הוספיס וטיפול פלאטיבי – Hospice and Palliative Care

new gun Shalom a registered nurse and a certified hospice and palliative nurse Hospice means the care of someone who is terminally ill I specialize in taking care of terminally ill patients who are facing their last month’s and and also couldn’t helping to control their pain and other symptoms that go along with their disease Hospice is a very it means that it means very a lot it means a lot to me it goes very deep into my heart to take care of those that are facing their final months weeks and days because not only do we take care of the patient but we take care of the family as well the the patient and family are seen as one unit and family can be mean many things often the closest friends and neighbors to the patient become the family so we also address their emotional and spiritual and social needs as well as the patient and the blood relatives we address the physical pain of course of the patient that’s number one and then we address the emotional pain and losses that go along with considering that part of your time on this earth is cut short perhaps shorter than you would have liked or shorter than you expected they also in the United States and other places in the world there are that there are many places that do pediatric hospice that take care of babies and toddlers and young children and young teenagers that are facing cancer and other terminal diseases this work is not easy it takes a big support system to take care of the patient the patient needs a big support system with friends and family and neighbors and the staff that take care of them need a big support system so most hospices have them excuse me they provide they provide weekly with the staff sorry that is that um we the staff need one another too because often we become very attached to the patient or we become very attached to the family member many of the family members there’s what’s called a secondary loss where the family not only loses their relative to death but but also loses the hospice nurse who has become many times a member of the family he or she comes so often during the week to the home and and the relatives look forward to that visit so we become like very close friends and if not family members so it’s called a secondary loss for them to also lose our visits as well and in most hospices in the West they have 13 months of bereavement care for those left behind after the death of a loved one they have meetings of other family members as well and they come together monthly the the hospice staff will send them cards they’ll make phone calls to the 50 other relatives and friends and close friends that have been left behind they do this for 13 months why because they help to get them through the first anniversary of the patient’s death which is the hardest time as men you can imagine or maybe you know those who are watching this may already have experienced that the the one-year anniversary of your loved ones death is a very very difficult time for everyone involved so the hospice tries to get them through that and then a month later and then if

they still need bereavement care then usually they will tell them where to go for private counseling for their grief grief is not easy there’s no time limit for grief often it takes years many grief specialists say that it may take up to two years for a relative to even begin to deal and cope with the loss of a loved one and then the brief work begins after that it’s it’s very difficult and like I said there is no time mind for grief to use it I have a son one thing I’d like to mention is that spirituality is a very big part dying for most people out of the hundreds of patients that I’ve taken care of only one patient that I cared for it was a proclaimed atheist he just believed that you’re born you live and you die and there’s nothing after death his reaction to his cancer was one of depression he lived his his last months in a deep deep depression he refused visits from from the non-denominational spiritual counselor who worked in our hospice unit he refused most visits from family or any neighbors that he had who wanted to come see him he just became very depressed and he became very in contrast to that most people become even more religious when they’re facing their their last days whatever their spiritual beliefs are they tend to go deeper into those beliefs they want an answer why has God done this to me why why me they go through many stages and they ask God you know why have you done this but why am I having to suffer like this and whatever the patient his beliefs are I tried to encourage them to go further into those beliefs I don’t put my own beliefs unto them that wouldn’t be fair I don’t want to confuse them at the end of life I want them to feel very specially peaceful mentally peaceful emotionally at peace with their spirituality collegiates and if I found that if most if patients are allowed to – and given the the given of the room if you will – to delve deeper into their spirituality they will do this with the help of the nurses with the even the doctors in hospice are trained to sit with the patient for longer than just 1 minute in and out of the room like sometimes we see in hospitals in hospice if that’s that’s not really seen too often even the doctor will spend time sitting at the bedside when he or she can it’s a wonderful thing all the staff in Canada including the nursing assistants we have many volunteers volunteerism is a very big part of hospice a hospice program and they go through a training program themselves a very extensive training

program where they learn the stages of dying they learn how to listen especially to listen not so much to speak but to listen which is so important for a dying person the patient needs to reveal so many things so many thoughts and so much confusion maybe so much anger that they might have for God for putting them in this painful situation so first we were like I said we take care of the physical pain that then we address the other issues the mental emotional the social issues than many patients feel very lonely at this time even when they’re in a room full of relatives visiting they can be very lonely death is lonely for some people and so we first if someone’s pain and other symptoms physical symptoms are taken care of then then we can move on to the deeper issues and spirituality is a huge issue in hospice care those that that do enter into a hospice program when they’re given six months or less to live say at the end of the live seulement held many say how appreciative they are to the staff and to the volunteers for allowing them to reconnect to their spiritual beliefs to their religion some of them have gone through life just maybe not putting so much emphasis on that on their spirituality but when you’re facing the end of this life that tends to become a very big thought Hospice definitely tries to work with the patient and the family as I said the patient and family are one unit I took care of principle while pertaining to the spirituality and the emotional needs of the patient and family I remember well a patient I took care of and her husband in in the United States she was on home hospice which Hospice is not a place Hospice is a concept of care for the terminally ill patient and it can take place in a hospice unit which can be a free-standing building it can be a unit in a hospital or a nursing home or it can take place in someone’s home generally people tend to choose to stay in their home when they’re dying they want to be in their bed they want to die in their bed they want to be have other familiar things surrounding them they want to have people able to come in and out of their house so I remember this one couple that I cared for and she was they were just such a lovely couple they were from the Jewish faith she the wife had ALS that’s better known as Lou Gehrig’s disease at least in as Lou Gehrig was a famous baseball player who who made this disease very famous actually it they become trapped in their body the intellect stays intact and the body just can’t move any longer it goes in stages but this this wonderful woman could not speak she she could speak with her eyes she could she could blink our eyes once for yes and twice for no she could smile at the beginning when I first started seeing her in her home she would do crossword puzzles every day in the newspaper and that was her joy that’s what she liked to do but as time went on she wasn’t even able to hold the pencil and hold the paper her husband of 50 something years of marriage was very devoted to taking care of her they were just a lovely couple and she became she became very worried at the end and like I said she couldn’t speak but I could tell in her face that she was very worried about what was going to happen to her how death was going to come for her and what was going to happen to her after her death she was literally trapped in this peril his body and when I could when I saw how much her anxiety was building on her face she have like furrowed brows and you know and she just seemed anxious all the time I asked her if she wanted a visit from our the hospice rabbi who was on staff

and the rabbi was a woman she was further up from the Reformation as’ synagogue and she was a wonderful lady who made several several home visits to this couple and I was there I’ve made arrangements to be there for her first visit and we literally all held hands around her bed and we held the patient’s hands as well my husband and the rabbi and myself and the nursing assistant and and we prayed for her that she can become more peaceful that she wouldn’t be an anxiety that she could understand that there was much more to her than this paralyzed body that actually everyone every being every living being on this planet it’s a soul everyone has a soul everyone is a soul and we’re all trapped in these physical bodies as a soul we’re trapped in these physical bodies and and at the time of death were released from this physical body and soul hopefully we’ll go back to God so we spoke like this to her and the rabbi told her the same philosophy that she wasn’t that body she wasn’t that that paralyzed body she was so much more and and then we made more visits more and more visits together with the rabbi and would continue to pray like this with her and and speak to her in this way and as the next month or two went on her body became weaker and weaker and her breathing became worse and until she finally left that body she passed away from that body and from this world and I really felt that at the end she was much more peaceful because of hearing this philosophy because she she no longer connected herself to the physical body that wasn’t working anymore and she really gained a great insight and understood that she was a soul and who belonged to God who was part and parcel of God and she had a much higher meaning to herself than what she was thinking her whole life and and her husband became more peaceful about losing his beloved wife and she became much more peaceful having realized these things and I remember her death being very peaceful for both of them so if Hospice does their best to reconnect or to connect a person to their religious upbringing their religious beliefs but we tried to take them even further an understanding that they are so much more than than that body that that is just breaking down day by day patience over the years have it asked me what I believe death means and I explained to them that death is not an ending death is an opportunity for a beginning that I date a lot of them say to me you know why am i suffering like this if I’ve been a good person I’ve I’ve tried to help people I’ve I’ve been involved with my church or synagogue or temple and you know ie I haven’t done anything intentionally to hurt anyone why would this happen to me and they asked me what I think about that and I explained to them the law of karma because I’m a strict believer in the law of karma for every action there’s a reaction that the reactions for getting I I personally

believe in reincarnation I believe that that whatever body were born in whatever circumstance where we come into in this life is from as a reaction from a past life and that we cycle throughout different lives within this material world to reach perfection and that perfection has got consciousness to become very to to to regain our relationship our lost relationship with God and if we if we don’t succeed in this life we may have to come back again and reincarnate again in this material world to try again and take up where we left off it in this life it’s a process and our our karma is such that that we’re getting the results of our karma for my past life like I said so when they asked me why am i suffering like this I’ve been a good person I explained to them it doesn’t mean that they’re not a good person in this life they may have made some mistakes in another life and now they’re getting the results of that in this life in the form of this disease we don’t do self punishment you know because we don’t know what who we were in last life we don’t know what we’ve done but we try to understand that everything good that happens to us is from a reaction from something we’ve done good and everything bad that happens to us in this life is something we’ve a reaction from what we’ve done maybe in something negative previously so it helps to put some understanding it’s as if you walked into a movie theater in the middle of a movie maybe you were late you didn’t come to the beginning of the movie and you see what seems to be a very pleasant man sitting behind his desk in his office and he’s he’s doing his work and he’s supporting his family very nicely and he has picture of his wife and children on the desk and he seems to be a very pleasant guy and all of a sudden somebody comes oh I’ll shoot him and he’s the fights over dead well why did that happened to him he seems like such a nice man why would that happen but we walked in in the middle of the movie we don’t know what he did before when we when we were late for that show so we don’t we don’t know what he had done to get that reaction of somebody busting in his office and shooting him so it’s like that in life we come in contact with many people and we see that they’re suffering in some way and the animals are suffering in some way but we don’t know why because we miss at the beginning we don’t know from previously what they’ve done to receive this reaction so karma is like that and without knowing and understanding the law of karma and my life like I don’t know how I would have gotten through seeing the suffering that I’ve seen well I’m being asked you know what is the difference between what I’ve seen in patients who pass away on a hospice program and those that don’t and I I have seen many patients pass away in a hospital setting and ICU machines with many tubes attached to their bodies I’m comfortable in that way and hospice not that we that would count anything out like that any kind of surgery any kind of radiation any kind of chemotherapy for cancer that is not counted oh it’s just that it is done at the end and it could be done for palliative purposes we do it to treat the symptoms for example I took care of my mother-in-law for almost a year when she was diagnosed with breast cancer and then she had surgery and it came back five years later and it was very aggressive and it spread to her liver the lymph nodes lung and liver and she passed away within six months so she had a big tumor in her pelvic bone but and in order to give her a quality

of life which is what Hospice is about we decided to do a light dose radiation treatment for just three weeks on that spot in the bone so that the tumor would shrink enough so that she was able to walk another couple of months with a cane and for her a very strong woman who was a master sergeant in the US Army during World War two she had nine children 25 grandchildren she was a very strong woman and for her independence was of great importance as it is to mostly everyone and so she she gained quality of life the last couple of months by us shrinking the tumor a bit and giving her a cane and she was able to walk some more rather than be wheelchair-bound so these things are not counted out in hospice radiation chemotherapy even surgery blood transfusion not every Hospice does this but some of the bigger ones do it in the United States and around the world and it like I said it’s done for palliative purposes for for pain and symptom management and to give the patient more quality of life which is what Hospice is all about for her to have been in the hospital all kinds of twos and IV machines and you know it she just she would have rather have left her just passed away she that to her wouldn’t have been quality of life and and it would have seemed senseless to keep her alive like that but Hospice we have a philosophy that it’s it’s all about giving them the best quality of life and that means something different for everyone not everyone would see walking with the cane as being quality of life but she my mother-in-law did the quality of life means something different to every single person and the hospice staff gets to know the patient and the family very very well so that we can direct them in this way so that they do get the best care for them which will mean something different for someone else but for that patient it might mean doing a little bit of radiation like we did for my mother-in-law so that’s the biggest difference I’ve seen in in patients who die in a hospital setting without hospice care there some hospice patients do pass away in the hospital with hospice staff coming to visit if they live in a nursing home they also can can have hospice staff come and visit in the nursing home because that’s their home where they reside and and Hospice comes in and and does the best they can to supplement what the the nursing staff and nursing home staff is get as providing for them so like I said Hospice is not a place it’s a it’s a philosophy it’s a frame of mind for this for the people who work in it and for those that come on and are signed on to it and and work with them you get more back from doing this care then you would ever put into it it’s it’s amazing like that it’s almost magical you people say to me even nurses say to me how can you deal with the dying all the time and you know isn’t it depressing it is so far from depressing it is it’s a joy it’s a blessing to to be allowed a place at the bedside of a dying patient right now I’m in India I come about once a year I helped build a 40,000 square foot prosperous facility here and outside of Delhi and most of the care that that we provide here is done for free for the very poor who are terminally ill right now the hospice has it’s called the bhakti vedanta Hospice they have 250 patients in different villages around the area they have teams that go out on a regular basis and visit the patients and families they educate the family how to take care of their relative in the home so that the patient can stay in the home as long as he or she can if the patient has some kind of symptom that isn’t being managed well at home then we invite them to come into the hospice facility and be cared for by the staff in patient and but as far as

we can we we try to help them to stay in their own house and just visit them in their home so that’s what I’m doing in India now and there’s always room for anyone who wants to come take a trip to India and volunteer here in a third-world country which is so very rewarding or like I said please seek out a hospice in your area and get to know the staff and see about their volunteer program because they’re they’re always in need of love and and care and the patients are so appreciative of anything that you can do for them so now I’m being asked what is the most important thing that I think is needed to work in a hospice situation to me the first thing that comes to mind is compassion compassion for someone else’s suffering empathy if you have the ability to feel what just a little bit what someone else is feeling to enter into someone’s world which is filled with pain and grief and loss then then that’s what’s needed most it’s it’s never possible to fully understand what a dying patient is going through everyone experiences something different we will each experience our own feelings of loss I tell people you know try to think of how much you think of in the future okay we all think in the future to get married we may want to you know go to college and get a degree a post-grad degree we may want to you know it’d be married and have children in the future we want at home we want you know so many things we may want you know two cars and and a boat you know you know or we’re thinking we you know when will we retire you know depending on your age and what stage you’re in in life you’re going to have different thoughts about your future and if all of a sudden you’re given a few months to live think about what a loss that is you you you’re you have the loss of no future you’re no you know your future is suddenly cut short and it becomes very sad for people so that the I was speaking about the loss of the future when suddenly your future is cut short to only a matter of mincer or weeks or and then days that is a big loss to most people because we do think a lot in the in the future with our plans and we don’t really realize it until all of a sudden it’s gone you know at my stage I’m thinking of the grandchildren and maybe a retiring part-time with my husband and you know in India to help with this hospice there’s so many plans and if suddenly I wasn’t allowed to even think like that any it would be one of the losses I would suffer so everyone has many losses that they think of on their deathbed and every person that’s watching this will think differently in that way but if if someone is standing there sitting by your bedside holding your hand not afraid to touch you no matter what physical deformities your disease might give you you’d be surprised how many patients actually suffer from touched deprivation because no one even family want to touch them anymore because they they’re not looking the same due to their disease so if you as a medical professional or as a hospice volunteer have the ability to feel that that love and compassion and warmth for another human being that is suffering so much and and for their family members who are going through so much grief and that I would say that’s some the biggest thing that’s needed to work in this field I’m being asked what is my connection to India why am I here helping with the bhakti vedanta hospice but bhakti vedanta is the name of my spiritual teacher AC bhakti vedanta swami he lived in this village from 1959

to 1965 and then he journeyed on a steamship from India to America to New York and actually lived in the Bowery at first and didn’t know anyone only had 8 dollars to his name the equivalent of $8 and and he came to the Western world to teach God consciousness to teach bhakti yoga which Yoga means to connect with God and bhakti means devotion so to connect with God through devotion and through devotional service and I was I became his student at the age of 16 and I’ve been his student for 40 years and you can do the math you’re how old I am and so it’s been a long time and that is he isn’t he is my connection to this village and the people and the culture and the spirituality materially it’s a very poor place spiritually it’s extremely rich and I gained a lot from being here from from teaching the staff who who were born most of them born and raised in this village and they gained a lot from teaching them and they teach me in return the first book that I read from written – translated from Sanskrit into English by my spiritual teacher AC Bhaktivedanta Swami Prabhupada was the called the bhagavad-gita it’s in an ancient text from historically dating back 5,000 years from in India and studying that text over the years has taught me that devotion to God devotion to your fellow man to to the dying to the living to patients and their families – to the needy that devotion that that work that you can do for them and give what you can give to them can take place anywhere by by any of you at any time even if it’s if it’s helping a dying person smile that day you’ve given that person a good day if you’ve reminded that person of God somehow if you’ve brought that woman or man or child somehow closer to understanding that they are more than just that sick body that they are a spirit soul inside of that body the body is temporary the soul is eternal there will never be the death of the soul the soul will live on just as God is eternal we as part of God are also eternal and that really at the end of this life there really is no fear because there is no death ultimately there is no death there’s only the death of the outside it’s like you put on a coat to go out into the cold weather you’re not that cold right you wouldn’t say I am this coat no you’re the person wearing the coat so we are the the soul wearing this temporary material body and that’s all that dies at the end of life the soul you me will never die we just hopefully will return to God so that service that we can give to someone else too I’m talking specifically to the dying because that’s what I do but but tell anyone anyone that you see on the street anyone that you you want to wish a happy day you know there’s so many ways to serve your fellow man and and woman and child there’s so many things that you can give of yourself that could be done anywhere you don’t have to come to India to a village you can do it in Israel you could do it in your hometown you can do it in your neighborhood anywhere where the Lord has put you that’s where you’re

meant to work and and I wish the best for all of you who are watching this and I hope and pray that you will consider what I’ve said and take it just a little bit if not all of it with you and and think about it and add to it thank you very much Rajan mother my brtt by hee me mother