Dignity means I get to choose when I’ve had enough and can’t face another day.

Dignity means not having my granddaughter wipe me after a bowel movement.

Dignity means being surrounded by my loved-ones at home.

Dignity means having my wishes respected by my family and friends.

All of these have been given in answer to the question, “What does the word ‘dignity’ mean to you?”  It’s a word that means different things to different people, and its definition changes with circumstance.  The way I define dignity today may be vastly different that thirty years from now when I’m incontinent, bedridden and dying.  I bring it up because last week I was interviewed for a newspaper article.

The article commemorated the one-year anniversary of the implementation of Washington State’s Physician-Aided-Death law.  Note that proponents refer to it as the Death with Dignity law and opponents call it Physician-Assisted-Suicide.  Obviously these two positions would fail to agree on the definition of ‘dignity.’

Proponents would say that an individual has the ultimate right to choose his or her own destiny and that this right should extend to the timing of the individual’s death.  Dignity means having control.  A survey of those who sought the legal lethal dose on Oregon between 1998 and 2008 provided input and insights into the reasons why one might choose to end one’s life.  One hundred percent of respondents said it was a matter of control.  They were living under the shadow of a terminal medical diagnosis.  Some disease processes rob the person of control over their own bodies.  Some say it is undignifying to have another person have to clean them after bodily functions.  Some fear their final days with diseases such as Lou Gherig’s Disease in which they may die aware of the fact that their lungs have just quit working.  Dignity means ending it before it gets to that point.

Over-against that we have the religious objections to any form of self-demise.  In the Western Hemisphere any form of suicide is considered taboo, though the taboo is breaking down.  In Eastern cultures it is often seen as an honorable way to avoid causing additional burden or shame to a family.  Both West and East, however, agree that the community, not the individual, is what’s important.  An individual has a social or moral obligation to act in a fashion that upholds and strengthens the community.  Choosing one’s own death day and time is undignified because it robs the community of going through a natural process with the patient.  Dignity means ‘bucking up and taking your fair share,’ as the British would put it.

Ultimately Hospice focuses on finding that balance between the patient’s right to define dignity and the effect of the patient’s choices on his or her friends, family and our Hospice staff.  While we do not deny that a patient has a right to define dignity as being able to end her own life, we also uphold that our staff will not dignify the action of self-demise by assisting or witnessing such an act.  We don’t turn anyone away but we know the limits of what we offer.  We believe that by offering the best possible care, the point becomes moot and death comes in its own time.

Rev. Ron Jetter, Executive Director

Lower Valley Hospice and Palliative Care

“The Guardian” is a great movie if you like water.  I’ve nearly drowned twice so water isn’t something I seek out where recreation or employment is concerned.  I don’t avoid it but it’s something I can take or leave.   I’m not a great swimmer and I’d just as soon stay out of harm’s way.  Thank goodness there are people who feel otherwise, such as those who serve in the United States Coast Guard.

The movie is about a veteran rescuer who works the Alaskan Gulf, played by Kevin Costner.  Nearing retirement he has taken a position teaching new recruits.  One of these recruits, played by Ashton Kutcher, notes that all the swimming records at the training academy are held by Costner’s character.  Young Kutcher takes it upon himself to see that every mention of the old-timer’s name is replaced and a new record time posted.

The seasoned rescuer patiently watches the young hotshot perform with athletic excellence as indeed, the bar is raised by the cocky recruit.  The veteran knows that the only test that counts is in the cold, angry waters of the North Pacific off Alaska’s coast where the Coast Guard’s work is done.

As expected, the new recruit loses his arrogance rather quickly when faced with life and death and the possibility of going out on a rescue and not coming back alive.  After a particularly gnarly day the kid asks the old man, “So, what’s your number?”  He has already broken ever record the teacher held in training.  Now he wants to know what record the instructor holds in real-life situations.  Costner casually answers, “Five.”

“Five?!!” responds Kutcher.  “You only saved five people in 25 years?”  To which Costner answers, “Why would I want to keep track of the ones I saved.  It was my job.  I only keep track of the ones I lost.”

A good death for a Hospice patient is one in which the person is at peace, the body is quietly relinquishing the breath of life and the sleep of death comes in gently.  Almost all Hospice deaths are ‘good deaths.’  It’s what we do.  It’s what we train for.  It’s or job.  Like the Coast Guard rescuer, our goal is to have zero in the other category.  We don’t keep track of the ones we serve who die at peace (actually we do; we’re required to report total numbers of patient served to State and Federal agencies).  It’s those rare ones who have a difficult time that bother us.  We know families are also in anguish when a loved-one is struggling or in pain.

The human body is complex and some of the things that go wrong are beyond our control.  It may make us feel like hanging it up and getting into some other kind of work.  But we remember that there are still others who need us.  We talk it out as a team.  We support one another.  We look at what we might learn so that next time there will be a better outcome.  And we’re good to go until the next ‘not-so-good death,’ and we go through it again.

I often wonder why people who do heroic work keep doing it after a particularly deflating experience, when it seemed that nothing went right.  I’m a chaplain to fire fighters/EMS and I see how an unsuccessful rescue affects them.  There are things beyond our control that will frustrate even their noblest efforts.  Yet they will go out again the next time they are ‘toned-out.’

The Coast Guard is still there patrolling the borders of our nation, including the cold, icy Gulf of Alaska, where rescues are frequent and treacherous.  Hospice nurses, social workers, aides and chaplains will continue to stand or kneel beside the beds of the dying.  The ones we lose will always be there in the back of our minds but we set them aside and go about doing what we’re called to do.  The numbers don’t matter.  Each person is an individual and the team will give its very best effort.  When you or your loved one needs us, we’ll be there.

Rev. Ron Jetter, Executive Director

Lower Valley Hospice and Palliative Care

I remember many years ago when a teacher asked the class, “Which is longer, January or February?”  My hand shot up immediately, and when called upon I answered, “February – it has eight letters.  January only has seven.”  The teacher went on to explain why I was wrong, how January had 31 days and so on.  But I wasn’t wrong.  I gave a valid answer; it simply wasn’t how she expected the question to be answered.  Her world didn’t have much room to look at things in new ways.  Not surprising, I don’t remember the teacher’s name.  I remember the ones whose minds were open to learning while they were teaching, and who  inspired me to look at things from as many different perspectives as possible.

A television commercial voice ended an advertisement for a prescription medication with the words, “Because your health is the most valuable thing you have.”  The statement as thrown out as though fact.  The makers of the product wanted viewers to accept it as unchallenged truth.  That’s not me.  I’m the one who can think of any number of things more valuable than my health.  I work in Hospice where our patients are running out of health.  Does this mean they have nothing of value?  By no means!

Our world seeks to find value in many things when health is declining and life slipping away.  Relationships with family and friends, hope of something yet to come, the joy of remembering life’s best moments are all of tremendous value, even surpassing value when compared to health.  In the end, if health is what we most value, we will be very disappointed.  And if we view health itself in a narrow way, we will be doubly disappointed.

Hospice is part of the Health Care Delivery System and Hospice is beyond it.  Because we provide medical treatment for physical pain and discomfort and because we receive funding from medical insurance (including Medicare and Medicaid) we are often lumped in with other providers, such as Home Care.

But Hospice is so much more.  Hospice blends a broad set of skilled staff at techniques to go way beyond what the merely medical will do.  In fact, Hospice is the one institution in our society that challenges the rest of Medicine to see people as whole, to recognize that we are physical, social, emotional, spiritual, financial, intellectual, cultural beings.

Medicine in our country is geared largely toward providing services approved by the American Medical Association, yet over the years treatments and techniques falling outside the approved methods have successfully lobbied for their right not only to exist but to receive Medicare and private insurance.  Acupuncture, massage, chiropractic and music therapy are licensed, recognized approaches that patients claim bring curative and palliative (comfort) benefits.

As a Hospice director trained and experienced first as a chaplain I continually advocate that Hospice be as open to providing the full range of approaches as possible, while also complying with and respecting the purely medical components involved in bringing physical comfort and management of physical symptoms.  Hospice was born out of the need to make the end-of-life process much larger than the medical world will allow.  Indeed, our greatest challenge continues to be helping individuals, families and physicians understand that enough is enough when it comes to expensive, wasteful, curative measures that actually cause discomfort and hasten death.  This last statement may seem bold but a Duke University study over many years concluded that Hospice prolongs life by helping people enjoy their final days.  The body, mind and soul respond to the cessation of invasive treatment in many cases and people enjoy a period of time with family and friends around, able to come to a sense of closure on life’s journey.

So which is more round, an egg or a the earth?  It depends on where you stand.  Sometimes to see a deeper truth we need to ask others what truth they see from where life has placed them.

Rev. Ron Jetter, Executive Director

Lower Valley Hospice and Palliative Care

A patient living at home needed a live-in caregiver, as observed by a daughter who lived a few miles away.  The patient’s son, living in another part of the country didn’t understand why his sister couldn’t manage mornings and evenings, utilizing a paid caregiver for only a few hours a day to save money.

A patient in a nursing home fell and broke a wrist.  A son living close by believed Hospice was doing a good job managing the pain and symptoms and didn’t see the need for disruptive hospitalization and surgery.  A distant son who shared Power of Attorney ordered the facility to call 9-1-1 and have the parent taken to the hospital to have the wrist repaired.

A patient living at home with a daughter sees day-to-day how the patient is declining.  Visiting siblings who have not seen the parent for several months are shocked by the decline and question sister’s ability to be a caregiver.

Four siblings cannot agree on what to do for their aging parent.  Two live close and two are further away.  The one living furthest is an attorney and the parent has given this one authority over finances and health.  Those who see the parent daily have a problem with this.  The attorney, however, believes that the siblings are deadbeats trying to live off of the parent’s resources.

All of these scenarios have occurred to Hospice patients, as well as to thousands of other elderly people who are not able to provide for their own care.  Coordinating care between those who see parents daily or weekly versus those who live away is problematic.  Physicians, Hospices, hospitals and nursing facilities all struggle with providing care when the authority to act is unclear or disputed.  When one of the children’s chosen profession is in medicine, finance or law, that child may feel the need to wear the professional hat rather than simply being a child and an equal sibling.  Or siblings may expect it when the professional just wants to be a family member.

Suddenly being an only child looks rather advantageous.  Naturally, it isn’t something that we who have siblings can change.  I have aging parents living in Boise.  My siblings are in Northern Idaho and Southern California and I’m in Central Washington.  I have an in-law living with me and my wife.  Managing care involves managing communications.   Here are a few things I’ve learned:

1.  Getting everyone on the same page may not be possible but at least everyone can have the same information.  If I have information, I share it with siblings.

2.  Being honest about expectations is essential.  If I fail to speak my mind for fear of hurting a parent or sibling’s feelings I will create a greater mess down the road

3.  Know the difference between needs and wants.  Needs of parents take precedent over wants of adult children.  This involves being flexible in planning.  Wants of parents are negotiable with wants of adult children.

4.  Respite for all is essential.  Preventing caregiver breakdown should be laid on the table and discussed frequently.  Planning visits to aging parents to help rotate respite duties gives primary caregivers the needed break.  Five consecutive days of non-caregiving (or shared caregiving) every six months is a good minimum.  This allows caregivers to catch up on things neglected, like self-care.

5.  Expect different perspectives.  Distance, individual personalities and life choices, individual areas of expertise and interest are all part of what give us perspective.  Recognize that perspective is just that…a viewpoint, not a complete and correct analysis of all the facts.

6.  Ensure that everyone knows what to do in a variety of circumstances.  Each state requires different forms to elect level of medical intervention to be given to someone incapable of self-determination.  If one person is the primary POA (Power of Attorney) for medical, consider having a secondary in case the primary isn’t available.  Sometimes decisions need to be made quickly.  It is easy to armchair quarterback after the fact but when things are clear up front our loved-ones stand a better chance of having their wishes respected.

7.  Be aware of the role that money can play.  Scenes of families sitting around a lawyer’s office listening to a will being read may be entertaining but in real life it’s best not to have surprises.  Family relationships can be permanently damaged by money concerns.  It’s best to talk them out openly with all involved.

Rev. Ron Jetter, Executive Director

Lower Valley Hospice and Palliative Care

It has been said that we never get a second chance to make a good first impression.  It may be stating the obvious but it’s true.  Overcoming a bad introduction or entry takes time and effort.  It’s best, when possible, to put the effort into making a good first impression.  In Hospice we may not get a chance for a second impression.  One out of every eight patients passes away within 72 hours of coming on to Hospice service.  For some the time on Hospice amounts to a matter of hours.

What can be done to make a good impression in three hours, if that is all we have?  It’s a question that our staff has had to face numerous times.  Though each person on the Care Team has a specific job to do, they make an impression as a Team.  From the time our admissions nurse speaks with a patient, family member, physician or facility nurse impressions are being made.  Are we both competent and compassionate?  Have we conveyed to those in need that we are here for them, that we are fully present, that all of our experience will be put to use to wrap them in a loving embrace to help the final hours of life go peacefully for both the dying and the survivors?

When we’ve had a few months to really get to know a patient and a family we’ve counted it as a special blessing.  We become extensions of the family in a small way.  From having called us at night or on weekends they already know that we’ll be there when they need us.  We have time to help teach caregivers how to be better at their labor of love, as well as take care of themselves.  When a death comes our Bereavement Team makes a natural transition, building on the history we have with the family.  Not surprising, such families will often include “In lieu of flowers please consider a gift to Lower Valley Hospice” in the obituary.

It was surprising to me, though it shouldn’t have been, when we began receiving numerous memorial gifts for a patient who was not on our service very long.  It had been a challenging situation, however, and the staff worked overtime, above and beyond their usual excellence.  Somehow, within the space of a few hours, we had been able to leave a great and lasting first impression, taking care of someone who was beloved to many.  Our work said to the community that they can count on us and the community said thank you by sending us resources to help compensate for the cost of our going that extra mile.

When things like this happen I want to know what went right.  We have procedures in place to investigate complaints and things going wrong and we take them very seriously.  We have procedures in place to ensure that things don’t go wrong and they work very well.  But when the potential for disaster turns into a jewel in the crown it makes me wonder, what was that extra ingredient that went into the care of one patient in particular?

The more I searched the more I realized that there was nothing special about the staff, apart from the fact that they are some of the most fantastic people I have ever had the honor of working with.  They did great stuff, but they give every patient that same care, whether they have months to do it or only three hours.  I finally decided that what made the difference is that we find ourselves blessed with some incredible people right now.  Not everyone survives past the two-year point working in Hospice.  For those who do, however, there is an incredible wealth of experience, compassion and commitment to end-of-life care.

I need to add a word or two about Hospice volunteers also.  Each of our patients has the option of having a volunteer come in.  Some sit and talk, some read or even sing with patients.  Some bring pictures and some play games.  But all of them have chosen to do something that can only be described as noble.  When a new volunteer brought along a high school student to a training I thought, “What a wonderful way to model to your child what it means to give dignity to others, no matter what their situation.”  This parent made a great first impression on me.

Rev. Ron Jetter, Executive Director                                                                                                                     Lower Valley Hospice and Palliative Care

Several years ago I received a call from a pastor in my denomination who had had a member of his congregation move to my area.  The member in question was no longer able to live alone and had moved in with her son and daughter-in-law.  I was asked to go visit and help make the woman welcome.  Because the caregiver children were not active in the church it meant I would also need to seek volunteers to assist the transplanted senior citizen to get to church on Sunday.  It wasn’t all that difficult and it resulted in helping the woman regain a sense of having some roots.  The people were unfamiliar but the faith that had sustained her through life was still nurtured through worship, fellowship and visits from me.  It wasn’t an uncommon scenario; I had made the same request of others when one of my flock relocated elsewhere.

The number of Hospice patients who experience dislocation is significant.  Sometimes they have moved here to be with a son or daughter and have never really made new connections.  They’ve outlived many of those they knew in their former home.  Sometimes a move from home to care facility becomes necessary if caregivers are stretched beyond their capacity to meet certain acute medical needs.

Most of us have relocated several times in our lives.  My wife and I once counted the number of different addresses we had between the time we left home after high school and the time we finally settled in to buy a home and begin a family 11 years later.  Eleven was the magic number.  An average of one move per year for over a decade.  Not surprising we’ve had only three addresses after that.  We spent almost 15 years in our first house here.  When we moved it was only 3 blocks and it was into a place suitable for my wife’s mother to move in.  We, too, became caregivers to one of the dislocated.  We have seen first hand the effect of ‘mom’ closing the doors on her 50 years in Boise, parting with beloved friends and possessions, leaving the church she and my wife’s father helped to start lo those many years ago.

Access to medical providers has been an important piece in helping ‘mom’ settle in here.  Providing support to keep her driving to church and pinochle at the senior center helps us all.  She has freedom and we are not yet caring for a homebound parent.  Familiar foods, familiar activities all help fill the empty space.  For those who relocate and don’t have access to familiar routines the emptiness remains a painful void.  There will be future loss of abilities; it is nature’s unbreakable rule.  As we age we lose touch with the life we have known. We will all need to face that loss and adjust as we can.

For those who find themselves as caregivers it behooves us to help our dislocated seniors to make new roots.  They will never be as deep as the ones left behind but they can nonetheless nourish body, mind and soul.  Helping them to talk about it is both informative and cathartic.  Feelings of grief and loss need to be expressed and ideas for adjusting need to be discussed.  We remind ourselves that our actions now are teaching our own adult children how to care for us when our own dislocation comes.

I still receive the occasional call from a pastor in another area.  I gently explain that I am no longer serving a congregation but have gone into the ministry of Hospice.  I provide contact information for other pastors so as not to create a dead end.  I know from that side of things how hard it is when there is no one like me on the receiving end of a relocation to accept the duty of providing soul-care.

Hospice is a place where we acknowledge dislocation.  It brings mental anguish, emotional grief and spiritual distress.  It is a reminder that time flows only one way, like the waters of a stream seeking the path to the ocean.  Just as the ocean receives all waters, so death will receive all living things, us included.  We cannot stop water from flowing down or humans from winding down.  What we can do is make sure that the quality of life is the best it can be at any given time and place.

Rev. Ron Jetter, Executive Director                                                                                                                     Lower Valley Hospice and Palliative Care

NBC News Reporter Edwin Newman once wrote a book called Strictly Speaking. Its subtitle was perhaps more interesting and more indicative of both Newman’s purpose in writing and his greatest pet peeve:  “Will America Be the Death of English?”  Newman, now 90, has been retired from broadcasting for almost 25 years officially but his life’s passion for accurate speech lives on in me.  The unspoken word has been my life and livelihood since entering the ministry in 1980.  It has been my passion since learning of the power of words, thanks to high school writing teacher, Mary Kay Smith.

One of the most common misuses of words (arguably) occurs when we speak of what we ‘feel’ when we ought to be speaking of what we ‘think.’  We have become abusers of the “F” word, so to speak.  For example, this morning someone said to me, “I feel that we should buy a new chair for the office.”  The use of the word, ‘feel,’ indicates that there is an emotion attached to the issue of buying a new chair.  In fact it was a logical decision based on a thought process resulting in a judgment about purchasing the chair.  It would be more correct to say, “I judge that we need to purchase a new chair,” or “I believe that it is time to buy a new chair.”

When we use the word, “feel,” the very next word in the sentence should be a word that describes or refers to the feeling.  There are hundreds of words describing feelings in the English language.  In my office are two cute laminated charts sporting variances on the happy face theme, each bearing its own descriptive word.  Generally, however, many of the words come under the general categories of (a) sad, (b) angry, (c) happy, (d) afraid or (e) numb.  For example, “I think it is time to buy a new chair but I feel anxious when I look at the budget.”  “I feel satisfied with my new car and I judge it was a good decision.”  The word after ‘feel’ is a feeling word.  If the word you tend to use after ‘feel’ is ‘that’ or ‘like,’ you probably should be using ‘think’ or ‘believe’ or ‘judge.’

I wonder if it stems from our inability to make decisions based on mental processes informed by emotion.  Decisions made primarily or solely based on how we feel about something are most likely to be decisions we will regret.  Decisions made with an awareness of our feelings but mostly out of a logical thought process will, in the end, be better decisions.  Sales people know this.  They will often press for a quick decision when the customer is in ‘good feeling mode.’  “Can’t you see yourself in the driver’s seat of this beautiful car?  Won’t your friends envy you when they see you in it?”  If they can get us out of mental mode into emotional mode, we are now hooked waiting to be reeled in.  The best purchases are made after sleeping on it.  This means agreeing ahead of time not to make a major purchase on the day you first look.  I judge you will make better decisions if you are able to do this and I hope you will feel satisfied with your choice long after the purchase.

A recent television commercial encouraged me within the first few seconds but by the end its writers had fallen into the same trap.  “Some medicines only make you feel better, but [our product] actually makes you better.”  Cut to live person saying, “I’ve been taking it a week and I feel better.”  While the word ‘feel’ was followed by a descriptive word (better), the ad nonetheless used doublespeak.  It criticized other products for only making you feel better, then had a live person saying she felt better after taking their product.

Is this really a big deal?  Does it really matter if we confuse ‘think’ and ‘feel?’  It matters to those who would turn us into objects to manipulate.  The overuse of ‘feel’ indicates we may be losing the battle.  Somewhere there is a place for the proper use of language.  It safeguards us in more ways than we know.

Rev. Ron Jetter, Executive Director                                                                  Lower Valley Hospice and Palliative Care

Captain Ron’s VIEW FROM THE BRIDGE

September 2009

I received a notice from an insurance company. Home, auto, life, health, I’m not sure which. They all come on a regular basis demanding my immediate attention, along with a thousand other things going on at any given time. It was a very nice letter, well written and personal. It was signed, Sincerely, The Finance Office.

It was similar to others I have received over the years. I have gotten personal greetings from “Operations Department,” from “Alumni Office,” and even from “Credit Division.” I suspect that actual human beings wrote those letters, and that offices, departments and divisions are staffed by those same human beings. When I have tried to contact one I must first wade through a series of finger exercises designed primarily to wear out the #1 key on my phone. When I do reach a person I always ask for a name. Sometimes the respondent will hesitate to give me one.

At times I get a little impish. I think being raised on a diet of Robert Frost poems is to be blamed for that. I am known to say, “Is this Mr. Department?” or “I’m guessing your mom and dad gave you a name. Since I already gave you mine, can I have yours? Then we can converse like two people, rather than a customer calling a Division.” It’s a little game I play to remind the people that I am also a person. After waiting on hold my mind comes up with all sorts of cute and clever ways to help coax the humanity out of the Office Department Center on the other end of the line. After all, it will be the only time I’ll talk to this person. My chances of getting the same person twice are pretty small when dealing with large corporations.

Last week a family member of a Hospice patient calling us up and asked to speak to the person in charge. It happens occasionally, though they usually prefer to talk with the nurse. Nonetheless, we don’t think of their loved one as J4525 or whatever their patient identifier is (yes, all charts include patient numbers, in accordance with medical records regulations). I wouldn’t dream of saying, “Oh, hello, oldest male progeny of J4525. This is Administration. How may I help you?”

Occasionally if people call after hours they will wait on hold while our answering service connects them to the nurse on call. We are just the right size, able to be personal with everyone with whom we interact. We aren’t so small that we would need to turn someone away or refuse to make a house call in the middle of the night. We aren’t so big that we forget that you and your loved-ones are people.

We do have departments. The largest is the Clinical Department and it has a Clinical Director. Her name is Debra and she will take your phone calls pretty much whenever you call, provided you aren’t trying to sell her something. The same is true of me. As the Executive Director I oversee those who work in Administration and Finance. But if you have a billing question, I won’t put you on hold while I refer you to finance. I’ll have Teresa pick up the phone and help you. Our departments tend to have names like Carmen, Elysia and Kathy. And if you call back, you won’t get someone else the second time.

Sometimes we get pretty busy and can’t take your call at the moment. We try to get back with you as soon as possible. If you are selling something, be persistent. You aren’t going to be our priority. Taking care of our patients and their families will always take precedent. Nothing personal. When you’re the one in need, you’ll appreciate that fact.

Rev. Ron Jetter, Executive Director Lower Valley Hospice and Palliative Care

Captain Ron’s VIEW FROM THE BRIDGE:

August 2009

Last winter was particularly drab, cold and prolonged.  I wasn’t the only one to think that.  The National Weather Service said that the winter months were colder than the average.  March, for example, was 10 degrees below normal overall.  It was on one of those early March days, driving under grey skies into a chilling, gusty wind.  I happened to be in Richland, driving north on George Washington Way.  It was as though I was driving in a black and white movie; the color had seemingly gone out of everything.  Then on my left I saw the Bali Hai Hotel with its colorful sign beckoning weary travelers.  The very name of the hotel dates its construction to sometime in the 1950’s.  Borrowing the name of a fictional island from Rodgers and Hammerstein’s “South Pacific” the hotel invited people to take a break from their journey and escape to a tropical island paradise.

James Hilton’s 1933 classic, Lost Horizon, may have served as the inspiration for the island.  In the book Hilton presents the world with the likewise fictional ‘Shangri La.’  It’s not an island, however, but a mountain retreat in the pristine air of the Himalayas, but warm and sunny.  Closer to our time is the 1972 Kenny Loggins song, “Vahevala.”  So convincing was the song that many thought Vahevala was an actual island.  Loggins says that he simply liked the sound of the word, which he invented, and which was inspired by actually sailing in the Caribbean Sea.  Kind of like the Viking version of heaven, known as “Valhalla,” but warmer.

Each of these, an author, a rock music composer and a Broadway play writing duo had one thing in mind: taking their audiences away from their own drab, gusty lives and transporting them to a place of warmth, love, peace and joy.  We sometimes call that escape. 

Entertainment is big business today because the need for escape is real.  People come home from a long day of work and escape into a good book.  Kids endure a hard week of school and escape to the movies Friday night.  Families endure months of a daily routine and escape on a grand vacation.

Hospice patients have the same need to escape.  Some are still capable of making one more trip to visit family, or one more venture to the lake to go fishing.  Some can only escape in their minds.  For anyone whose circumstances limit how much one can physically escape daily reality, it is especially important to find ways of traveling away mentally.  Some Hospice volunteers bring photos or travel videos to patients.

Most of us have experienced times in our lives when we were in just the right place at the right time. Weather conditions were ideal.  We were doing what we wanted to do with those we most wanted to do it with.

This well of memories provides a wonderful resource for Hospice patients.  Maybe the disease has progressed to the point where they won’t check off any more items on their 100 things to do before I die ‘bucket list.’  What they can do, however, is travel in their minds or memories to a place that brings peace and comfort for awhile.

As a chaplain I have used a technique called Guided Imagery, in which the patient is narrated from their physically limiting place to a mental awareness of somewhere else.  I learned the technique during a retreat at a monastery many years ago.  The friar who instructed me suggested finding ways to involve the senses.  It doesn’t mean I need to go out and pick a bouquet of flowers and put them under someone’s nose. Merely the mentioning of the scent, along with narrating a description of the meadow in springtime, will help bring those memories into the present.

Some think that Hospice patients want to talk about dying.  Some do but many do not.  They want to remember life, to celebrate life, to live as fully as possible until the flower fades and the curtain closes for the last time.  Hospice is a wonderful concept and we at Lower Valley Hospice are a collection of unique individuals with lots of creative gifts offering a wide array of techniques to help people enjoy one more visit to Shangri La, even if they can’t leave their beds.

Rev. Ron Jetter, Executive Director Lower Valley Hospice and Palliative Care

It sounds crazy but it’s not.  Tell me what you don’t like about me.  Tell me what I’m doing wrong.  Tell me what I could be doing better.  No, I admit I don’t want to hear what you have to say but I need to hear it.  We all do.  There is always room for improvement and the only to know what improvement looks like is to hear about it when expectations aren’t met or the results weren’t what we desired.

Feedback is necessary but difficult.  Separating constructive criticism from the plain old garden variety of criticism can be difficult.  Constructive criticism comes from those who genuinely want to provide necessary information to help me or this vessel SS Hospice stay on course.  The other kind is often referred to as dumping.  Then again, dumping comes from people who are angry, and I’m willing to admit that sometimes people have a righteousness to their anger.  It represents their passion, their caring, their hurt.  I like to offer listening to general criticism in order to earn the right to also hear the constructive critique.

Ships today have sophisticated navigational systems that help them plot their course to within a few feet.  We’ve improved things since Christopher Columbus set sail in 1492, hoping that he’d run into some kind of land before the crew mutinied.  For 56 of those 57 days they could only guess where they were with no land in sight.  Now we have GPS to guide us and Radar to know who else is out there sharing the high seas with us.

One month following the passing of a Hospice patient our ship’s navigator, Lyla, sends out surveys to the families of our patients.  She then goes through an elaborate ritual that I can only assume involves magic or at least mathematics because when she gives me the report, it allows me to see clearly what obstacles lie in our path.  The surveys contain 5 questions that ask the respondent to rate us on a scale of 1 to 10.  The questions ask if we provided emotional support to the family, respected the patient’s wishes, ensured patient’s needs were met quickly, helped the patient to die on his or her own terms and provided the family with the information they wanted to understand what was going on.

If you’ve watched the weather report on the evening news during a storm you’re familiar with Doppler Radar showing green on the map where rain is actively falling.  In Florida it shows yellow and red too, indicating far more rain than we ever get.  White is for snow and purple is for lots of snow.  We get purple sometimes.  When the map shows nothing it means we have clear weather. When I look at surveys and summaries and see nothing but 9s and 10s it’s like watching a boring weather report.  Oh, I don’t mean to minimize the fact.  I praise the wonderful people with whom I work.  When I see an 8 it’s like green on the Doppler.  Time to pay attention.  I don’t want it to get to the point where I’m seeing yellow or red.  There were two 8s on two different questions in the last bunch.  Not bad out of a dozen surveys.  Still, ignoring them is like Captain Edward John Smith of the Titanic saying to himself, “We only hit a little bit of the iceberg…and this is an unsinkable ship!”

Did we provide emotional support to patient’s family?  Apparently we could have done better.  Part of what makes Hospice such a blessing for people is that the nurse, social worker, aid, volunteer and chaplain become well-known to the patient and families.  In the case of the two families who gave us an 8 both patients were on our service for only a matter of days.  How can we encourage people to invite us in sooner so that we can provide the support?  How can we encourage physicians to talk with patients about the benefits of having Hospice earlier?  When 1 out of 8 patients receive three days of Hospice or less it is very hard for our whole team to do our best work.

Rev. Ron Jetter, Executive Director Lower Valley Hospice and Palliative Care