The Hardest Part of My Day Job

Today the doctors, nurse practitioners, physician assistants, and I had a luncheon meeting with representatives from the small hospital in town that has merged with the big city hospital nearby and are now merging and blending their separate VNA/Hospice services into one cohesive whole unit that will better service our area, as our local VNA associated with the small hospital did not offer palliative care. As of right now that service is more readily available to our local patients because of this merger.

It was a very informative meeting, but also a very difficult one for me to attend, even though it's my job to connect our patients to VNA, hospice and palliative care providers if it's not done at the hospital discharge level, or release from a skilled nursing facility to home when the patient expresses a wish to die at home.

It was difficult for me because we just lost John's Mom seven months ago and his 94 year old Dad is becoming more frail every day. I still feel, even though John's brother is an MD, that they didn't do all they could have done for Mom. I still feel, nearly 16 years later, that we failed my Mom in that respect also. My Dad was given two weeks to live in early 2011. He spent one week in the hospital then was transferred to a skilled nursing facility. The day before he passed my brother and his best friend visited him. There is a cellphone picture of Dad and my brother both of them smiling, happy as clams (my brother was Dad's only son and had flown home from Nevada when I'd told him "You can come home now and see Dad while he's still here with us, or you can fly home for his funeral next week, it's your choice." He chose wisely and it was a relief to me that at least they got to see one another one last time.) They had a great visit that Saturday afternoon when my brother finally got here after his flight was detoured down south due to a blizzard here and he had to take two hopper flights and ended up in providence RI instead of Windsor Locks, CT. The next day I went to see Dad and he never woke up during the hour and a half I sat with him. The nurse had medicated him due to pain and anxiety and he was resting peacefully. I left him new pictures of Kelly, and the red fox that had been frolicking in the back yard along the woods at lunchtime that day digging up an acorn stash from under the deep snow. I will always associate that red fox jumping and diving so joyfully into the snow with my father's lifelong youthful, playful spirit. I truly believe the fox was in my backyard at that time on that day for a reason. (Dad was gone in the wee hours of Monday morning, the day my brother had to fly back to Nevada.)

Anyway- the meeting was very well presented and informative. I managed to blink away the tears of tenderheartedness five times, and I learned the difference between palliative care and hospice. Palliative care is for patients who have frequent exacerbations of chronic illness but are not in immediate danger of dying. Palliative care brings them comfort, and opens discussions between the patient and the patient's family members about options as end of life approaches as the disease progresses. They provide information for the patient and family member, hold informational meetings, answer questions, have an MD who goes in to be the eyes and ears of the attending physician when the patient is too weak to make it into the office to be seen. The palliative care MD may contact the attending MD and let him know the patient is ready to transition to hospice, or back to regular VNA skilled nursing with eventual discharge from service if they are improving, rallying. Hospice is for terminally ill patients with 3 months or less life expectancy. It can be extended to another three months as long as the patient is not showing signs of improvement. Hospice provides comfort care and places pain medication and anxiety treatment medication in the home which keeps the patient comfortable. Hospice also provides counseling to family members to help them prepare for the impending loss of a loved one, and then bereavement counseling and support for up to 13 months, and sometimes longer after the patient passes. They also hold remembrance services and group events for families who've recently lost loved ones as a support network.

I really didn't fully understand all this until today since I haven't had much exposure to palliative care since our local VNA didn't offer this service. I just occasionally stressed about finding a service that offered palliative care when a patient's family asked for that, but usually by the time they asked the MD had already put the patient on hospice, or the patient passed away overnight before I had a callback from the service I'd contacted.

I like being able to help people. This is just one of the many things I do in my day job as the medical secretary who also does all the prior authorizations for medications, gets the prescriptions and documentation needed to the suppliers for durable medical equipment, hooks patients up with oxygen, CPAP and nebulizer machines and supplies, sets up transportation services to MD appointments, helps patients fill out forms for patient assistance programs when they can't afford their medications, helps patients with disabled placard requests, etc. I also make sure all the various reports and paperwork that gets faxed and brought into the office on a daily basis gets seen and signed and returned in a timely manner. All that plus the VNA connections as well. I am a busy lady at my desk every day.

Most days I come home feeling good about what I do, but there are days when I come home feeling sad- those days when a patient goes on hospice, or dies.

It's never easy to say goodbye.