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End of shift: RN finds hospice care invaluable for her dad

Monday April 22, 2013
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When the call came on a Monday, I wasnít surprised; I had been expecting it for more than a year. My bag had been packed for months. My stepmother said, "Your father doesnít know how to shower." I answered, "Do you need me right away or could it wait until Thursday? Iíd like to finish up with my students if possible." Thursday would be fine, she told me.

At age 20, my father had been a pilot in the Air Force during World War II. He was a natural leader, progressing to wing commander and first lieutenant before the end of his active service a year later. He would retire 40 years later from the Air Force reserves as a major, having worked in aviation sales while raising five children with my mother, who died 25 years ago.

Two years ago, Alzheimerís disease had robbed him of his short-term memory. The late effects of radiation therapy for oral cancer had made eating less-than-pleasant, with dysphagia, coughing and choking on even thickened foods. Yet he was independent in showering, dressing and simple meal preparation; he also managed his own medication administration.

His long-term memory was blissfully intact, so my family and I spent many happy hours talking about "the old days." We learned many noteworthy facts about his childhood and wartime service. In one of his 38 missions over Europe, the floor of his cockpit was blown out, leaving nothing but the seat between him and eternity. He talked about how he never felt fear during a mission, with so many instruments to handle in the B-17 and the need to constantly focus on the target while staying in formation.

We shared many enjoyable days. He loved to attend Mass on Sunday, which we followed by poring over scrapbooks from the í40s, í50s and í60s. This would stimulate many stories; he might even sing "The Hoboken Song" from his high school days.

But I knew he couldnít continue very long if he wasnít eating. Before I left home that day to go see him, I called his doctor, who suggested hospice even before I could request it.

Having worked in hospice care for almost 30 years, I knew they could provide the emergency box of comfort meds and the pronouncement to avoid 911 at the end. The rest I figured I could do myself. My father was raised in a religious atmosphere and had become increasingly more spiritual in his later years. He also had prepared a healthcare proxy and a living will, declining all heroics.

I was right about the comfort kit: The lorazapam, morphine and atropine drops were indispensable when symptoms arose in the middle of the night. And when the inevitable occurred four weeks later, the pronouncing nurse was courteous, thorough and efficient. All as I expected. What I was unprepared for was my reliance on my fatherís nurse, Helene Levin, RN, BS, CHPN.

It started with her suggestion for Nitrostat for right-side chest pain of unknown origin. It worked faster than the morphine and had fewer side effects. Then she came up with an ingenious solution for administering the Nystatin when he no longer could hold it in his mouth: Apply on a toothette and rinse later.

The biggest challenge for me was the correct dosing for end-stage symptoms to make sure Dad would have a peaceful death. He needed frequent changes in dose during the last 12 hours to prevent choking and dyspnea. She provided the support for me to administer what he needed. Her calm, compassionate presence reassured my father.

My father had told me months before that he was ready to go back to God, but I couldnít have handled his passing nearly as well without Helene. She bolstered my confidence while generously and gently sharing her knowledge. She never implied I should be "just the daughter." She recognized my need to be his nurse, too.

My fatherís courage and acceptance of lifeís struggles were an inspiration to his family and friends. But the greatest lesson he taught me was to have faith and give thanks for everyone who enters our life. I will be forever grateful to Helene, who helped me make my fatherís last days comfortable in his own home and give him the peaceful death he wanted. •


Mary A. Cooke, RN, MA, CHPN, is the nurse educator for Compassionate Care Hospice, Brooklyn, and an adjunct faculty member at the College of Staten Island (N.Y.).Write to editor@nurse.com or post a comment below.