now the loved ones continue their trek without the physical presence of their fellow traveler who made it over the top. Their path has been smoothed and made easier by the preparation and support of hospice staff. The sojourner has gone on ahead and is out of sight, but warm memories remain.

Bereavement support groups are available for those who have experienced loss. It is helpful to be with others who are stumbling along with the feelings of confusion, anger, and loneliness that you are experiencing.

Hospice is not a route to be avoided. It can be the smoothest, most comfortable and beautiful way to travel to the pinnacle of life on this earth.

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