community hospice

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 hospiceCommunity Hospice

Community hospice care focuses on quality rather than length of life. It provides humane and compassionate care for people in the last phases of incurable disease so that they may live as fully and comfortably as possible. The community hospice philosophy accepts death as the final stage of life: it affirms life and neither hastens nor postpones death. Hospice care treats the person rather than the disease, working to manage symptoms so that a person’s last days may be spent with dignity and quality, surrounded by their loved ones. It’s also family-centered – it includes the patient and the family in making decisions. Community hospice care is used when you can no longer be helped by curative treatment, and you are expected to live about 6 months or less if the illness runs its usual course. Community hospice gives you supportive or palliative care, which is treatment to help relieve disease-related symptoms, but not cure the disease. Its main purpose is to improve your quality of life. You, your loved ones, and your doctor decide together when hospice care should begin. One of the problems with hospice is that it’s often not started soon enough. Sometimes the doctor, patient, or family member will resist hospice because he or she thinks it means you’re “giving up,” or that there’s no hope. This is not true. If you get better or the cancer goes into remission, you can leave hospice and go into active cancer treatment. But the hope that community hospice brings is the hope of a quality life, making the best of each day during the last stages of advanced illness. Some doctors don’t bring up hospice, so the patient or family member might decide to start the conversation. If your treatment isn’t working anymore and you’ve run out of treatment options, you can ask your doctor or a member of your treatment team about community hospice.

Community Hospice-The End is a series about end-of-life issues.

In a Venn diagram and community hospice illustrates of tending helpless people at the extremes of life, the circle of caring for a dying person overlaps almost completely with the one for caring for a baby. Both are repetitive, intimate, often gross, sometimes funny, weirdly frantic even as they’re crushingly tedious, and a total act of devotion. In the nonoverlapping part of the end-of-life circle, there’s pain, grief, despair and a dreadful fading. There is movement not forward, toward consciousness, but backward, away from it. And for all of your endless patience there is nothing at the end. Community hospice represents death, and your only job is a kind of mothering right up to the lip of the abyss.

Many people already know this, but I didn’t. Ali, my 47-year-old best friend of 44 years, was dying of ovarian cancer in a Coney Island community hospice, and I was a death novice. I could flip through my mental scrapbook of our lives together — past stitching the last-minute buttons to her wedding dress, past teenage afternoons in Postermat on Eighth Street, past even the fold-and-seal letters from camp, all the way back to our Snoopy stuffed toys, who were often sick and had to be bandaged in Kleenex and fed bits of gingersnap, their feverish, grimy plush cooled with ice cubes while we watched afternoon reruns of “Emergency!”. But as a grown-up, I hadn’t really been through it.

It was hard even before it got worse than we could have imagined, back when we thought it was as hard as it could get. Back then, Ali was in the hospital still. It was the beginning of the end, and she was in so much pain. She needed to be massaged and held and to eat cold chunks of watermelon by the quartful. She had a horrible, leaking tube that emptied the contents of her stomach into a bag and left behind a deadly thirst. The more she drank, the more the tube drained away, and the thirstier she became. It was mythological. For a while she craved a particular kind of German mineral water, then strawberry Popsicles, then San Pellegrino grapefruit soda. Since my babies were the kind that nursed every 20 minutes, this was familiar to me — the constant guzzling, as well as the constant thrum of doing that often drowns out the bigger existential story.

I’d announce that I was going out for a minute of fresh air, only I never would — there was never time — even though time passed so excruciatingly slowly. When you’re pregnant you hear that your baby will sleep for 20 hours of every day, but then somehow the minutes never clump together into any meaningful stretches. It was like that with Ali. She needed dry pajamas, fresh sheets, more ice, a bite of yogurt. She needed a new drainage bag, a clean lap pad. She needed blood drawn and potassium injected and Ativan added to one of her half-dozen drips. It took an hour for her husband, David, and me and a nurse to get her into a chair by the cracked window so she could see the sunset, feel the breeze, only by the time we got her there she needed to return to bed. David and I made dirty jokes about Ali’s thigh-high medical compression stockings, and she laughed. We cried in each other’s arms and also were bored.

The community hospice was better, but also, of course, worse. I couldn’t stop myself from looking into all the open rooms, the dying people so grayly flat in their beds they were already like ghosts. There was a baby, too, dying across the hall in a crib. It was unspeakable.

Ali had vases and vases of flowers along her windowsill and I devoted myself to culling and rearranging them. I borrowed surgical scissors, spread out a towel, dragged over the trash can, and turned 15 vases of decaying roses and hydrangeas into five vases of gorgeous ones. It reminded me of sitting captive beneath a napping baby, clipping my fingernails simply because I could reach the nail clippers and it was something to pass the time…………

See more of this community hospice article

Mothering My Dying Friend – The New York Times.