chs2020 – Page 4 – Blog Posts

Home Runs for Hospice Hits It Out of the Park

Going to the ballpark usually means sitting back in the stands, relaxing and watching your favorite team take the field. You cheer when the rookie pitches a smoking fastball that blows by the first batter to log his first-ever strikeout. Or maybe you cry tears of joy in witnessing a walk-off grand slam home run for your team, which allows them to make the playoffs after a drought of too many years to count. For attendees of the second annual Home Runs for Hospice at George M. Steinbrenner Field (the New York Yankees home for spring training), their trip to the park was quite a different and unique experience.

What is Home Runs for Hospice?

Home Runs for Hospice is a breakfast event organized by Chapters Health System to educate the community about how LifePath Hospice provides care and support for patients and families who are in need of compassion. The mission of LifePath Hospice — as well as Good Shepherd Hospice and HPH Hospice — is to provide people in our community, with or affected by advanced illness, the opportunity to access a variety of compassionate healthcare choices no matter what their financial circumstances might be.

Over the last 35 years, the community has come to depend on LifePath Hospice to assist with end-of-life care. As the first speaker at Home Runs for Hospice, Andrew Molosky, president and chief executive officer for Chapters Health System shared, “Championing events like Home Runs for Hospice and making donations throughout the year help support the minds, bodies and spirits of our patients and their families — especially in the form of grief counseling, which is considered an otherwise unfunded program.”

In 2017, LifePath Hospice provided one-on-one grief counseling for 1,227 bereaved family members, and 1,636 grieving hearts found comfort in support groups offered by the Circle of Love Center.

“In addition to grief support, we provided $1.7 million in unfunded care last year alone. People count on us — people like Aaron,” continued Andrew. “Here’s his story.”

At the age of 57, Aaron lost his wife and three months later his mom died. Not long after these tragic events, Aaron also became unemployed and therefore could no longer afford his rent. His pick-up truck became his home. During an unusually cold January and failing health due to aggressive cancer, he asked the Melech Hospice House to take care of him.

Flooded with visits from friends during the day, Aaron would disappear for hours in the evening. A search each night found him back in his pick-up truck. And here’s the reason: His most prized possession – his wife’s ashes – was in his truck. By being in close proximity to her ashes, Aaron felt her presence. In his days at the hospice house, he found a new family in the staff. It did not matter that Aaron was too young for Medicare and too poor for private insurance, the staff cared for him like he was their own family. Aaron passed away peacefully from this earth with love and dignity.

Words from the Heart

From butterfly kisses and little league games to family dinners, these are types of moments that make life rich. Each day is an opportunity to make memorable moments: to laugh, hold the hand of someone you love or fulfill a final wish. During the Home Runs for Hospice program, the speakers’ stories helped every attendee understand completely how important it is to take advantage of every moment life offers us.

The program opened with former LifePath Hospice chaplain Guy Glass. Here’s a story about a patient who made a profound impact on Chaplain Glass’ life and his philosophy about making moments matter.

Years ago, I had a special patient, Mr. Steven Williams, who lived in a poor part of Tampa. There was no doubt he was poor, very poor. For his entire life, Mr. Williams never had the best of anything. In fact, he had a pretty rough existence. It was around Thanksgiving 2011 when I dropped by to see Mr. Williams in the morning, and his decline shocked me. I knew that day there wasn’t much time left so I asked him one of our big questions,“Mr. Williams, do you have any unfinished business we need to take care of at this point in your journey?” He became really quiet. I could see the wheels turning and spinning in his mind. And then, Mr. Williams looked at me, and his eyes suddenly twinkled. He said, “Chap, there are more fish out there to catch, and I’m running out of time to catch them. Before my life is done here, I want one more fishing trip. Just one…a real one, I want a good one. I want a boat. I want a lake. I want to catch a few more fish, and then I can graduate and go fishing in heaven.”

At that moment, I caught and felt his dream. I got it. We shared a moment. We jumped to action. I said to Mr. Williams, “Let’s make this happen.”

Mr. Williams spent a day filled with fishing joy on Lake Tarpon around Christmas 2011, and he caught some fish. Mission accomplished. It was a moment: A dying, old man’s dream came true. Joy is that mystery that awakens in us when we seize moments and live beyond ourselves.

Due to the generosity of LifePath Hospice and its benefactors, I was able to give Mr. Williams the very best care at the end of his life. Together, we gave him the ability to make the best of every single moment.

Mr. Williams taught Chaplain Glass valuable lessons: Seize every moment to the fullest and live for a dream beyond yourself. Find a light in making the lives and dreams of others come true. Remember what matters most at the end of our lives is that our lives matter. Really matter.

Metaphorically speaking, each and every one of us can find our own Mr. Williams and make sure he gets to go fishing one more time. Together, we can make moments happen.

There are many more stories of how LifePath Hospice impacted patients and families, which will be shared in future blogs.

At Chapters Health System and its affiliates—Good Shepherd Hospice, HPH Hospice and LifePath Hospice, every day is devoted to educating our patients and keeping them in the place they call home. We are dedicated to ensuring that patients, young and old alike, and their families are able to make educated decisions about important healthcare matters. For more information, please call our helpful Chapters Health team at 1.866.204.8611 or send an email to info@chaptershealth.org.

About Phoebe Ochman

Phoebe Ochman, Director of Corporate Communications for Chapters Health System, manages all content and communications for the not-for-profit organization.

Support from Our Home Runs for Hospice Sponsors

Special thanks to the Home Runs for Hospice sponsors listed below. Due to their generosity, 100 percent of the financial investments made at the event will go toward any unmet or unfunded needs at LifePath Hospice. And like all good investments, this one comes with an expected return: compassionate end-of-life care for the needy and bereavement support for grieving hearts of any age.

Word Series Sponsor

Regions Bank

Grand Slam Sponsors

Cushman & Wakefield

The Gertrude Spear McGrew Trust

PAR, Inc.

Tampa Bay Lightning

Major League Sponsors

Caspers Company

The Lowry Murphey Family Foundation

Triple Play Sponsors

AmeriCare Ambulance Company

Richard & Valarie Blau

Anne & Mike Carney

DeBartolo Family Foundation

Dave Finkel

Friendly Smiles Dental Care

HealthSmart Benefit Solution

J.O. Delotto & Sons, Inc.

Andrew & Amberly Molosky

Dennis Olden

Prida, Guida & Perez, P.A.

Cliff & Suzette Rhoades

Sabal Trust

Seacoast Bank

Patty J. Sharrock

Wallace Welch & Willingham

Jim Wurdeman

How Hospice Helps Stroke Patients (DRops of Wisdom)

Today we continue “DRops of Wisdom,” our physician blog, with Dr. Stewart Stein, the associate vice president of medical services for Chapters Health System. He describes the importance of raising stroke awareness during the month of May, National Stroke Awareness Month.

Raising Stroke Awareness

When it comes to raising awareness about heart disease and breast cancer, the American Heart Association and Susan G. Komen Foundation have helped educate millions of Americans about the importance of knowing your numbers and for women, taking the time for monthly self-breast exams. Understanding the perils of stroke and neurological disease could use a decided push in a similar direction.

According to the American Stroke Association, the following are current statistics about stroke:

About 795,000 Americans each year suffer a new or recurrent stroke: approximately 610,000 of these are first attacks, and 185,000 are recurrent attacks.
On average, a stroke occurs every 40 seconds.
Stroke kills nearly 133,000 people each year, making it the fifth leading cause of death.
On average, every 3 minutes 45 seconds, someone dies from a stroke.
Approximately 40 percent of stroke deaths occur in males and 60 percent in females.

Helping Stroke Patients

As indicated in the numbers previously mentioned, many individuals fall victim to multiple strokes. This fact then lends us to think about what happens to these stroke patients. What care might they need?

One of the most difficult decisions a physician or healthcare practitioner will ever make is knowing when it’s time to refer stroke patients to hospice. Studies, however, indicate that most patients who could benefit from hospice care simply aren’t referred early enough. Additionally, many patients and their families do not realize they can self-refer to hospice.

All too often, patients wait too long to be referred to hospice. They are fearful of what that might mean. The myth is out there. Unfortunately, people believe they should only access hospice service when they have mere days to live. If patients choose hospice, it doesn’t equal giving up. The reality is hospice care options allow people to make the most of life with their time remaining.

When Hospice is Right for Stroke Patients

Stroke patients are eligible and can be referred to hospice when indicators, such as the following, are present:

Physical decline whereby patients are limited mainly to being in bed and are not able to perform daily activities of living (activities like bathing, eating, etc. and therefore require assistance)
Inability to stay hydrated and decreased food intake (this issue usually is displayed as trouble swallowing)
Current history of aspiration into the lungs that doesn’t respond to treatment
Unintentional weight loss about 10 percent of body weight over the last six months or more than 7.5 percent over the prior three months
Other chronic health issues

If physicians are not sure whether their stroke patients might be hospice eligible for services at any of our Chapters Health System affiliates— Good Shepherd Hospice, HPH Hospice and LifePath Hospice — we are always available for consultations.

What Would You Like to Read about in Future Posts?

In “DRops of Wisdom,” we want to feature posts with subject matter that interests you. Please leave a comment or email us with your ideas.

At Chapters Health System, every day is devoted to educating our patients and keeping them in the place they call home. We are dedicated to ensuring that patients, young and old alike, and their families are able to make educated decisions about important healthcare matters. For more information, please call our helpful Chapters Health team at 1.866.204.8611 or send an email to info@chaptershealth.org.

About Stewart W. Stein, MD

As associate vice president of medical services for Chapters Health System, Dr. Stewart W. Stein’s extensive background in end-of-life care and a commitment to the delivery of exceptional hospice services are of great benefit to patients and families.

How to Spot a Stroke

Devastating effects of a stroke can be potentially kept to a minimum if the crisis is caught early. Do you know the early warning signs of a stroke? It is as easy as knowing the meaning behind a four-letter acronym.

Learn about F-A-S-T

The four-letter acronym is the word FAST and here’s what it stands for so anyone can speedily access care and minimize the effects of a stroke:

F — Face drooping. Individuals having a stroke can also feel as though their face is going numb. A good rule of thumb is to ask them to smile. If their smile is lopsided or droops on one side, they might be having a stroke.

A — Arm weakness. Stroke victims can also experience numbness along with weakness of their arm. If you ask them to raise both arms and one drifts unprompted, they might be having a stroke.

S — Speech difficulty. Often when someone is having a stroke, they can start to slur their words, not be able to speak at all or be difficult to understand. If you ask them to say a simple sentence like, “The dog is black,” and they can’t repeat or be understood, they might be having a stroke.

T — Time to call 9-1-1. Even if the person’s symptoms have decreased, call any way. When it comes to stroke, time is of the essence and you shouldn’t delay in seeking treatment.

If you are not sure, don’t hesitate. Call 9-1-1 anyway as it is better to be safe than sorry.

Gift of Giving Courtesy of Women Supporting Good Shepherd Hospice

Generous, charitable and bountiful are all synonyms of the adjective “giving.” When it comes to the gift of giving, it can mean different things to different people. This is especially true when you think about hospice. For those who have experienced the benefits of hospice, the gift of giving takes on a personal significance that is quite unique. Yet there is a common thread that runs through everyone — hospice care touched their hearts.

The Gift of Giving at Good Shepherd Hospice

For one such woman, hospice affected her deeply. Although Cindy Sternlicht spent her entire career in healthcare, it did not prepare her to become her mother’s caregiver. “My mother had Alzheimer’s disease, and as she declined physically, responsibilities for her care mounted,” shared Cindy. “During my mom’s hospitalization in 2011, we were presented with the option of a hospice care referral to Good Shepherd Hospice.

“For me, it was immediate relief as the burden was off of my shoulders, and I could just be a daughter” continued Cindy. “Within 24 hours, Good Shepherd Hospice was there with a hospital bed, walker and oxygen. If I had any questions, staff members were readily available to answer them.”

Cindy was affected so profoundly by her experience with hospice care she decided to act and spread the word. “The healthcare staff members have a unique hold on compassion and empathy. It changed my outlook so much. I just wish more people in the community knew that hospice can change a long-held and misguided view on end-of-life care. It did for me.”

In 2012, Cindy and two other women joined with the Chapters Health System Development Department in starting the group known as Hospice Women of Giving.

Hospice Women of Giving Explained

As described by Cindy, Hospice Women of Giving is a group of women with a duo-fold mission. “The group is founded on a desire to build awareness about services offered by Good Shepherd Hospice and gain monetary support for services not funded in any other way,” explained Cindy, who also happens to be the chairwoman of the group. “Every woman involved in our group makes a difference — small and large — whether with a time commitment, advocacy or through donations.”

Hospice Women of Giving is dedicated to strengthening hospice-related programs through collective contributions made to Good Shepherd Hospice. The group also provides women with opportunities for education in an effort to foster and develop women’s capacities for philanthropic leadership and advocacy.

“In fact, on Monday, May 14 at the Lakeland Hospice House, we will have a guest speaker, Attorney and Chapters Health System Board Member James Joiner, talking about an important subject requested by many of our members — the legal aspects of end-of-life and estate planning,” Cindy shared.

The annual contributions of the Hospice Women of Giving members are pooled and used to support unfunded programs and services of Good Shepherd Hospice as voted on by the membership. In three years, the group has provided nearly $35,000 in funding to support Camp Brave Heart, chaplain services with technological resources and Good Shepherd Hospice’s inpatient hospice houses.

Examples of Funded Projects

“Over the years, Hospice Women of Giving has funded projects having a profound impact on patients and families,” said Cindy. “When our chaplains demonstrated the many ways iPads could help them communicate with patients of different faiths and languages through music, pictures and translation, we were thrilled to purchase them for Good Shepherd Hospice.”

Another project that proved to be quite beneficial to patients was the purchase of linen kits. “Hospital beds do not take conventional twin sheets,” explained Cindy. “To alleviate the stress of families needing to run out to get tall twin sheets, our group bought and assembled 400 linen kits for distribution in 2017. The kits were received so enthusiastically by patients and staff that the group immediately chose to fund the project again in 2018.”

During the group’s annual meeting held at the beginning of each year, members review requests from staff. As a member of Hospice Women of Giving, your voice counts when members collectively vote on which patient care-related projects to fund. Also important is the annual education program held each fall, along with several social and membership events. Attendance is never required but always encouraged.

“People sometimes ask if it’s depressing to be involved with hospice, and the answer is quite the opposite. It’s rewarding, and hospice is life-affirming. Ultimately when you support Good Shepherd Hospice, it is a gift of giving from the heart,” concluded Cindy.

About Phoebe Ochman

Phoebe Ochman, Director of Corporate Communications for Chapters Health System, manages all content and communications for the not-for-profit organization.

Interested in Becoming a Member? Here’s What You Need to Know

Any woman in Polk County is welcome and encouraged to become a member of the Hospice Women of Giving. You will join other women who are committed to participating in the educational and philanthropic goals of the group.

The most important benefit of membership in Hospice Women of Giving is the satisfaction of knowing you are part of a collaborative and informed group choosing to make a difference in our community.

Active Member ($500 annually)

Invitation to annual meeting to vote on project funding
Tour of Camp Brave Heart that takes place annually at the Circle F. Dude Ranch
Invitation to an education program held in the fall
Special recognition in the Chapters Health Annual Report
Receipt of a special hospice update with insider briefings
Personal tour of a hospice house and/or the Bethany Center, the children’s grief center

Junior Member ($250 annually over 2 years) — available to women ages 21 – 39

Same benefits as active membership.

Get the Hospice Women of Giving member application here. Or if you already are a member, you can conveniently renew your membership here.

If interested in attending the upcoming Hospice Women of Giving event at the Lakeland Hospice House on May 14, please call 863.583.3129. Light refreshments (and wine) will be served. We hope you can plan to join us for this educational session. And please bring a friend who might also be interested!

If you have questions, would like more information, or would like to join the Hospice Women of Giving, please contact Liz Anderson, Associate Vice President of Development at Chapters Health System at 813.871.8111.or andersonl@chaptershealth.org.

Raising Skin Cancer Awareness: Know What to Look For

Living in Florida, residents can expect approximately 250 days a year to be filled with the sun’s strong rays. It’s no surprise that the state’s nickname is the “Sunshine State.” Despite the obvious, however, many Floridians do not understand the perils of the sun. Every year, the month of May is set aside to raise skin cancer awareness.

Raising Skin Cancer Awareness

The statistics are startling. According to the American Academy of Dermatology, the incidence of skin cancer is higher than all other cancers combined. In fact, it is believed that one in five Americans will develop skin cancer over the course of their life. Here is the breakdown of the estimated number of Americans who will be diagnosed in the United States in 2018: 178,560 new cases of melanoma, 87,290 noninvasive (in situ) and 91,270 invasive. In addition, the American Cancer Society projects invasive melanoma will be the fifth most common cancer for men (55,150 cases) and the sixth most common cancer for women (36,120 cases) this year.

No matter if it is winter, spring, summer or fall, it is important to examine your skin every month in search for anything that looks suspicious. But would you know the difference between normal, benign (not harmful) or harmful? By following some simple ABCDEs, you can be on the right side of the bell curve and raise your skin cancer awareness IQ.

Knowing Your ABCDEs

When it comes to early skin cancer detection, specifically melanoma, which can be deadly, knowing your ABCDEs can be a lifesaver.

But where does one begin? When checking your skin, a good starting point is to be on the lookout for any new growths or moles. From there, you can become a skin cancer detective by observing the following ABCDE clues:

Asymmetrical. If you have a mole already, imagine drawing a line through it to divide it in half. A warning sign of melanoma is that the two halves would not be equal.

Border. If the border or edge of a mole or lesion is uneven, scalloped or there’s a notch, there can be cause for concern.

Color. The majority of benign skin spots are one color ─ usually brown. A red flag is a lesion with a number of different colors or shades, usually a variety of browns. And believe it or not, melanoma can even be patriotic in appearance — red, white and blue.

Diameter. The diameter of a mole is very telling: The larger the diameter of a mole, the more suspicious the lesion. Statistically, melanomas are about the size of a pencil eraser.

Evolving. A prior growth that’s changed significantly or a spot that itches, bleeds or doesn’t heal could be an alarm.

If you discover one or more ABCDEs during your skin check, make an appointment with your physician for a comprehensive skin cancer screening. The good news is that when caught early, the cure rate for skin cancer, even melanoma, is high.

At Chapters Health System and its affiliates—Good Shepherd Hospice, HPH Hospice and LifePath Hospice, every day is devoted to educating our patients and keeping them in the place they call home. We are dedicated to ensuring that patients, young and old alike, and their families are able to make educated decisions about important healthcare matters. For more information, please call our helpful Chapters Health team at 1.866.204.8611 or send an email to info@chaptershealth.org.

About Phoebe Ochman

Phoebe Ochman, Director of Corporate Communications for Chapters Health System, manages all content and communications for the not-for-profit organization.

Learn How to Protect Your Largest Organ

Does the following ring true about your past habits? Have you ever lathered up with baby oil in preparation for a glorious day on the beach? Or did you buy a deluxe package of tanning salon sessions due to your desire to not look pale as a ghost for an upcoming vacation? If these scenarios sound familiar, hopefully you have corrected your habits by now and opted for applying lotion with a high SPF when outdoors and said no to speedy tanning on ultraviolet (UV) radiation beds. But is that enough to protect you against skin cancer?

Skin Protection Tips

It’s not just sunny days we need to worry about. If a day is partly cloudy, your skin can still be exposed to harmful UV rays. There are definitely some things you can do to protect yourself from skin cancer.

The following are some simple tips to assist in proactively keeping a skin cancer diagnosis to a minimum.

Avoid sunburns and tanning beds. It is theorized even one severe and blistering sunburn in childhood can almost double your chance of developing melanoma later in life. Exposure to UV light from the sun or artificial source like tanning beds is one of the main risk factors for developing skin cancer.
Seek shade. The sun is at its peak between 10 a.m. and 4 p.m. If you need to be outdoors during this time, try to stay in the shade as much as possible.
Apply sunscreen. It is best to use a sunscreen with an SPF of 15 or higher each and every day. If you anticipate being outside for an extended period of time, lather on a water-resistant, broad-spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.
Wear protective clothing. Cover your head with a broad-brimmed hat and protect your eyes with UV-blocking sunglasses.

Get a Free Skin Cancer Screening

If caught early, most skin cancer can be completely cured. Take advantage of some of the free skin cancer screenings offered around Tampa Bay.

The Watson Clinic South and Highlands will host free skin cancer screenings on Saturday, May 5, 2018 from 9 a.m. to 12 p.m. at 1033 N. Parkway Frontage Road and at 2300 E. County Rd. 540A. Appointments are required to take part in these screenings, so call 863.904.2656 to schedule your appointment at either of these two locations.

For the 22nd year, Morton Plant Mease is continuing its tradition of offering free skin cancer screenings on Melanoma Monday, May 7, 2018 from 8 a.m. to 1 p.m. at the Cheek-Powell Heart and Vascular Pavilion on the Morton Plant Hospital campus, 455 Pinellas St., Clearwater. The public is invited to this free event, but registration is required. To register, call 727.953.9013.

Every year for the past 20 years, Moffitt Cancer Center’s Mole Patrol® has offered free skin cancer screenings across the Tampa Bay area. The next Mole Patrol will take place at MacDill Air Force Base during AirFest on Saturday, May 12, 2018 from 9 a.m. to 4 p.m. In addition, the Mole Patrol will offer screenings at Pier 60 on Clearwater Beach on Saturday, July 28, 2018 from 9 a.m. to 3 p.m. weather permitting.

Kent Haruf’s ‘Benediction’ Review: An Utterance of a Blessing

When the majority of us close our eyes and imagine Colorado, we see snow-capped mountains, skiers on the slopes and the mile-high city of Denver. But there is another, less-known image of the 38^th state — the flat plains to the east of the capital. With a minimum number of pen strokes, Kent Haruf quickly paints a deft picture of this unique location, which sets the tone, time and place of his novel “Benediction” within its first pages.

Benediction by Kent Haruf

Haruf’s novel opens in the fictional town of Holt, which is loosely based on the author’s hometown of Salida, Colorado. The reader is immediately introduced to Dad Lewis, and we learn at the outset that he has been diagnosed with cancer and the prognosis is poor. Dad is a realist, and during the drive back to Holt from the hospital in Denver, he stares out the window pondering the countryside. He says to his wife and mother of his two children, “I just want to look out at this country. I won’t be coming here again.”

Dad knows the truth. It is spring, and he’ll be dead before the end of the summer.

“Benediction” is one of those few rare-case novels where you know from the get-go where the story will end. The pages in between make Haruf’s novel worth the investment in time. Although a fictional portrayal of a man’s end-of-life experience, it is very true and spot on.

Exploration of End-of-Life Caregiving

When a family receives the news of a terminal diagnosis, it can be devastating. Some members rise to the occasion, and some fall short. Caregivers bear the brunt of how taxing it can be on them physically, emotionally, mentally and spiritually. Dad’s family circle is small, and the burden of his care falls to his wife, Mary.

Shortly after the couple returns to their homestead packed with the bleak news, Mary collapses and is rushed to the hospital. Fortunately, Dad’s neighbors help him in the short term until Mary returns. But the couple knows they need assistance and fast. Thus, calls are made to hospice and their daughter, Lorraine.

The ever-practical Dad quickly begins to tidy up the loose ends of his life, which require decisions that are deeply introspective. The Colorado native needs to figure out what he’ll do with the hardware store he has owned and run for the last 40-plus years. Would Lorraine be willing to leave her life in Denver and permanently move to Holt? Or should he just call it a day and sell the store? And yet, like many families, there was another option. Dad Lewis could theoretically patch up the rift with his son, Frank, who left town shortly after his high school graduation.

Family Dynamics

As the chapters unfold, slowly we understand why the family — more accurately Dad — was at odds with Frank. The conversation between Dad and Lorraine highlights just how impossible the solution of Frank’s involvement with the store would be as a choice.

Lorraine: But if I took over, what about Frank?

Dad: What do you mean? Frank wouldn’t be coming back.

Lorraine: But what about him? How is he mentioned in the will?

Dad: He’s not mentioned.

Lorraine: Why isn’t he?

Dad: Because he left.

Lorraine: So did I.

Dad: But not like he did.

The Lewis’ minister tries to step in to help broker the tear to the familial tapestry. Reverend Rob Lyle does not want Dad to leave the world without making amends with Frank. But it is to no avail. Dad’s mind is made up: The relationship is beyond repair.

At the End

As Dad’s time on earth draws near, Haruf shares quite an accurate description of a visit by a hospice nurse. She takes his vital signs, questions Dad about how he is feeling and asks him to describe his pain level. Dad answers that he could live with the pain, and again she tells him he doesn’t have to live with it but could have relief. At the end of the visit, Dad thanks the nurse for coming as he looks at his wife and daughter standing at the foot of the bed watching and listening. Lastly, “The nurse leaned forward and took his hand and pressed it warmly and said she’d be back, to call her if he needed anything, anytime day or night, and then packed up and left.”

Out of earshot, Mary and Lorraine have a conversation with the nurse and ask the burning question, “How long do you think now?” The nurse responds honestly a couple of weeks but sometimes patients surprise us. As she leaves the nurse imparts these words of wisdom, “He’s lucky to have such good care. A lot of people don’t. But you need to be sure to take care of yourselves too.”

About Phoebe Ochman

Phoebe Ochman, Director of Corporate Communications for Chapters Health System, manages all content and communications for the not-for-profit organization.

The Ins and Outs of Book Awards

During the course of his writing career, Kent Haruf won a number of literary awards. What were the awards and what criteria did he need to meet?

In 1986, Haruf won the Whitling Award for fiction. Since 1985, this award is presented annually to 10 up-and-coming writers in a number of different categories: fiction, nonfiction and poetry. The winners are chosen by a committee of writers, scholars and editors, which are selected every year by the Whiting Foundation.

In 1999, Haruf’s novel “Plainsong” was a finalist for the National Book Award. Established in 1936 by the American Booksellers Association, this honor is bestowed on one winner and five finalists in fiction, nonfiction, poetry and young people’s literature each November. Additionally each year, there are two lifetime achievement awards: Distinguished Contribution to American Letters and Outstanding Service to the American Literary Community.

In 2005, the author was recognized twice for his novel “Eventide” — the Colorado Book Award and as a finalist for the Book Sense Award. The first award is presented to Colorado authors in a number of categories, ranging from fiction to biography to creative nonfiction. The Book Sense Award winners were chosen from 2000 to 2008. In 2009, the recognition was renamed the Indies Choice Book Award to commemorate the importance of independent booksellers to American literary history.

In 2009, Haruf received the Dos Passos Prize for Literature now known as the John Dos Passos Prize for Literature. This award is bestowed on recipients because they have the distinction of being under recognized and in the middle of their career.

Haruf’s “Benediction” was shortlisted in 2014 for the Folio Prize. This award is given to authors based on a literary work in which the subject explored achieves perfect expression.

The author died in November 2014 of interstitial lung disease.

Celebrating Hospice Volunteers

Every April across the United States, organizations celebrate the importance of volunteers. This year, the week of April 15 to 22 has been set aside to thank those special individuals who give their time and talents to help others. At Chapters Health System, our hospice volunteers come in all shapes and sizes. People can volunteer at any age with a variety of opportunities available to them — patient and family support, office work, grief support and even thrift store help. So during National Volunteer Week, we are spotlighting a few hospice volunteers who play an integral part in our organization by bringing their gifts, skills and life experiences to us.

Hospice Volunteers at Sun City Center

After working for Olin Corporation for 30 years in Illinois, Hazel Johnson moved to Sun City Center in the 1990s and quickly discovered she needed more to keep her busy! When a friend passed peacefully under the care of hospice, she decided to check out what was then Hospice of Hillsborough County.

On July 5,^,1995, Hazel began her journey as a hospice volunteer and has continued to volunteer since then. Every Thursday morning for nearly 23 years, “Haze”— as she likes to be called — arrives at the Fred E. Wiswall Resource Center in Sun City Center ready to help with whatever needs to be done in the office. She assists with everything from filing medical records to mailing condolence cards for the Bereavement Department. Over the years, Haze has seen many developments at hospice, including company name changes, the opening of our first hospice house, electronic charting, etc.

On days that Haze is not busy with LifePath Hospice, she enjoys following the Tampa Bay Lightning and line dancing. When asked what she would like to be remembered for, Haze quickly responded, “compassion and caring.” After 23 years as a dedicated hospice volunteer, we are sure her wish will come true.

Robert (Bob) Nichols’ interest in volunteering has been a work in progress. He and his wife, Linda, retired to Florida from Massachusetts in 1997. In his former position as an engineer, Bob traveled extensively, so it is not surprising to learn that the couple lived on a sailboat in the Caribbean for several years until ultimately settling down in Sun City Center.

While Linda was active in several hospice organizations over the years, Bob was interested in a variety of other things. When Linda agreed to become the volunteer pantry manager for LifePath Hospice in 2015, Bob began to pay closer attention to her amazing dedication to the hospice philosophy. Volunteers and staff at the Wiswall Resource Center collect groceries for the pantry, which are then provided to hospice families in need. In March 2016, he became an office volunteer so he could help Linda in the pantry. As time went on, Bob spent more time in the pantry, not only filling orders but also stocking shelves.

Linda and LifePath Hospice Volunteer Coordinator Luanne Lane always encouraged Bob to expand his volunteer horizons and explore patient/family volunteer opportunities, but he said he preferred helping in the pantry. After learning that Bob enjoyed playing dominos in the Ukraine, Luanne approached him once again. She had a hospice patient who wanted someone to play dominos with him. The news hit home, and Bob agreed to complete patient/family training so he could enjoy dominos with the patient. A week ago, Bob was assigned to the patient, and now both men are enjoying their head-to-head domino battles.

Hospice Volunteers in Temple Terrace

With a successful 30-year career in banking, Bobbie Walker (lovingly called Ms. Bobbie) believes strongly in the power of service rendered. It is important to give 100 percent to helping others in need, which then carries over to looking at life with a positive outlook.

At 78 years of age, what would be Ms. Bobbie’s next adventure? Of course, it would be volunteering. She always wanted to volunteer but never had enough time while she was working and raising three boys as a single mom. It was now time for Ms. Bobbie to give a little.

In the eight years since becoming a hospice volunteer, Ms. Bobbie has provided more than 4,000 heartfelt service hours. From speaking engagements and helping in the office to visiting patients, she does it all. She was also part of the planning team that started the food pantry service in the Temple Terrace Resource Center for LifePath Hospice patients and families.

Ms. Bobbie has learned a lot from volunteering. She was taught card games she didn’t know, learned life lessons from a 103-year-old patient and received many hugs from appreciative patients and families. Ms. Bobbie realized that hospice volunteering is all about lending an ear and just being yourself.

It’s pretty simple for Ms. Bobbie. “Volunteering for hospice is a wonderful way to spend my retirement years, basking in the joy of helping others who need the help.”

How to Volunteer

If these stories strike a chord, please consider becoming a volunteer for Chapters Health at any of our affiliates—Good Shepherd Hospice, HPH Hospice and LifePath Hospice — in Citrus, Hardee, Hernando, Highlands, Hillborough, Pasco and Polk counties. It’s as easy as filling out an application, just click here. There are many ways to volunteer and we’d love to have you.

About Phoebe Ochman

Phoebe Ochman, Director of Corporate Communications for Chapters Health System, manages all content and communications for the not-for-profit organization.

Volunteering and Realizing Dreams

While in high school, Marlene Aboytes began a chapter of a national program known as DreamCatchers, which fulfills hospice patients’ wishes. It was so rewarding that upon her entrance to the University of South Florida (USF), she decided to launch the program at the college. Marlene spent two semesters working to meet the regulations and guidelines to make DreamCatchers a viable student organization at USF.

Marlene has grown the DreamCatchers membership to more than 50 members, and USF is the only Florida university to offer the program with its sole affiliation being LifePath Hospice. Some members of the group like to operate behind the scenes while others have become active hospice members. The DreamCatchers deliver gifts for Valentine’s Day, thank veterans for their service and send birthday wishes.

Recently, a memorable hospice wish was fulfilled with the coordination of a birthday party by the group to celebrate a patient’s 102^nd birthday. After an assessment with the family, Marlene coordinated the day focusing on key points in the patient’s life. In reviewing the patient’s milestones, one of her three daughters shared that they were given a memory that would last a lifetime. The family sent their gratitude for the event and specifically recognized Marlene and the group of young college students who participated in making the day special for everyone.

Each staff member and fellow volunteer Marlene meets has only positive things to say concerning her work ethic and desire to see that patients are made to feel better. And therefore, it is not surprising that with a commitment to hospice patients this strong, Marlene actually changed her major in order to pursue a career in social services.

Medicare Hospice Benefit Explained (DRops of Wisdom)

Today we continue “DRops of Wisdom,” our physician blog, with Dr. Andrea Miller, the medical director for Good Shepherd Hospice. She describes the Medicare hospice benefit.

What is the Medicare Hospice Benefit?

Second only to being asked tips on how to talk about hospice, I am often asked, “What is covered under the Medicare hospice benefit?” In the Unites States, Medicare covers 100 percent of hospice services, with no out-of-pocket expenses to the patient or family. Additionally, most private insurance companies and Medicaid cover hospice services.

At all affiliates of Chapters Health — Good Shepherd Hospice, HPH Hospice and LifePath Hospice — each hospice patient has a unique plan of care that addresses their specific end-of-life needs. This plan also takes into account the needs of the caregivers.

The Medicare hospice benefit for patients and families includes the following:

Home visits by nurses, social workers, hospice aides, chaplains, physicians, nurse practitioners and volunteers as described in the patient’s plan of care
Medications, supplies and durable medical equipment related to the hospice diagnosis
Assistance with advance care planning
Support and education for caregivers
Counseling, emotional and spiritual support
Grief support before and after death

Who is Eligible for the Medicare Hospice Benefit?

In order for patients to access the Medicare hospice benefit, they must be eligible for Medicare Part A. They must also agree to pain/symptom management and not curative care.

Following Medicare hospice benefit regulations and rules, in order for any of the Chapters Health affiliates to provide care for patients, the community physician or hospice medical director must certify that, based on his or her clinical expertise, the patient has a prognosis of six months or less should the diagnosis runs its natural course. It is important for patients to understand and know that their physician—if chosen as the attending physician—will continue to see and care for them if that is what they desire. However, a patient’s physician can refer him or her to hospice but does not necessarily need to be the attending physician. The patient or family can also ask for a patient to be evaluated by hospice.

Under the Medicare Hospice Benefit, Are There Different Hospice Levels of Care?

Often times, patient’s symptoms can change, resulting in an adaptation of the plan of care. Under the Medicare hospice benefit, patients are able to receive four different levels of hospice care based on their situation.

Routine Care: Visits are made according to the plan of care and are provided wherever the patient calls home — private residence, assisted living community or nursing home. Day-to-day care is provided by caregivers.

Respite Care: When caregivers need a short-term relief, a hospice patient can be admitted to an inpatient facility for up to five days and still receive routine visits from the hospice team.

Inpatient Care: When a patient needs short-term, round-the-clock care due to a variety of acute medical needs, inpatient care is available in a hospice house. This level of care is strictly available for acute symptoms that cannot be managed with routine care.

Continuous Care: If a patient is experiencing acute pain and symptoms that cannot be managed with routine care, continuous care can be offered. This level of care is provided for a minimum of eight hours per day. Although not exclusively, the continuous care provided is primarily nursing care. Once reaching a state of comfort, the patient can return to routine care.

We are always available to speak with patients, families and physicians about any questions they might have about the Medicare hospice benefit and other hospice and palliative care topics.

What Would You Like to Read about in Future Posts?

In “DRops of Wisdom,” we want to feature posts with subject matter that interests you. Please leave a comment or email us with your ideas.

About Dr. Andrea Miller

Dr. Andrea Miller, Medical Director for Good Shepherd Hospice, is a local resource for area hospitals seeking to educate staff on issues surrounding chronic conditions, palliative care and hospice programs.

The New Card is in the Mail

Do you know that personal identity theft occurs every 2 seconds? This fact is staggering, and the demographic hardest hit happens to be people age 65 or older. This is the reason why the Centers for Medicare and Medicaid Services (CMS) developed an initiative to combat identity theft by issuing new Medicare cards without Social Security Numbers.

Starting next month, CMS will begin mailing new Medicare cards that include a new Medicare Number. The mailings will be staggered across the country throughout the year, with completion expected by April 2019.

The new Medicare Number is unique for each individual who has Medicare and will be a combination of 11 numeric and alphabetic characters. As soon as the new card arrives in the mail, patients should destroy their old card. Patients can start using the new card immediately. Medicare Advantage members who have plan-issuer ID cards will not be affected by this change and can continue using their plan cards.

Helping You Prepare for the Change

As part of the new Medicare initiative roll out, Florida residents are scheduled to start receiving new cards after June 1, 2018. With such a widespread undertaking, cards might arrive at different times for friends or neighbors.

In the meantime, if you have Medicare, please make sure your mailing address is up to date. If an address needs to be corrected, you can contact Social Security here or call 1‐800‐772-1213, and TTY users can call 1‐800-325‐0778. With the new Medicare numbers, your benefits will not change.

Social Workers in Hospice Explained

During the course of the calendar year, most months are intimately tied to health observances. The month of March is no exception. There’s colon cancer awareness. There’s a week devoted to educating the public about patient safety, and at the end of the month, there’s national Doctor’s Day. But did you know that every March, there’s another profession that’s honored? During the third month of the year, social workers are recognized across the country, and the important contributions they make to society are highlighted.

According to the National Association of Social Workers, approximately 650,000 social workers in the United States make the lives for the people they come in contact with better. To grasp how this mission is accomplished, it is important to start by understanding the role of social work. As defined by the Merriam-Webster dictionary, social workers provide social services, specifically for the investigation, treatment and material aid of the economically, physically, mentally or socially disadvantaged. Now taking the definition once step further, how does the role of social workers change or adapt for hospice?

Social Workers in Hospice

To understand the importance of social workers in hospice, you need to be aware of the complexities of emotions that occur during end-of-life care. When faced with advanced illness or a terminal diagnosis, people tend to rely heavily on their family and friends, along with an interdisciplinary team from hospice assisting with care. Physicians, nurses, aides, chaplains and social workers come together as a unit to combat end-of-life challenges often faced by patients and their loved ones.

Social workers, as key members of the hospice team, find ways and strategies to assist families and or caregivers enhance the well-being of the loved ones who face the harsh realities at the end of life. Hospice social workers are trained to look at situations in order to bring people together to discover tactics to address pressing issues. They find solutions in order to allow hospice patients to make the most of life at the end of life.

The following are some functions that social workers can assist patients and families with:

Aid patients in filling out advance directives
Provide counseling
Help families determine funeral arrangements
Offer education about caregiving, coping skills, non-pharmacological symptom management strategies
Connect with additional community resources

Addressing Anticipatory Grief

At the end of life, emotions run high and can span a wide range. Grief is expected after a patient dies. However, when a patient is under hospice care, anticipatory grief can take place. This form of grief is the reaction to the expected or anticipated loss.

For someone who is in the throes of anticipatory grief, symptoms can be divided into a number of categories: physical, emotional, cognitive and spiritual. Physical symptoms are changes in sleep and/or appetite and headaches. Emotional symptoms are feelings of sadness, anger, self-reproach, anxiety, loneliness, helplessness and numbness. Examples of cognitive symptoms are disorganization, forgetfulness and confusion. And lastly, spiritual symptoms are questioning the meaning of life and faith along with anger at God.

Not only do they grieve their diagnoses, hospice patients also experience anticipatory grief for other reasons such as their families’ future loss and decreased independence. Additionally, they might grieve the lack of time left to reach future goals and dreams.

As each person is unique, the same holds true for the manner in which hospice workers assist patients and families to deal with anticipatory grief. At the University of Massachusetts, Hultman and his group identified the importance of allowing patients and their families to grieve in their own way. From this foundational belief, social workers can help patients and families find the methods that will allow them to cope — it isn’t a cookie-cutter approach.

About Phoebe Ochman

Phoebe Ochman, Director of Corporate Communications for Chapters Health System, manages all content and communications for the not-for-profit organization.

Learning to Say the Right Thing: Principles of Ring Theory

Do you have a family member, friend or co-worker who has a terminal diagnosis? Are you struggling with the appropriate words to say any time you call or drop in for a visit? Do you also worry about saying the wrong thing? You are not alone.

Based on her own personal experience, Clinical Psychologist Susan Silk developed a simple program to make sure people learn how to say the right thing and no longer worry about putting their foot in their mouth. She named it the Ring Theory.

How Ring Theory Works

Draw a circle that is known as the center ring. Whomever you know currently in crisis write his or her name within that circle. Next draw another circle around the first one, and put the name of the person next closest to the crisis within that ring. Keep drawing larger and larger circles until you are done. According to Silk, this ring of circles is the person in crisis’ kvetching order.

The following is an example on how ring theory is put into practice. Fifty-year-old Deborah was recently diagnosed with stage IV colon cancer. She is married to Daniel, and they have four children who are aged 20 to 26.

Here are the rules. Deborah is in the center ring and she can say anything she wants — anytime, anywhere to anyone. She can complain, whine and kvetch as much as she wants to or feels compelled to utter. She says, “Why me?” and “This is horrible!”

Any person can voice similar feelings but only to those housed in larger rings. For instance, Daniel can say to the children, “Why us?” and “This is so difficult for your mother.” The couple’s eldest child, Aaron, shares with his best friend the following, “I worry that mom will not be at my wedding.” On the flip side, utilizing the ring theory, Aaron would not say to his mother, “Mom, I don’t think that I can handle your cancer.”

Any person talking to another individual in a ring smaller than he or she is in — closer to the crisis — has a goal and that is to help. Don’t give advice, and refrain from whining. Before you say anything, ask yourself whether what you are about to say is comforting or supportive. Words that are supportive would be: “Can I bring you a casserole?” or “I’m sorry” or “The diagnosis must really be difficult for you.”

In a nutshell, you just need to remember: Comfort IN, dump OUT. You can say whatever you’d like to say just avoid complaining inward.

Hospice Aide Extraordinaire: Patricia Johnson and Her 40 Years with Good Shepherd Hospice

For once in her life, Hospice Aide Patricia “Pat” Johnson was speechless. She had no inkling that her co-workers, family, friends and even her pastor would all gather together to honor her 40 years of service with Good Shepherd Hospice.

“After 40 years, I feel in no way tired,” confessed Pat shortly after she walked the red carpet into the multipurpose room at the Lakeland Hospice House. “I tell everyone that I still have a couple more years before I officially retire.”

Hospice Aide from the Beginning

How does a person start a career as a hospice aide? In Pat’s case, as a young girl, her mother would ask her to help elderly neighbors by giving baths, assisting with meals, etc. These activities definitely set the stage for Pat’s career as an adult. The following are the actual duties of a hospice aide:

Proper hygiene and grooming of patients
Assist patients with bathing, dressing and feeding
Supervise nutritional and supplement needs of hospice patients

Although her professional career started with Mid-Florida Home Health, Pat was on the ground floor when Good Shepherd Hospice was established in 1978. A doctor, nurse, chaplain and social worker teamed up to take care of a friend and a couple of years later, the hospice provided end-of-life services to 178 families.

Over the years, Good Shepherd Hospice grew and joined with LifePath Hospice in 2004 to provide quality palliative care and relieve suffering of those affected by life-limiting illnesses and end-of-life issues across three counties in Central Florida.

Thoughts from the Executive Director

At the celebration for Pat, Executive Director Kyle Zenkner was profoundly moved by the thought of 40 years of service. He shared the following with the group:

“Have you ever known someone who on the surface seems shy, modest and ordinary but behind it all is the most loving, gracious person you ever met? They abound in exceptional talent and good work yet they are your typical unsung hero. They rise to the occasion and in times of need shine best in life’s darkest hours. This person is someone we can describe as a diamond in the rough. Like naturally occurring diamonds can appear quite ordinary, even rough around the outside, their beauty and worth come from the extreme pressure under which they are formed and the harsh process of cutting and polishing that are used to reveal their inner beauty and value.

“So we are gathered here today to honor such a person. Pat has been a model employee for the past 40 years. She is one of the few original employees and certainly has become an asset to the company. I appreciate the selfless service she has given for so many years. Without the loyalty and hard work of individuals like Pat, who helped us get things started, Good Shepherd Hospice could not have achieved our present stature.”

Pat was awarded a plaque in the shape of a book, which commemorated 40 years of loyal and dedicated service. And as part of her service anniversary, the hospice aide was given a sizable check as a bonus. As an additional surprise, Pat was awarded a “golden ticket,” which entitles her to spend the day with Chapters Health System President and CEO Andrew Molosky. Pat found out that Andrew was interested in discovering how to stay with one organization for 40 years, so he is coming to learn from her.

As the festivities wound down and it was time to partake of the refreshments, Pat stood up to retell and share words that came to her as she drove into work that morning; “I don’t feel no ways tired. I’ve come too far from where I started from. Nobody told me it was going to be easy. People ask me how I do it, and I answer I do it because I love people!”

About Phoebe Ochman

Phoebe Ochman, Director of Corporate Communications for Chapters Health System, manages all content and communications for the not-for-profit organization.

Putting the Last 40 Years in Perspective

Forty years of service with one organization is awe-inspiring. During the time span in which Pat has worked at Good Shepherd Hospice, here are some thought-provoking highlights.

In 1978, the following occurred:
- With an investment of $12,000, Ben and Jerry opened their first ice cream parlor.
- Louise Joy Brown was the first test tube baby born.
- Home Depot was founded in Atlanta.
- The comic strip, Garfield, made its debut.
Seven U.S. presidents were elected and in office: Jimmy Carter, Ronald Reagan, George H. W. Bush, Bill Clinton, George W. Bush, Barack Obama and Donald Trump.
The first woman named to the Supreme Court was Sandra Day O’Conner, who served from 1981 to 2006.
Quite a number of technological advances took place:
- GPS was unveiled in 1980.
- In 1982, Apple Computer introduced the Macintosh computer and in 2007 the first iPhone was launched. Apps emerged the following year.
- CDs entered the market in 1984 while DVDs began the slow death of the videotape industry in 1996.
- In 1989, the World Wide Web came into existence with business email surpassing traditional mail delivery by 1997.
- Google started in 1998 and Facebook in 2007.
During the 1980s, the following are some historical highlights:
- Fall of the Berlin Wall took place.
- United States Hockey team won the gold medal at the 1980 Winter Olympics.
- Royal Wedding between Prince Charles and Lady Diana occurred.
During the 1990s, the following are some historical highlights:
Madeleine Albright was appointed as the first female U.S. Secretary of State.
The first Harry Potter book was published by author J. K. Rowling.
Scientists unveiled “Dolly” thttps://www.jkrowling.com/he first successfully cloned sheep.
“Seinfeld” began and ended during this decade.
Companies prepared for Y2K.
During the 2000s, the following are some historical highlights:
- First contested American election for president was decided ultimately by the Supreme Court.
- The attack on September 11 orchestrated by Osama bin Laden led to tougher security measures to combat terrorism.
- Hurricane Katrina destroyed New Orleans and its levees.
- Barack Obama became the first African-American president of the United States.
During the 2010s, the following are some historical highlights:
- Final shuttle flight landed at Kennedy Space Center, which ended NASA’s shuttle space program.
- Chicago Cubs won first World Series since 1908.
- More than two thirds of Americans own and use SmartPhones.

‘The Bright Hour’ Review

Two weeks ago on the blog, we shared a review of Paul Kalanithi’s “When Breath Becomes Air” with the mention that coming soon would be the review of Nina Riggs’ memoir, “The Bright Hour,” which chronicles her thoughts about living and dying. Although Nora Krug in her Washington Post review compares “The Bright Hour” to “When Breath Becomes Air,” the two books handle the end-of-life journey differently.

Nina’s Bright Hour

Nina Riggs was a typical mom with two sons: helping them with homework, arranging playdates and taking last-minute trips to the grocery store. And then her life took a dramatic turn in 2015.

Due to a strong family history of breast cancer, Nina knew the importance of mammograms. Her paternal grandfather died of the disease along with other family members, including her mother. A routine mammogram uncovered a small breast cancer lesion, and Nina opted for a single mastectomy followed by chemotherapy and radiation treatment.

Her mother used to joke; “Dying isn’t the end of the world.” It wasn’t until Nina learned that her breast cancer treatment had not prevented the disease from becoming metastatic and incurable did she understand what her mom meant. She shares; “There are so many things that are worse than death: old grudges, a lack of self-awareness, severe constipation, no sense of humor, the grimace on your husband’s face as he empties your surgical drain into a measuring cup.”

Her Mother’s Journey

Nina’s mother battled breast cancer for eight years. This struggle helped Nina cope with the stress of her own disease. End-of-life care was a frequent topic of conversation. In fact, the mother and daughter read Atul Gawande’s “Being Mortal” together. The discussion within the pages of this bestseller prompted both of them to think about what mattered most to them in their respective lives on a personal level. It helped them navigate their way toward the edge of life “in a meaningful and satisfying way.”

Both women struggled with the fear of the unknown. “When it comes to illness, dying, death—those darknesses—it seems we are still so very much Plymouth Pilgrims—all fear and fretting and fortifications, and a strong sense of our own alienness in a hostile land,” writes Nina, who is the great-great-great-granddaughter of Ralph Waldo Emerson.

For both women, hospice helped them along with the loved ones they left behind. Nina thought it strange that the word “hospice” makes people’s faces fall. However, the more she thought about it, the more Nina was struck by the beauty of the word. “It’s comfortable and competent sounding.”

Fitting Ending

Obviously, anyone reading Nina’s memoir knows how it ends—the spread of cancer took her life. In the afterward by her husband, John Duberstein, we learn a number of additional and poignant details:

Nina finished the manuscript for “The Bright Hour” in late January 2017.
Morning was Nina’s favorite time of day. John describes, “Before she got sick, she used to bounce out of bed at first light, and she insisted on open blinds when we went to bed, even if we were in a hotel with an eastern exposure in the desert.”
It was only fitting that Nina died at 6 a.m. on February 26, 2017, just before the sun came up.

About Phoebe Ochman

Phoebe Ochman, Director of Corporate Communications for Chapters Health System, manages all content and communications for the not-for-profit organization.

Preparing for a Peaceful Passage

Chapters Health System and its affiliates—Good Shepherd Hospice, HPH Hospice and LifePath Hospice—are dedicated to providing guidance and education for people facing death. Sometimes the greatest fear is that of the unknown. Though each of us will experience the end of life in our own way, understanding the final phases can help prepare both the dying person and those who love them—for one of life’s most personal journeys.

Physical Signs of Approaching Death

Like other stages in life, there are physical changes that are expected in the dying process. Just as pregnancy prepares a woman’s body for the birth of a child, the body transitions in preparation for death. These changes are normal. Knowing what to expect and how to care for a dying person eases the transition for both the patient and caregiver.

Possibility of pain: Many people die without having pain. However, if pain occurs, the hospice team will show you how to give the patient medicine that can relieve the pain. How do you know if your loved one is in pain? Ask the question. When the person can’t communicate, look for other signs of pain, i.e., tension in the face, frowning, restlessness or difficulty calming your loved one.

Decreasing activity: As the body approaches death, a patient’s activity level decreases. Your loved one will spend more time sleeping. This is the transition time between life and death so try to create a calm, peaceful environment and don’t attempt to keep them awake. Keep in mind that hearing is the last sense to be lost so it’s important to be reassuring and stay close by.

Skin temperature, color and breathing pattern changes: As death draws near, it becomes more difficult for the body to regulate temperature. Hands, feet and legs may be cooler than the rest of the body. It isn’t necessary to place extra blankets or turn on the heat for your loved one. On the other hand, you may also notice that your loved one is hot or appears to have a fever. In this instance, keep the room temperature cool.

Depending on the illness, a person’s skin can take on a yellowish appearance. Sometimes a grayish tone to the face is noticeable. Closer to the end of life, the patient’s skin has a spotty pattern of blue or purple discoloration and can appear on fingernails, hands, feet and legs.

Additionally, your loved one will begin to have changes in breathing. Rapid, slow or shallow breathing can occur. At times, breathing may even stop for 10 or more seconds.

Refusing food and drink: In the natural process of dying, an individual needs little or no food or fluids. To keep the mouth moist, you may wet a toothette (oral swab) and gently apply to the inside of his or her mouth.

Saying Goodbye

As you begin to see physical changes in your loved one, there might also be emotional changes. The person may tell you they are ready to die. He or she may want reassurance that you or other family members will be all right. They may need you to say that it’s okay to let go.

Try to understand that your loved one is doing the work that needs to be done to let go. There are many different ways to say goodbye, and no one way is best. There’s no magic answer. Just follow your heart.