The hospice journey is never taken alone.  A team made up of family, friends and professional caretakers and volunteers work together to ensure that the patient’s wishes are honored.  But each patient has a different personal support system as well as very individual wishes for end of life.   Recently, Hallmark Health Visiting Nurse and Hospice, located in Boston’s northern suburbs, faced a unique challenge - to fulfill a patient’s desire to not die alone when there was only a small distant family to offer support. 

In April 2006, one year after her husband died, “Alice” was diagnosed with colon cancer.  At eighty-two years old, she also suffered from a multitude of other health issues including chronic lung disease, a heart condition and impaired vision.   Her only relatives were two nieces who lived in another part of the country and locally, her husband’s nephew and his wife.   Because of her failing health and her limited family support system, Alice moved into a nursing home and in October, she chose to receive hospice care. 

According to Jeanne Bruno, Hospice Chaplain, Alice’s case was an example of the incredible power of the team and hospice’s goal in honoring a patient’s wishes. “Because Alice had a tremendous fear of dying alone, her primary care nurse pledged to her that we would try to support her in the process as best we could.                                                           

For many patients, family members remain by the bedside and keep vigil with their loved ones in their final hours before death.  Determining the time of Alice’s decline and pulling together a vigil team who would be available to maintain the vigil created a challenge for Bruno and the Hospice Nurse, Kathy Murphy, Social Work Intern Peggy Brown and volunteer coordinator, David Dismas. 

Their initial first step was for Dismas to contact two hospice volunteers who regularly visited with and had developed a great admiration and close relationship with Alice.  Additionally, Dismas enlisted the help of other volunteers who were “at the ready” to participate.  Another participant in the vigil was Alice’s nursing home roommate, “Evelyn”.  In the time that they had shared a room, the two women had formed a friendship and close bond.   

“Pulling together a team of people for a vigil can be a challenging and awesome task, but it was really a testament to Alice and her amazing personality that the vigil team grew and succeeded,” explains Bruno. “She was very vulnerable, but she had a strong, responsive personality that people gravitated to.”

Initially, the vigil team consisted of five hospice employees who volunteered their time, roommate Evelyn, three hospice volunteers and Alice’s nephew and his wife.  Eventually, the nursing home staff joined the vigil as well.  “The nursing home staff were impressed that this was being done, and before we knew it, the aides were participating

and even the laundry staff would sit for a few minutes and keep vigil,” explains Bruno. “For everyone in the nursing home, the experience really modeled what hospice does.”

Linda Twohig, RN, BSN, Director of Nursing Services at Courtyard Nursing Care Center in Medford, Massachusetts, has worked in the nursing home environment for over twenty years, but had never before seen anything that matched Alice’s vigil.  “Everyone knew that Alice was dying and once Hallmark Health VNA and Hospice began the vigil, it seemed to just blossom,” explains Twohig.  “It was very special, not only for the patient’s family, but for the staff as well.”    

Every hospice patient is different and every plan of care must be developed to specifically meet the needs of the patient.  Hospice Nurse Kathy Murphy understands that concept very well.  In a situation with another hospice patient, she arranged to have an ambulance bring the patient up to her summer place so that she could see it for one last time. 

For Alice, her desire to not die alone may have stemmed from a tragic early life.  Her mother had died when she was young.  Her father was unable to care for her and she ended up in foster care.  “I believe the wounds of Alice’s early life played into her fear of dying alone,” says Bruno.  “The hospice team gave her multiple caregivers who provided unconditional love.”    

On March 14, 2007, Alice passed away.  She was not alone.  Hallmark Health VNA and Hospice and the team of people dedicated to keeping a vigil, fulfilled her wish, but hospice’s work did not end there.  The individual who had developed the closest bond to Alice, her roommate Evelyn is receiving grief counseling from Hallmark Health VNA and Hospice.  “I stayed right with Alice, holding her hand,” explains Evelyn.  “Hospice was wonderful.  They stayed with her day and night and after she passed, they included me as if I were part of the family, coming to visit with me, letting me talk.  It made it a lot easier.”

Bruno explains that one of the commitments of hospice is that its work doesn’t end when the patient passes away.  “We still had a commitment to Evelyn to help her through the process.  Our continued involvement for bereavement support provided by a social worker, chaplain and volunteers serves as yet another example that the hospice journey is never taken alone.”

Hallmark Health Visiting Nurse Association and Hospice, Inc., has been providing services for more than twenty-five years to patients living in twenty-three cities and towns in the Greater Boston/northern suburbs.  The Hospice sees approximately five hundred patients a year and utilizes a team approach to care.  At the core of this team is the patient and family, supported by hospice nurses, bereavement counselors, a hospice chaplain, social workers, a volunteer coordinator, hospice certified home health aides, rehabilitation therapists and volunteers.  In addition to providing traditional hospice services, Hallmark Health VNA and Hospice offers patients complimentary therapies such as massage, Reiki, foot reflexology, polarity, shiatsu and acupuncture.  The agency also provides a Palliative Care Program and numerous support groups for adults and children.  Inpatient care is provided in both hospital and extended care settings.