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Hospice: Tools for dignity and comfort

In hospice, we have tools for dignity and comfort in death

Date: Nov. 22, 2014

Original Dallas News Link: Dallasnews.com

The first time she visited the home of a dying person, Krystal Alvarado nearly jumped out of her skin.

“I was a nervous wreck,” she said. As a young acute-care nurse, Krystal saw death as an enemy to fight at full bore, not as a certainty to quietly embrace.

“I’m like, ‘Get the crash cart! We need to save him!’”

The patient was dead in two days. And Krystal knew hospice care was not for her. “I thought, ‘I will never, I could never be that kind of nurse.’”

But after only five years of nursing in emergency rooms and surgical suites, her view on fighting to preserve life at all costs had changed completely.

“I saw so many patients come in and we gave them an overabundance of care. We were doing life-saving procedures on people who clearly were not going to be able to function in life,” she said.

“It was the saddest thing. They weren’t living. There was no quality of life. I thought, ‘There has to be something I can do as an individual to make this better.’”

And that’s how life led her back to the place she had sworn off — to the bedside of hundreds of dying people.

Comforting, caring, relieving pain, bringing dignity in death. “I knew this is what I went to nursing school for,” Krystal said.

Today she directs hospice care as vice president of nursing for VNA, the North Texas nonprofit we first knew as the Visiting Nurse Association.

It seems we’ve all talked more lately about death and dying, but we can’t top Krystal. Death is her life.

“I wake up every morning excited,” she said. “This is not just a job for me. This is a ministry.”

And Krystal makes a pretty good evangelist for changing our thinking about hospice care. “There’s such a stigma to the word. People see it as giving up,” she said.

“But it’s really about focusing on the quality of life instead of the quantity of days. This isn’t about just helping you die. It’s about helping you live.”

This recently has been in the public’s view because of the assisted death in Oregon of Brittany Maynard, the young woman with terminal brain cancer.

Krystal said she never judges others’ decisions about the end of life. But she says good hospice care prevents the kind of death Maynard feared.

“If we would have had the opportunity at the VNA to intervene, she would have had a comfortable, pain-free dying experience,” she said. “I’m certain of that.”

In this ministry of hers, the major sermon Krystal preaches is that hospice care should be used more and sooner.

Currently, fewer than half of people who die received hospice care.

And of those who did, half were in hospice care for three weeks or less. A third were in hospice for less than a week before death.

Krystal said that’s evidence that patients, families and doctors alike wait too long to accept the inevitability of an approaching death.

“People just don’t want to have that conversation — and doctors are as bad as anyone about avoiding it. They’re just human, too,” she said.

Good hospice care should begin months, not weeks, before death. But Medicare and private insurance pay for hospice only when all attempts at curative treatment have stopped. And that’s a tough call for people to make.

Krystal would like to see more use of what’s called palliative care as a bridge between hospice and full-out treatment mode.

The key is for people to begin talking about end-of-life issues and educating themselves long before a moment of decision arises.

“We’re making decisions in crisis,” she said. “And that’s why we have so many people living who don’t know they are living.”