You know, they say that it takes all kinds to make the world go around. To everyone, there are different ideas, traditions, views, values and purposes in life that skew the way we move forward in life. To some, it is the tradition of family. Maybe going to grandma’s and grandpa’s house on Sunday after church for lunch with the whole family is tradition. Maybe a dad instilling in his children a hard work ethic your word is your word, a handshake between two people is a contract, showing up for work on time and giving your all to the company you work for.

How you make decisions in life, in relationships, at work or play depends on the values that drive you. Your values reflect your beliefs about how life should be. To take it a little further- do your values line up to what you tell others? Do you put those words into action? So say you tell a friend that you value a healthy lifestyle with staying fit, exercising every day, eating fresh whole, organic foods, but yet when you go out to eat together, you’re actually getting the cheeseburger-loaded, French fries, and chocolate shake. Your values and beliefs now have no meaning as you have given a mixed signal to your friend. Or maybe you made a promise to your child to come watch them play ball and “something came up.”

So what values or beliefs make you tick? Are there some values or ideas that you want to change into new? How can you take action on keeping what you believe in and transitioning it into action? First, you need to determine what exactly it is you believe in. Make a list of those things that are important to you. Define your action into steps on how you are going to accomplish those values.

Secondly, have someone close to you hold you accountable to meet your goals. It would be good to have someone that will listen to your ideas and yet be objective to guide you along. Don’t choose someone that will hinder or make it more difficult as you could lose sight very easily of the mission you have set before you.

Lastly, take it one day at a time. Everyday remind yourself of your action steps in meeting your goal. The things of old that made you tick before can change into new things, new values, new traditions, and new purposes in life. Even if you meet just one of your items on your list, you are taking the right steps forward. Once you get into the new habit and developing the new attitude toward making your values possible, it will come as second nature to you. Press on.

Article By Author Paula Span, New York Times“>

Article By Author Paula Span, New York Times

The conversation took place two years ago, but Dr. Daniel Matlock still recalls it quite vividly. You tend to remember when a physician colleague essentially brands you a Nazi.

Dr. Matlock, a geriatrician who specializes in palliative care, had been called in to consult when a woman in her 70s arrived at the University of Colorado Hospital, unresponsive after a major stroke.

She’d done what we’re forever chiding people for not doing: She’d drafted a very specific advance directive and had even taken the trouble to have it notarized. It unambiguously said: no life support, no artificial nutrition or hydration, no nursing home.

The ambulance crew had put her on a ventilator — standard procedure. After the palliative team removed it, she was able to breathe on her own, which isn’t uncommon. She even opened her eyes, though she couldn’t track or follow objects and remained unresponsive. That’s when the prominent surgeon directing her care ordered intravenous fluids.

Dr. Matlock, alarmed at this direct contradiction of her preferences, tells the rest of the story in a post on the GeriPal blog, published by geriatricians and palliative care docs at the University of California, San Francisco. After talking with the patient’s sister, who held her medical power of attorney, he called the surgeon to suggest stopping the IV.

“You would have been hung in World War II for doing what you are doing now,” the surgeon said.

Let’s pause to think about that for a moment.

Within a few days, the woman was transferred to a hospice unit, where the IV was removed and she was permitted to die. But Dr. Matlock’s anger at his colleague and his sorrow at the woman’s treatment, or mistreatment, have persisted. “You work so hard to do what’s right for the patient,” he told me.

And he was sure he was right. Administering fluids to a dying patient increases the person’s secretions and makes breathing more difficult, palliative care doctors are taught. “Dehydration is a gentler death, with less agitation,” he said. But quite apart from that, the woman had done everything but stencil “no IV” across her forehead.

A palliative care consultant, however, couldn’t overrule the surgical team whose patient she was. “I went home that night feeling really bad,” Dr. Matlock said.

What prompted his account of this unpleasant exchange, all these months later, was a startling study recently published in The Journal of Palliative Medicine. After surveying nearly 700 physician-members of a national hospice and palliative medicine organization, the authors report that more than half had had at least one experience in the past five years of another physician or health care professional referring to their treatments as “euthanasia,” “killing” or “murder.”

This, despite palliative practices being broadly accepted as legal and ethical, as reducing suffering while honoring patients’ autonomy.

About a quarter of the respondents had heard similar accusations from a personal friend or family member, the study found. And 25 doctors (4 percent of the respondents) had been formally investigated on the question of whether they had hastened a patient’s death.

“It was cathartic for me” to read the study, Dr. Matlock said. “It was helpful to know I wasn’t alone.” But it’s not exactly reassuring news for the rest of us.

We’ve had frequent discussions here of end-of-life care and why the “good death” so many people want proves so elusive. We can, with ample reason, blame physicians who don’t want to talk or think about dying. (A favorite joke among hospice workers, who tend toward a dark sense of humor: Why are coffins nailed shut? To keep oncologists from administering more chemotherapy.)

And physicians have often responded with their own stories of family members who won’t accept that further treatment is futile and urge another operation, another drug, another something.

But here’s another part of the dynamic, apparently: Even when the system works as it’s supposed to, and palliative care specialists arrive like the cavalry to provide comfort care, to stop fruitless and painful interventions and to support what patients want, their own colleagues may brand them murderers.

It takes strong doctors to stand up to that kind of verbal abuse, to explain that courts and ethics committees have approved care that’s intended to reduce suffering, to point out that the patient’s own wishes are paramount. Perhaps they have to be stronger than we know.

“The culture is changing,” Dr. Matlock told me. “But it’s not changed yet.”

 

See original article HERE.

Though I have had many experiences with death in the past, three people stand out to me the most: my uncle Tad, my grandmother, and my grandfather.

Part I:

 Uncle Tad

Uncle Tad gave the best hugs. The kind of hugs that really make you feel loved and cared for. I used to get one of his hugs several times each summer when he and my Aunt Patty visited for family pool parties. Uncle Tad had the job of grilling the hamburgers and hot dogs, and he seemed to always wear an apron that said, “Kiss the Cook”.

After eating lunch, everyone, except Uncle Tad, would jump in the pool to relax or play volleyball. Uncle Tad would pull his comfy lawn chair out, set it on a shaded edge of the porch and take a catnap. I always wondered how he could sleep with all of us making so much noise and in 100˚ heat no less.

During 2007, Tad and Patty were fulfilling their love for the outdoors on a trip out of state when he suddenly suffered a cardiac embolism. That day, God called Uncle Tad home.

Aunt Patty traveled back to Texas where she stayed with my family and I while making funeral arrangements. This would be the first time I would hear that Uncle Tad would be cremated. Although I knew cremation was an option, I had never known anyone to be cremated nor did I ever put much thought into it. At this point, the thought was frightening. I can now say I was more frightened by the fear of the unknown and uncommon. However, at the time, it wasn’t something I was comfortable with quite yet.

A few days after Tad’s death, we held a service in his honor, and all of the family came together in support of one another. I knew that day would be difficult and somewhat uncomfortable, but I never imagined what came next.

As the funeral service ended, we loaded up the flower arrangements, and got ready to head back home. Before I slid into the back seat of the truck, I saw Aunt Patty walking towards me.

She said, “Kelley, would you like to hold Tad on the way home?”

I looked down at the beautifully carved wooden box in her arms holding Uncle Tad’s remains and simply nodded my head.

At first, this made me very nervous, so I got in the truck, and Aunt Patty sat the box down beside me. I was uneasy about the situation on the drive home, but halfway there, I felt God’s presence calling me. I looked down to my right where the box sat and picked it up. I wrapped it in my arms like it was him and held on tight.

At that exact moment, God eased my fear and enabled me to feel a sense of Tad’s spirit. I’ll never forget what an extraordinary feeling it was to hold “him” in my arms. Nothing could ever amount to the many miracles God has shown me when I simply open up my heart and trust Him to guide me.

Several months later, Aunt Patty traveled to Montana and spread Uncle Tad’s ashes. Though I have now healed from Tad’s sudden death, I can’t help but smile when I look back on the day of the funeral– when God gave me a chance to hug Uncle Tad for the very last time.

To be continued…

As some of my very close friends know, in my early working years I wanted a husband, house, career, and to go fishing. And you know children, “they cost too much”, “your life will never be the same again”, you will “never sleep again the rest of your life,”, and best yet “this world is too awful to raise a child in now days.” No children were ever a part of my “plan.” My selfish way of thinking that children would just interrupt what life had to offer, would soon come to an end. God had better plans. As time went along-my female hormones telling me my “time’s ticking”, “you don’t have much time”, and “you’re only getting older” started nagging me. God prodding me and my husband had a way of changing our mind on the concept of bearing children.

Becoming pregnant for the first time at age thirty-four was exhilarating. Sharing all the excitement and joy with our friends and family was more than I could have ever imagined. Eight weeks later, I miscarried. A roller coaster of emotions from happiness to devastation set our path for a little while. But even though my heart was filled with hurt and pain, God surrounded me and my husband with much love, friendships, co worker’s, and family who spoke words of comfort and compassion to us. Not knowing if we could ever have children was a terrible and painful journey. But the desire to have a child was now in us and the thought of the possibility that a child could be the “gift” I really longed for.

Laken, my now 9 year old daughter, was born in March of 2003. I was thirty five. That day God gave me the best “gift”, the opportunity to be her mother. The day she was born, Dr. Kelley Tibbels who delivered her spoke such words of wisdom and blessings over her, and us. He said, “Take this time to look at her, smell her, and just soak this moment in because you will never get this time back.” And so I did. And I cried, and cried, and cried.

It has been a wonderful nine years getting to know my sweet daughter. I thank God that He has allowed our time together and allowed me and my husband to raise her. Since then, God has blessed us with another child, his name is Levi. You know, I believe God has a sense of humor. Modern day technology is always true because our eyes believe what we are thinking we see. The 3-D sonogram showed the baby in my womb was a girl. Uh, he was not. Yes, “HE!” Trust me, with the bag full of pink girly stuff, the doctor, me and my husband were in pure shock! And believe me, having Levi when I was thirty eight, could have killed me with heart attack being in shock like that!

So, this Mother’s Day, reflect on the “gifts” that you have been given. I know, some of you may not have children yet, but reflect on whatever you love dearly, and only imagine your world not having them in it. It would be kind of boring, huh?

My Sweet babies Levi -5 and Laken - 8 Happy Mother's Day!

“My mom is 75 years old and still works as a nurse full-time,” she said. “She is definitely my inspiration.”

To Jan, working for Solaris Hospice is not just a paycheck. After 17 years as a nurse, Jan has developed what she calls a ‘hospice heart’. “My mom always told me that you’re never too good to do the dirty stuff,” she said. To this day, Jan carries her mother’s words with her. “Death is a part of life that people are not very comfortable with,” Jan said. “I don’t just want to take care of their physical needs but their mental, emotional, and spiritual needs, too.”

One of the reasons Jan came to work for Solaris was the faith that she shared with the Solaris team and family. “I firmly believe that what’s on the other side is my Lord and Savior,” she said. “I believe this is my missionary work. This is where God wants me to be.”
Jan truly feels hospice care is her calling and believes she has been blessed with an amazing team of caregivers. “We see people at their worst and their best. This job takes a lot of patience and kindness,” she said. “But, most of all, it takes a lot of love.”

The love Jan shows for her patients is largely accredited to not only her love of the job but also her love for her husband, Malcom. “I like to call him my ‘hospice husband’,” Jan said. “ No matter what time of day it is when I get a call, he’s always so supportive.”
Though Jan may have a demanding or stressful day at work, she still shows undeniable compassion for her patients.

“It’s not about me. It’s about them,” she said. “It may be tough, but it’s so rewarding.”

Billy Mahoney

When someone says “Panama”, you probably think of the Van Halen song. If not, then I applaud you. When I think of Panama, I think of a country that brought an experience to me that I never thought I would have the pleasure of encountering. In August of 2009 I was taken along as a videographer for a mission trip that was made possible by Solaris. I had never been on a mission trip. I had never even been out of the country (aside from Mexico). I honestly had no idea what I was going to see or what to expect.

The day before we were scheduled to leave I had flu-like symptoms and felt like twenty miles of bad road. Lucky for me I work with some of the best medical specialists a person could ask for. Whatever they gave me could only be described as unicorn tears mixed with pure magic because it knocked the sick right out of me. The day we landed in Panama I was as close to 100% as I could be. The trip could officially begin.My first impression of Panama was a surprise to me. The city was busy but it was nothing I hadn’t seen before in Dallas or any other major city. The people were friendly, spoke English and I even bought a pair of Converse shoes. The next day we traveled to the motel where we would be staying for the next few days. This is where I started to see the real changes. Flip-flops in the shower don’t drink the water and “What’s that smell?” kind of changes.

Billy's a little hot.

Our transportation included tight packed buses or trucks equipped with roll cages. I think the moment I realized I was on a mission adventure instead of a mission trip had to have been crossing the river in the equivalent of a Ford Ranger packed with 10 plus people. The footage I captured was quite shaky. I chalk this up to hanging on tightly with one arm and flailing about with my camera hand. I figured if the truck tipped over then at least I’d have my last moments forever immortalized on videotape. Luckily for myself and the rest of or crew we made it safely across. Well, half the crew made it across; the other truck’s driver wasn’t as “brave” as ours. So, the other half of our team had to hike a pretty lengthy distance uphill. Actually, it was essentially a mountain. I was kind enough to capture their happy faces when they arrived.

I am officially out of my element at this part of our trip. I am in a remote mountain village where the living units are made out of mud and sticks. There was however a school building made out of brick, which would become the housing for our medical camp. The amount of people that showed up was like nothing I had ever seen. I began to understand what we were really doing here. I was witnessing people not only going out of their way to help others; we left our country to help others. Aches, pains, infections, hygiene issues and other everyday problems were amongst the highest ailments to make the list. This may not seem like a big issue, but when we have everything for treating these symptoms at our fingertips, we really start to take them for granted. I realized that thinking about how I was uncomfortable in the humid climate sure sounded petty.

It began to rain pretty hard near the end of our day. This of course made the original river we crossed rise and the drivers were not about to try to cross again. This meant we were going to be trekking down the mountain on foot. I fell one time and slid down about 7 feet, which would really be the only time I feared for my life on this trip. Traveling down this mountain was an eye opening experience for me. It was raining, we were in a mountainous rain forest and I was overwhelmed with the adventure I was on. The closest I had ever been to an experience like this was from behind a television screen or a videogame controller. I was crossing a bridge that was mere feet from a roaring river. It was incredible.

River Crossing

The next couple of days were spent traveling very far out on less traveled roads to very remote locations. A medical camp was set up at a sound structure, teams were broken up to go inform the surrounding people due to there being no telephones and I was witnessing the entire experience. We had at least four translators with our groups the entire trip. I find it very interesting to see the translation process. The patience and procedure is really amazing. I realized that translating was not the only area I saw patience and care though; our entire group was doing something to help. Whether it was packing medicines, establishing a single file line or even praying for someone who wanted it; everyone was helping out for the benefit of others.

By the end of this trip I had seen a multitude of things I had never expected to see. I was a part of a group of people who willingly left the comforts of their home to travel to another’s and give help where it was really needed. I was enriched in a different culture and surrounding that I could have never experienced anywhere else. I saw a kindness in people that I wish I saw more of from the mass public on a daily basis. Solaris gave me the opportunity to broaden my knowledge of another country other than the one I call my home. When I hear the word “Panama” I smile.

Billy Mahoney

By: Charles F. von Gunten, MD, PhD  

“Imagine a patient who has advanced cancer who has been admitted to the hospital complaining of 10 out of 10 pain. Your goal is to get the pain under control quickly. The most important fact to remember is this — the time to pain control is the same as the time to the maximum concentration of the opioid in the blood.
So for a drug such as morphine given intravenously, the time to maximum concentration is 8 minutes. Therefore, successive doses of morphine can be given every 8 minutes. For someone whose pain is completely out of control, 10 out of 10, you want to double the dose to get that pain under control.
So for example, with the patient I described, with 10 out of 10 pain, he might have been on a patient-controlled analgesia dose of 1 mg of morphine. You want to double it to 2 mg. If after 8 minutes that pain is not controlled, you double it again. That would be a 4-mg dose. Wait 8 minutes. If the patient is not experiencing any relief, then you want to double it again to 8 mg. If the patient is still not getting any relief after another 8 minutes, double it again to 16 mg.
The point here is you’re doubling the dose of the opioid at the level of the receptor. When the patient begins to describe relief, you found the dose that is controlling that person’s pain.
The most frequent mistake that people make is they dose every half-life. When someone is in a pain crisis, you want to get on top of that pain quickly. You want to avoid the demoralization that comes from not being able to deal with the pain right away.”

Most fear associated with pain can be alleviated through improving both the patient’s and family’s understanding of pain. Below are some common myths about pain addressed in a new website produced by a division of the National Hospice & Palliative Care Organization (NHPCO) called Caring Connections. A special area of their website, called LIVE without pain, is focused on improving pain education among the general public, but particularly among those in end of life care (including family caregivers).

Some people think that pain is a natural part of aging or illness – that is a myth. There is almost always a reason for the pain and most physical pain can be managed.   Learning the truth about pain and what you can do to manage your pain can help you focus on other parts of your life and enjoy your days. 

The following statements and answers provide some facts about pain and pain management.

• “If I tell the doctor about my pain he or she will think I’m a complainer.”
  Response: It is the doctor and healthcare provider’s responsibility to work out the best way to control pain. To do this, they rely on you to tell them about your pain. They can’t do their job unless you do yours.
• “Of course I have aches and pains. I’m old.”
  Response: Pain is not a normal part of growing old. Pain in older adults, just like pain in any other age group, is your body’s way of telling you something needs attention. You need to talk about this with a doctor or your family caregivers so the issue can be treated.
• “My father is confused. What he says doesn’t make sense, so I can’t tell whether he’s in pain or not.”
  Response: Even when people are confused, oftentimes they can let you know when they are in pain. It may be helpful to look for changes in mood, activity level, body language, and facial expressions.
• “I’m afraid of addiction.”
  Response: Research has shown it’s very unusual for people who have pain to become addicted to pain medicines. People who have pain need to be treated, so concerns about addiction, in most cases, should not enter into the doctor’s decision to prescribe these medicines.

When misinformation like these common myths are dispelled it brings confidence. When patients and their families feel confident about their care they can truly put life first. They can enjoy a quality of life with whatever time they have left.

Read as many surveys as you want and you will find this is the ultimate goal at the end of life. This is what patients want. Not to lie in an ICU bed, or to fight through chemotherapy and radiation and have no strength or energy left to enjoy their family. The process of dying is not just a medical event, it is an extremely personal one. When modern medicine can no longer offer a cure for their disease, the focus should shift to producing the best quality of life possible. The overwhelming majority of people want to spend their last months, weeks, and days in their own home, surrounded by the ones they love.

One of the first steps in making this possible for more people is to give them confidence about their own care. Improving education about pain is just one part of the equation, but it’s a big part. Ignorance leads to fear, and fear plays no part in producing a true quality of life.

When I first began reading, I truly concentrated on listening to the words and using them to live out my day. As I continued to read and listen, life, as I knew it, became less congested with earthly noise and easier to see the truth.

March 29, 2012

“Stop trying to work things out before their times have come… When something comes to your attention, ask Me whether or not it is part of today’s agenda… Though the world around you is messy and confusing, remember that I have overcome the world…”

Ecclesiastes 3:1; John 16:33

This scripture in itself has become my way of life. No matter what hardships we face, there is always an answer. Take a moment to step back, breathe, and ask Him. Ask Him what He has in store for you that day. Ask Him how you can serve Him best. Ask Him to guide you. Ask Him anything.

I’ve also learned that Jesus’ answers to my questions may not become clear to me immediately. This is where faith comes in. Though I do not yet have an answer, I have FAITH that He is by my side through this journey, and he has equipped me well.

We all travel a winding road, but sometimes we forget how to ask for directions. At times, we even fall off the map due to our own stubbornness. However, within these battles each day, I find comfort simply in knowing He is there. That faith in itself has brought me peace.

In hospice, a challenging field in itself, we stay focused on end of life care and comfort for the patient. This, I know, is not always an easy task. Our staff has seen some of the most heartbreaking moments as well as some of the most extraordinary moments in the lives of our patients and families. Though I have not seen those moments first-hand, I know that there are times when we all need someone to ask for help or thank for abundant blessings.

Since beginning to read Sarah Young’s book, I’ve learned several lessons. Most importantly, I’ve learned that peace comes slowly. All we have to do is ask for help.

By: Susan Jacoby, OP-ED contributor for The New York Times

 

 

 

“The hospice room and pain-relieving palliative care cost only about $400 a day, while the average hospital stay costs Medicare over $6,000 a day. Although Mom’s main concern was her comfort and dignity, she also took satisfaction in not running up Medicare payments for unwanted treatments and not leaving private medical bills for her children to pay.
A third of the Medicare budget is now spent in the last year of life, and a third of that goes for care in the last month. Those figures would surely be lower if more Americans, while they were still healthy, took the initiative to spell out what treatments they do — and do not — want by writing living wills and appointing health care proxies.
…end-of-life planning is one of the few actions within the power of individuals who wish to help themselves and their society.
As someone over 65, I do not consider it my duty to die for the convenience of society. I do consider it my duty, to myself and younger generations, to follow the example my mother set by doing everything in my power to ensure that I will never be the object of medical intervention that cannot restore my life but can only prolong a costly living death.”

 

For full article click here.

Heroes Never Die from Solaris Hospice on Vimeo.

Read more about Billy’s experience with Rocky in his article called The Rolling Credits.

The Philadelphia-based American Board of Internal Medicine Foundation and a coalition of nine medical societies released their top-five recommendations Wednesday for unnecessary tests and treatments that should be reduced to cut costs to the healthcare system.

The recommendations suggests late-stage cancer patients who stand to benefit little from chemotherapy should be taken off anti-cancer drugs and given hospice care at the end of life.

According to the recommendations, as many as ten to 15 percent of cancer patients receive chemotherapy in the last two weeks of life.

Dr. Dave Casarett, head of hospice for the University of Pennsylvania Health System, said the source of the guideline, the American Society of Clinical Oncologists, was surprising to him and represented a shift in thinking.

“It very clearly identifies the elephant in the room,” Casarett said. “This is a phenomenon, this pattern of aggressive treatment up until the very last hours of life, that those of us in the palliative care world see again and again and again, but it’s not something the oncology world has specifically identified in a public way before.”

Casarett said he hopes the recommendation opens lines of communication for doctors and patients to talk about hospice and palliative care without feeling like they are signaling to the other party that they are giving up.

Read the full article here.

What do you think? Is this potential change in thinking needed?

What does that mean? LOL. We are in a new technological cyber fast-fingered age of the English Language. For those of you not hip to the initials, it means: “Laugh Out Loud”. Or if it is really, really funny, you could say ROFL. Stumped? It means “Rolling on the Floor Laughing”.

Your laughing now, aren’t you? Well you should be! They say laughter is good for the soul. It has medicinal qualities. “The old saying that ‘laughter is the best medicine,’ definitely appears to be true when it comes to protecting your heart,” says Michael Miller, M.D., director of the Center for Preventive Cardiology at the University of Maryland Medical Center and a professor of medicine at the University of Maryland School of Medicine. So why don’t we do it more often if it helps our heart? We need to learn to incorporate it into our daily work schedules.

Paul McGhee, PhD, www.LaughterRemedy.com stated that “Nurses and others who regularly work with people who are seriously injured or ill constantly tell me that they would burn out on their job very quickly if they didn’t find a way to lighten up in the midst of the emotionally difficult work they do. If you’re having surgery, the last thing you want is a surgeon who is feeling burned out—physically and emotionally drained. Your life could be hanging in the balance. Doctors and nurses have no choice but to find ways to recharge their batteries and provide quality care, no matter how stressful the day has been. If humor works for them, it will also work for you.”

Once you have laughter marked on your schedule, you’ll find it easier and easier to let go of workplace upsets as you head home, allowing you to be totally present and have fun when you’re with your family. And this, in turn, helps you return to work each morning refreshed and ready to tackle the day’s problems.

So, how do you incorporate laughter into the workplace? Look for it. Anticipate it. Find out what makes you get tickled or even on the floor laughing. There are even aps that bring laughter. I can just hear someone laugh and get the giggles even if I don’t know what they are laughing about. I have a daily devotional book that is called “Laughter For A Woman’s Soul” by the Women of Faith and it has stories of funny things that happen to women that we all can relate to. If you work in a team environment, like hospice, then the scenario below you will find humorous.

And lastly, don’t forget: “A good belly laugh is worth two cups of coffee and one trip to your therapist.” (Paul McGhee)

We spent about a week trekking through the mountains with a diverse team and holding medical camps at various places along the way. The trek alone could inspire hundreds of blog posts that still would not cover all that we experienced. Suffice it to say that by the time the trek ended, the four of us were keenly aware we had left the mountains as changed men. It had been decided long before our boots hit the trail that we would spend our last Nepali night unwinding in a hotel in Thamel, a popular tourist district in Kathmandu. The team at MountainChild had already planned to take our large group to that area for a day of shopping, so it worked out well for the four of us to say our goodbyes and split off.

When the full group arrived our MountainChild guide, Scott, agreed to take us around to try and help find us a decent hotel. The first stop appeared to be a nice place, but we were met with the unfortunate news that they were fully booked. It was right at the beginning of the trekking season, and there was potential for many of the hotels in Thamel to give us the same report. The manager at this first hotel offered to call around for us in an effort to save us the trouble of running all over the city. Though the manager was able to find a potential replacement, Andy and our guide came across another that seemed better.

Steve on the trail

So we rolled our luggage through the ridiculously crowded streets and into the courtyard of our temporary home. That night we were treated to a veritable feast of grilled meats courtesy of the hotel’s owner. It was a welcomed respite from a week’s worth of mountain meals dominated by vegetables and rice. During this feast we were joined in the courtyard by many of the other guests staying at the hotel, a number of which were from the United States.

As we stuffed ourselves we struck up a conversation with an American man sitting nearby. We went through a few of the typical pleasantries…How did you find yourself in Nepal?…Is this your first time in the country?…How has your stay been so far?…before finally landing on our lives back home. Over the years I’ve become accustomed to having to explain the term hospice to those who ask about my profession. On this trip, the explanations were far more plentiful since all four of us received similar questions and had to give similar answers. But, something different happened when this gentleman heard our response.

A wave of recognition hit his face as soon as the word hospice entered his ears. He began to tell us a story of how he was the primary caregiver for his grandmother when she was on hospice. He talked about the peace and dignity that hospice afforded her during her end of life process. His voice was on the verge of cracking as he described the compassion shown by the hospice professionals that worked with his family and how much it helped them during the toughest of times. He described it as one of the most incredible experiences of his life. Though the story appeared to be decades old, the positive emotions associated with it were still very fresh. As he finished, he raised his glass to the four of us and thanked us for what we do.

I was completely taken aback by this entire exchange. We were still processing what we had experienced in the Himalayas just a couple days before; an experience which completely changed our lives but garnered merely an obligatory “oh, cool” from this gentleman not ten minutes earlier. Yet, when talk turned to the things we do every single day, the things we get paid to do every single day, he was floored.

As this brief exchange came to a close I couldn’t help but turn my thoughts toward the greater meaning of what had just happened. When we initially left the mountains, I wondered how I could go back to life as usual without feeling like I was missing something extraordinary. My concerns were rendered moot all because we just happened to strike up a conversation with this one hotel guest.

Over the last few months, I’ve spent a number of hours thinking about that evening. I’ve thought about the events that led up to that moment, how a slight variation here or there would have changed everything. I’ve thought about the hotels that didn’t have room for us that day and wondered what our evening would have been like if they did. I’ve thought about how unlikely it is that this particular gentleman happened to be at the same hotel as us on the same evening as us, sitting in the same part of the courtyard as us. I’ve thought of the look of intense gratitude on his face as he shared his story with us. I’ve thought about how fortunate we were for our paths to cross and to share in that moment.

We have a number of terms in our vernacular to describe events such as this: coincidence, fate, synchronicity, destiny, God’s plan, luck, serendipity, and random occurrence are but a few. I can’t say exactly which I would use as a descriptor, but I do know this: that evening was, and will forever be, a vivid reminder that by working in the field of hospice I have an extraordinary opportunity to serve an extraordinary purpose every single day.

Following is an excerpt from the article. Click the link provided at the end to read the full article on why doctors must become more comfortable with breakpoint conversations.

In Sweden, we have what we call a breakpoint conversation, a communication about the transition to end-of-life care,” Dr. Gunilla Lundquist, a palliative care specialist at Umea University and lead author of the study, told me in an interview. At the breakpoint, the goal changes from prolonging life to providing comfort and physical, psychological and spiritual support. “It can be days, it can be weeks, even months until death, but you know it’s a short time,” Dr. Lundquist said.

To learn the effect such breakpoint discussions had, the researchers compared about 1,200 cancer patients who’d received “information about imminent death” with 1,200 who hadn’t; in both groups, patients’ median age was in the late 70s.

In the last week of life, the informed group didn’t suffer more pain, anxiety, confusion, nausea or respiratory problems; such symptoms were well controlled in both groups. And in some ways, those who’d had their prognoses clearly explained fared better. They were more likely to have drugs already prescribed for use as needed, eliminating last-minute scrambling. They were far more likely to die in the place they preferred (70 percent) than the uninformed group (39 percent). Their families were significantly more likely to be offered bereavement support.

“The health care personnel were more aware of the patient’s wishes” after a breakpoint conversation, Dr. Lundquist said. “They knew the preferred place of death. In the uninformed group, they didn’t know as much.”

In this country, we tiptoe around the D-word until so late in the game that even now, when more than 40 percent of Americans die under hospice care, about half do so within two weeks of admission. Even expert hospice teams can’t provide many of the elements of a good death — and they believe there is such a thing — in mere days.

……“Discussion is delayed to the point where the dying patient and family don’t have the opportunity to say, ‘Goodbye, forgive me for my mistakes, and I love you,’” Dr. Teno explained in a separate e-mail. And most Americans still die in hospitals, though they overwhelmingly say they want to die at home.

Click to read the full article: A Conversation Many Doctors Won’t Have

The proper technique in cleaning windows from www.do-it-yourself-window-cleaning-tips.com:

1.  If the window is super dirty you will want to give it a pre-wash. Using your scrubber or a natural sponge, soak the entire window. Then use your squeegee to remove the dirty water.
2. Use a scraper to get any hard dirt off the window.
3. Next use a squeegee to clean the window with a certain amount of pressure and speed you have to use to avoid getting window streaks.
4. Now that the window has been squeegeed off, you will need to wipe the edges. Also known as detailing. It is very important to wipe all the remaining water from the edges in order to get that crisp, flawless finished look.

All those steps to say: the windows into our lives are our eyes. Don’t you wish that in any given situation you could see flawlessly? Have you ever found yourself misunderstanding people or missing out on blessings because of the cob webs covering your eyes? Maybe even having regret or wishing to do something over again in order to fix it. Sometimes the things that we may not deem as important are the richest blessings that are occurring right before our eyes.

Like cleaning the windows, clearing our head, heart, and eyes to what we see and hear is important to not get caught up in the daily grime (or drama). No matter what goes on in life, there is always something to be thankful for, or a blessing to be seen. Clear the smudges, cob webs, dirt and grime so you are not driving down a dangerous path. If you don’t know what blessings are, here are some examples: life, your health, a wonderful job that you look forward to going to everyday, your family, children who make you smile and laugh, your animals that love you unconditionally whether you had a bad day or not, the beautiful scenery God gives us every day with a sunrise, sunset, stars to gaze upon, flowers that smell like perfume, and friends that love you no matter how bad you feel or look. Need I continue on?

We all have bad days and sometimes it feels like a monsoon that has struck us blindly. But, how we choose to handle that monsoon is what matters most. Clear the dust from your eyes and heart, make daily choices to see things in the way of blessings, and your life will change. Your window to the world is getting clearer, I just know it!

by Billy Mahoney

If someone would have asked me when I was 18 “Where do you see yourself in 10 years?” I certainly wouldn’t have answered “Editing video for a hospice company.”  And yet, here I am. Working for a hospice company. Editing video. It’s instances like this that really make me think, “What does life plan on giving me next?”

I have been involved in almost every aspect of video production. From the underappreciated grip to the high and mighty director. I have shot, edited and written every type of genre. I’ve worked for lawyers, televangelists, edited a 30-minute pilot for Fox’s Atom Films and even helped create a program being displayed in restaurants all over the United States.  My wife and I left thousands of media opportunities to come to a small town and work for a hospice company. Sound crazy? Maybe, but I have no regrets.

The public knowledge of hospice is so minor that we get uncomfortable speaking about it because we think we know what it means. This is why I am proud to do what I do and happy I made the change from big city to small town life. I am blessed with the ability to tell a story through visual means. Through video I can educate and entertain in the same medium. Video production is one of the most effective marketing tools we have available to us. Any time you turn on a television, computer or even your phone you have video ready at your convenience. This puts great pressure on someone in my position to ensure that whatever is viewed is entertaining, tasteful, educational and contains no violations. It also gives me a great sense of pride when all of the above are accomplished.

Out of all of the video projects I have created during my time at Solaris Hospice, one stands out to me beyond the rest.  I met a man who shared a common interest with me through an action figure collector group on Facebook. We were both comic nerds with ridiculous collections and we were within driving distance of each other. It really is a tiny world. We talked for a good while about our favorite characters and storylines, but then the conversation turned down a road I could not have foreseen. He told me about his father’s recent battle with Alzheimer’s and he told me how much he appreciated the involvement of hospice. He then proceeded to tell me that the hospice he had dealt with was the very company I worked for. I then worked up the courage to ask him if he would mind speaking about his experience with our company on video, but adding a twist by relating it to comics, a subject he was obviously willing to speak on and made the entire project more comfortable. Through the process I can honestly say that he has become one of my best friends, someone I can trust and relate to. I find it amazing that shooting a video about hospice, I found a truly amazing story that I wasn’t looking for and learned a great deal more.

I witness the world of hospice through a lens or in front of a computer screen.  I view the uncut, extended versions of lives that are close to the rolling credits. These stories are real people’s lives and I believe they deserve a happy ending in the way of quality and comfort.  Now that I am educated on the subject, I couldn’t see my future without hospice. I wouldn’t want a future without it. Not only has it given me a new outlook on death, it has given me a new outlook on life. What does life plan on giving me next?

     “It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little… They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits.

Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life.

How has it come to this—that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.

Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures.

As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night.”

Read entire article at http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/

I’m asked frequently whether my job is depressing, or if I have difficulty not bringing my work home.  With few exceptions, I can honestly answer an unequivocal, “No”.  In fact, I don’t find caring for dying patients depressing at all.  There have been more sad moments than I can count, but that number is dwarfed by the moments that I count as joy.  I have learned a lot from dying patients and their families, and hopefully I have honored some of those pearls by applying them to my own life.

I suppose it’s easy for me to consider my own mortality, I’m faced with it every day.  I know that time is coming, I just haven’t been told when.  Only ten percent of the population dies suddenly, which leaves most of us to face it as a “process”.  Just like other things in our life that we know are coming, I think it’s worth thinking about how we will handle dying.  Some of this planning is philosophical, but much of it is practical as well.  Does your family know how you feel about life sustaining measures in the face of prolonging a life with no quality?  Will your children be left to wonder whether you would want artificial nutrition or ventilation with no hope of meaningful recovery?  I can’t tell you how many times I have sat with families who are facing difficult decisions about whether to continue certain interventions when a prior discussion would have made it simple.  My wife and children will not be left wondering if I would have approved of their decision.

In terms of the less practical matters, I’d like to share an excerpt from Steve Jobs’ eulogy given by his sister and published October 30, 2011 in the New York Times:

When I arrived, he and his Laurene were joking together like partners who’d lived and worked together every day of their lives. He looked into his children’s eyes as if he couldn’t unlock his gaze.

Until about 2 in the afternoon, his wife could rouse him, to talk to his friends from Apple.

Then, after awhile, it was clear that he would no longer wake to us.

His breathing changed. It became severe, deliberate, purposeful. I could feel him counting his steps again, pushing farther than before.

This is what I learned: he was working at this, too. Death didn’t happen to Steve, he achieved it.

He told me, when he was saying goodbye and telling me he was sorry, so sorry we wouldn’t be able to be old together as we’d always planned, that he was going to a better place.

…

Steve’s final words, hours earlier, were monosyllables, repeated three times.

Before embarking, he’d looked at his sister Patty, then for a long time at his children, then at his life’s partner, Laurene, and then over their shoulders past them.

Steve’s final words were:

OH WOW. OH WOW. OH WOW.

I’ve seen this moment in some variation many times, and as I read this description of such an intimate moment, I was reminded that death is the great equalizer.  Here was a man with every resource imaginable, but in the end, even Steve Jobs saw that death could be done well.  I hope that someday, death doesn’t “happen” to me, but I “achieve” it.

End of life caregiving can often mean having feelings of loss - grieving over someone who is sick or the loss of your life before the illness. Once you realize what is truly happening you then accept your role as the caregiver, with all the new demands and duties involved in providing such care. Then you find purpose and meaning in the experience. Providing care for someone who is dying can be personally rewarding even in the midst of those demands.

While you are providing care, it is most important that you be patient with yourself. Caregiving can be a rewarding and exhausting experience. Identifying and managing what causes you stress will gain you a lot of ground. Here are some helpful tips:

1. Make a list of things you need help with so when someone says, “Let me know if there is anything I can do,” you can point to the list!
2. Allow someone to come and give you a break, even if it is for a short time.
3. Take care of yourself by eating healthy and exercising to keep your strength up.
4. If you are able, attend a local support group. You can share your experiences and gain new knowledge and helpful advice as to what others are doing.
5. If you have feelings of being overwhelmed, anxious, angry, scared, frustrated, lost, confused, and tired reach out and call your doctor or a local hospice. They have staff trained to assist you with your feelings.

Unfortunately, being an end of life caregiver comes with no prior training. It brings new responsibilities and many unfamiliar tasks. Knowing what your loved one desires at the end of life is a hard conversation to have. Hospice care has a team approach where our nurses and medical directors assist with pain and symptom management for anyone who has a life expectancy of six months or less. Hospice chaplains and social workers also provide emotional and spiritual support. Hospice social workers can assist in educating you regarding the Medical Power of Attorney, Advance Directives, the Out of Hospital Do Not Resuscitate form, as well as Financial Power of Attorney and funeral arrangements for your loved one. At Solaris we have our own pharmacy and durable medical equipment to provide those items related to the hospice diagnosis. Solaris has hospice aides and volunteers who can also provide additional care to help lighten your caregiving load. If you are a caregiver, or know of someone who is, please feel free to share this valuable information with them.

Here are some area resources that may be of assistance:

Solaris Hospice

Area Agency on Aging

Texas Department of Aging and Disability Services

Meals on Wheels

AARP

I am a list-maker. Anything and everything that I can write down on a clean sheet of notebook paper satisfies me, but I can’t just make one large list of several different departments. Each category must have it’s own headline and nothing can be misspelled. Perhaps that is my perfectionist mind-set kicking in, but behind every human, is a mind reeling with reason.

Therefore, I have a reason that I am addicted to lists. I am constantly worrying I will forget something important or forget what comes next on my agenda for the day. At times, I simply have ideas that I like to write down. The true concept of my list however, is not the list at all. In fact, I tend to remember everything I’ve written down and hardly ever forget something important.

I believe my sole purpose of obtaining a running list is merely an outlet to express my perfectionism. But, the art of perfectionism is sometimes a truly remarkable insight into a person’s mind.

Within Solaris Hospice, no matter the job title or task, I’ve noticed that I make several lists each day. Today, however, I realized something. It’s not about the job we do. It’s about the people we affect by completing such tasks. By simply marking off a task on my many lists, I am affecting the lives of employees, physicians, families, and most importantly, our patients.

Behind every Solaris patient is an entire Solaris family. Some of us work directly with these people and families in the field, but others like me are behind the scenes. No matter the job we are assigned to do, we must always do it with the mind-set of a perfectionist. If we remind ourselves daily that our simple notes, lists, and appointments are always for the better of our Solaris family, we will always succeed.

Each day is a new opportunity to become a better caregiver. Today, I challenge you to find an outlet for perfection. Just as I make lists, find something you can use to perfect your work ethics. And at the end of each day, remember to think of how simply creating a list can affect an entire network of people. Remember that while a nurse sits with a patient in pain, what we do behind the scenes can still make a huge difference.

We do not always have to be perfect, but we do have the responsibility of striving for it.

Over time, social workers and chaplains, also known as Family Services, develop skills and a knowledge base that are focused on maximizing the quality of life for the patient and family, and promoting and supporting positive changes in the patient. A common practice for helpers in our society is to approach those they help as defective in some way and assume their problems result from their personal flaws or weakness. This approach can create a web of negative expectations about the patient, the patient’s environment, and the patient’s capacity to deal with the problems of daily life.

During times of upheaval and change in life, patients and families may experience seasons of deep doubt and questioning. They feel uprooted, set adrift, and utterly alone. Sometimes they respond with a deep sadness, other times with numb silence, and still at other times with rapid activity in an effort to prove to themselves that they are still in control.

At the time of initial terminal illness diagnosis or pending loss, patients and families ask various questions: Why me? Where is God? Why do good people, like my friend, have to suffer so much? What will I leave behind as a memory of myself? Beliefs that were once sustained and made sense are no longer valid. The process of major change in life can stir up unusual feelings, dreams, and memories. These experiences, if left unattended, can have long lasting effects on their well being. Our social workers and chaplains are wonderfully professional and prepared to journey with our patients and families when they are ready to seek, restore, and rediscover a vibrant social and spiritual life.

It is a belief that whenever we come face-to-face with another person, we encounter something holy, something sacred. Our staff is wonderful at speaking words of life and truth, as well as providing supportive encouragement and resources to live life to the fullest in hospice care. Our patients, families, friends, and fellow peers deserve our reverence and awe!

Our Family Services staff use a positive approach in which they are guided by an awareness of what the patient or family has accomplished, and not by any preconceived ideas of problems or weakness. Creating a positive hospice team-patient relationship is important in helping the patient and family through the demands of dealing with a terminal illness. Building on those strengths sets the bond between the hospice team and the patient and family, which gives them hope and confidence. With added confidence and education, the patient and family become more willing and able to assist the hospice team in taking control of their own care, in which they become true experts. This can and will change patients and families lives for generations to come.

Obviously, we love what we do or we would have made a change years ago. I don’t necessarily agree or disagree with changes in healthcare but I do wish it would come at us a little slower.

This morning I received the following email from my brother that made me realize how a simple gesture can change your thoughts and day, “one pebble at a time.”

My Brother: Eddy Roach

I was feeling a little overwhelmed with life and my job this morning but I knew how to fix it… I decided to do something nice for someone else because, as we all very well know, nothing good ever comes from feeling sorry for yourself.

I left the house early this morning and drove over to Panera Bread to pick up fresh gourmet bagels and cream cheese for the office: Cinnamon Crunch, French Toast, Blueberry and Walnut with a variety of cream cheeses.  While I was there I picked up a cup of coffee for myself, but the bagels were for the office.

And it worked like a charm! Slowly pebbles then larger stones began to fall out of my coat pockets allowing me to breathe again. It doesn’t matter if all the bagels sit on the break room counter uneaten or if one or two of my fellow employees whine because there is no lox or smoked salmon, I have already gotten my win.

I just wish I was a better person who always knew how to do something nice for others before I start feeling so overwhelmed.  Maybe I need to replace the Post It Note on my door at home from, “How Am I Not Myself?” to, “What Am I Doing Nice, RIGHT NOW, for Someone Else?”  Maybe that would fend off all the stones that seem to gather in my coat pockets and the black dog hairs that frequently float into my life. It is worth a try because this morning that simple act of doing something nice for someone else really worked.

Thank you Eddy. You have always been a giver and one of the wisest people I know. Thank you for reminding us it’s the simple gestures we do that give us the most rewards.

He said that growing up, he was not a “hugger” and that he learned to hug from his mother in law, who has since passed away. Some of the families that were there shared legacies of their mother and how she had unconditional love for their family. Another talked about how cooking to their mother was very important and anyone that came over would never leave hungry.

During the memorial, we blended two different colors of sand signifying that as the sand can no longer be separated neither can the memories of our loved ones.  As much as our families shared stories about their loved ones, they were also deeply appreciative of our staff for their knowledge in getting their loved one out of pain, the comforting visits to pray for them, or the volunteer to allow them to rest.

To make memories and to leave a legacy takes a special kind of love as evidence from a former patient in this poem below:

“Hospice Nurses and Volunteers”

It takes a special kind of love

To know just what to do

When entering a pain-filled home,

Where a life is almost through.

You meet the needs of people who

Need healing while they live.

You help them find the dignity

To plan and to forgive.

This is what you’re all about.

You never criticize.

You’re there to love and to accept

And never moralize.

You offer to each family

A ministry of hope.

You bring to them the courage to

Be strong and learn to cope.

So many rivers yet to cross;

So many unshed tears.

Your caring and compassion show

The way to conquer fear.

As we walk through life, we have opportunity everyday to leave memories and legacies not only with our family, but with those we come face to face with. Do you have a contagious smile? How about a firm handshake? Or a meal to share with a friend who may be going through chemotherapy treatments? Sharing tears where there is overwhelming fear or sadness? If you polled most Solaris staff they would tell you they feel they have been called by God to work in hospice and that it is a ministry of hope.

Chances are you don’t watch Breaking Bad, a TV show about a high school chemistry teacher diagnosed with lung cancer who turns to producing meth as a way to secure his family’s financial future. Chances are that very description sounds really strange and even absurd to you. It’s not often that a TV show truly makes you think about really tough moments in life, but that is exactly the case with this particular scene.

It was once said, “People of capability inspire us.” What capability do you see in people that you believe are confident? What are those characteristics? Now think of someone who exudes low trust. Gandhi said, “The moment there is suspicion about a person’s motives, everything he does becomes tainted.” In hospice the moment we receive a referral, we start building that trust dynamic with our patients, families, doctors, hospitals, nursing homes, and community. In building that trust, we must present ourselves confident of the knowledge of hospice philosophy and services available to them.  You might ask, “How do we do that?”

First, we need to develop our integrity. We need to walk the talk. We need to have the courage to work in agreement with our values and beliefs. Do we stand behind what we say we are going to do? Do we walk in the presence of our core values set by the company? If it is mutually beneficial to the patient, then trust builds accordingly. Secondly, what are our skill levels and can the family see that in us? Are we able to solve problems quickly in crisis situations? Do we consult with other team members who have those skills and knowledge needed to solve problems?  What is our attitude toward the patient?  Lastly, do we deliver results? Have we met or even exceeded meeting the patient’s goal? What does your track record say about you? If our past results and current performance get things accomplished correctly we gain trust, confidence, and credibility to those involved, those who are watching us. And by word of mouth, that confidence and trust you gave to the patient is passed along to others who desire the same in their lives.

The National Council of Hospice and Palliative Professionals has identified some core principles that you may see in yourself or strive to have.  They are:  integrity, honesty, straightforwardness, fairness, love, kindness, civility, openness, authenticity, humility, recompense, gratitude, loyalty, respect, responsibility, accountability, performance, learning, continuous improvement, courage, clarity, and stewardship. If you serve in any position with Solaris Hospice, you probably have many of these core character traits that gain trust and confidence to those we take care of everyday at their end of life.

But the times, as Dylan opined four and a half decades ago, they are a-changin’.

We’ve managed to achieve connectivity in ways once thought to be impossible. At any time, day or night, staff members can communicate vital information with one another through email and secure messaging. Critical business information can reach central locations from even the most distant outposts in no time at all. Our most productive computers are no longer tethered to an office desk but instead are being carried in our purses and pockets. We have unlimited communication power at our fingertips. And as every good IT nerd knows, with great power comes great responsibility.

PwC’s Health Research Institute released a report late last year which indicates that healthcare providers are beginning to explore new ways to use patient data. Nearly 75% of those responding said they have either already implemented, or plan to implement, systems which expand the use of patient data beyond the traditional means. That is a staggering number but it is followed in the report by something even more staggering: only 47% have addressed the privacy and security risks associated with that expanded use.

I have no doubt that the majority of the 75% are planning to capitalize on the fresh wave of connected technology in order to find new uses for patient data. While I applaud this step forward it is rather disheartening to see that a scant 47% have even bothered to address security risks. This should be, and must be, a statistic that is improved upon. If 75% of providers responding plan to expand the use of patient data then 100% of them should also be addressing potential security risks. We owe our patients nothing less.

My particular area of expertise does not grant me the privilege of being directly involved with our patients. While this is also true of the majority of healthcare IT professionals it does not excuse us from the responsibility that comes with contributing to overall patient care. The IT decisions we make and the technologies we implement come together to form a significant addition to the level of care our company provides to its patients. It is our duty to handle the privacy and security of our patients with the utmost care. While I believe that healthcare providers would benefit greatly from embracing advancements in technology we have to refrain from playing fast and loose with patient data simply because we want the newest and shiniest.

Someday I will move from being an employee of a healthcare provider to being a patient of one. When that happens, do I want to be with an organization that took the time to consider the privacy of my information or one that didn’t bother? In my opinion that’s a pretty easy choice.

In life, be it at work, home, or school, we have people in our lives that are sometimes called our “sandpaper person.” These people tend to just rub us the wrong way. There are many different difficult personalities that we deal with on a daily basis. In the book Difficult People at Work by Business Management Daily these personalities are categorized into several types.  There are Power Players: Tyrants, Bullies, Credit Grabbers, Malignants, Power Posturer as well as Indirect Aggressors: Button Pushers, Putdown Artists, Saboteurs, and Undercover Operators. Some are described as Underachievers: Coasters, Peddlers, Space Cadets, Success-Phobes, Wise Guys. Other difficult personalities are Mercurials, Zip-Lips, Perfectionists, Control Freaks, and Bulldozers.

There is no escape from difficult people. So how do we handle the people that rub us the wrong way? What can give us peace in any situation? Can we prepare before anything happens? Here are some positive helpful hints in dealing with a variety of difficult people:

1. Don’t Let Them See You Sweat – During a trying situation, always appear firm, strong, and unemotional. Probably one of the harder things to do is to keep control of your emotions. Do not overreact or act out on impulse. Let them rant and rave. You must appear serene and not a threat. Respond effectively in a well-constructed, non-emotional, factual way. Most difficult people expect you to respond the same way they do.
2. Soften Them Up – What we don’t realize is people who are difficult have usually been hurt in some way in the past. Stopping the vicious cycle of nastiness can perform miracles. Try complimenting them on an achievement, or asking their advice on an area you have questions about. Showing kindness goes a long way. This may be difficult at first, but everyone has some good qualities in them.  Accept the challenge in finding those good traits and compliment them on it. See if that relationship does not change.
3. Review Your Mentor’s Behavior – How do those you look up to respond to difficult people? Are they in powerful positions? Do their actions make you respect them? Do others enjoy being around them? What characteristics do they possess that make you want to be like them? Are they appropriately firm when they need to be? Are they gracious? Do they stick to the facts and not bring emotion into the situation?
4. Learn from the Interaction – Set your feelings aside, avoid being defensive, and ask yourself, “Why is this person able to make me feel bad so easily?” Check your self-esteem. Check the source. Is this someone you have to listen to? Ask good questions like, “What do you mean?” Ask for suggestions. Prioritize what is and what is not important. Can the problem be fixed or is the person just asking too much? Do not let bad interactions keep you up at night. A response, especially one that is not defensive, will earn you more respect.
5. Motivate – Some people who do not want to achieve the same goals as we do can be a “sandpaper person.” These people are the opposite. They are intelligent and have great skills. Ask what motivates them. Give these people clear assignments and ask if they understand the goals. Set timetables and negotiate if it is not realistic. Give feedback to add to their support, encouragement, and reassurance while trying to turn them around.
6. Don’t Enable – Enabling can hinder a person’s progress to meet certain goals. Accept him as he is. Some people will never self-motivate, but are loyal and trustworthy. Offer practical help. Some people just need help organizing.  If this is your strength offer to assist. Don’t do things for them, but make use of their unused talents and giftings. It could be a win-win relationship.
7. Be Assertive – In order to not be taken advantage of in some relationships, you have to be assertive. It is that calm confidence.
8. Maintain Your Self-Worth – Remind yourself that it is the other person, not you. Stand back from the outburst.  Remind yourself that you are a competent and a worthwhile human being, no matter what they think. Do not doubt yourself. Remember all your good qualities.
9. Positive Feedback – Give positive feedback to people who have low self-esteem. They feel very unworthy and insecure even if they are doing very well. Give them a lot of compliments and it will lift them up.
10. Look at Yourself – What gives you a sense of peace about dealing with difficult people in the workplace, home, or school? Are you insecure in certain areas of your life? Do these people remind you of your parents or a sibling?

Most of the time a person is strong in one area where others tend to be weak. The goal is to get the different types of personalities to work together so they make a good team that compliments each other. Working with patients who are terminally ill is hard in and of itself. Dealing with death and dying everyday can make the most patient person have personality issues. So it is important to find positive ways to handle difficult personalities in the home or at work with co-workers. It can benefit the team approach. How can you start today to take those steps in dealing with difficult people in a positive way?

But what is love? It is the intense affection for another arising out of kinship or personal ties. Have you ever had that kind of love for anyone? Or been loved by someone like a spouse, your parents, sibling, or a friend? We all want to be loved unconditionally with no strings attached. It means acceptance and contentment in our relationships with others.

I’ve spoken to hospice patients who have been married for 40, 50, even 60 years.  Often I ask, “What has been the secret to your long marriage?” Most of the husbands responded first by talking about being content, having peace, and love. We have a lot to learn from the generations before us. Maybe we could pass along a Valentine Treasure…

Valentine Treasures

Valentine treasures are people who
have often crossed your mind,
family, friends and others, too,
who in your life have shined
the warmth of love or a spark of light
that makes you remember them;
no matter how long since you’ve actually met,
each one is a luminous gem,
who gleams and glows in your memory,
bringing special pleasures,
and that’s why this Valentine comes to you:
You’re one of those sparkling treasures!

By Joanna Fuchs

If you work in hospice, then you know that we are in the business of love. Loving our patients and their families. Showing grace, mercy, and compassion for those who are at the end stages of life is love. Even when loving them is not easy and challenges you at every level. The greatest example of someone who loves, comes from the Love Chapter in the Bible. 1 Corinthians 13:4-8: Love is patient and kind; love does not envy or boast; it is not arrogant or rude. It does not insist on its own way; it is not irritable or resentful; it does not rejoice at wrongdoing, but rejoices with the truth. Love bears all things, believes all things, hopes all things, endures all things. Love never ends. As for prophecies, they will pass away; as for tongues, they will cease; as for knowledge, it will pass away.

Do any of these characteristics describe you? In what ways can we grow in our personal lives to show more unconditional love?

The following blog is written by a beautiful, spiritual woman from the inside out. She is passionate about compassion and everyone who knows her, knows it.

Beverly Robinson - Assistant Administrator

What an honor!

I have worked for Solaris for almost 14 years and in just about every capacity-nursing, medical records, billing, QA, referrals, compliance, and assistant administrator. I think about all of the stories we could tell from over the years, but mainly I think about what an honor to take care of someone at the end of their life and what a difference it can make in not only the patient’s life but in our own.

Hospice is not a word to be afraid of but a word that brings service, comfort, understanding, and education to people with life limiting illnesses.

Over the years, many people, upon hearing that I work for a hospice, have a surprised expression and ask, “How can you do that kind of work? Isn’t it awfully depressing?” This always makes me smile, which may be inappropriate for such a serious question.  On the contrary, I feel that there is so much that can be done to help people coping with a serious condition that the rewards to all concerned…patient, family and caregivers…can produce a great deal of relief and even satisfaction.

I know that all of the hospice workers: nurses, social workers, chaplains, volunteers, office staff, physicians, and administrative staff feel the same as I do.  To watch pain be replaced by comfort, anxiety by relaxation, insomnia by sleep, anger and fear by peace…these are the rewards hospice workers experience. Certainly we all grieve the deaths of patients we have come to know and love. We grieve with the family and friends who have given so much to their loved one. Yet our sense of loss is replaced by the satisfaction of knowing that we made a difference. We helped to make things better for the patient and the family. What a tremendous honor to be a part of that.

As painful as it was to watch, I realized that within that crushing defeat was the secret to greatness. Most people, if they are honest, really want to be great at something. If people were given the choice to be great at one thing, almost everyone would choose something. A great singer, athlete, business man, doctor, artist, or a thousand other things. But why do most people never achieve greatness? I believe it’s because the secret to being great at anything requires the courage to be horrible at first.

The fear of being horrible at something is what keeps most people from ever being great at anything. Fear tells us we’ll look dumb when giving our first speech so we never give one. We’re afraid of failing and letting people down so we never start that business we’ve dreamed of. Fear of failure is common to man, but those who achieve great things understand that failing to make the attempt is the real failure. They understand that doing nothing leads to nothing – least of all success.

The thing we forget is that if we’ve never tried something, of course we should be horrible at it. My 10 year old is being taught the fundamentals of basketball for the very first time. She played against another team in a real game for the very first time a few weeks ago. Her team is not good, nor should they be. They are learning. They have yet to win a game but they are doing the only thing that gives them the possibility of a win – they’re playing. We all want the win but too often fear keeps us off the playing field.

There are amazing people with amazing talents sitting on the sidelines of life because of fear. They know what they want to be great at, but fear of failing or simply being bad at something keeps them from ever taking the first step. Maybe you’ve been there before, or maybe you’re there now. Stop beating yourself up if you don’t feel like an expert at something yet. Stop abandoning all your plans just because things don’t go perfectly on the first try.

Decide that you’re going to be ok with being horrible at something in the beginning. It’s the only way to truly ever be great at anything.

What do you think? What are some ways to overcome fear to start something new?

An analysis of end-of-life data on 4500 adults showed that patients who received hospice care lived 29 days longer, on average, than patients who did not (J Pain Symtpom Management 2007:33:238-246).  The benefit was most pronounced for congestive heart failure and cancers of the lung, pancreas, and colon.

While most people, including physicians, are surprised when I tell them about this study, those of us in hospice are not.  These patients are almost always receiving much more care than they would normally.  It’s easy to see that patients on hospice have better access to things like medications, medical equipment, and many more eyes and ears following their progress.  Symptoms such as pain, nausea, and shortness of breath are better controlled.  Many studies have shown that uncontrolled pain hastens death, probably by increasing stress hormones that increase risk of blood clots, heart failure, infections, and can accelerate tumor growth.  Hospice patients also spend fewer days in the hospital and therefore have less exposure to infections.  Perhaps more importantly, patients have access to psychosocial and spiritual support that dramatically improves quality of life.

I can’t tell you how many times someone has expressed gratitude about the incredible impact hospice had on their loved one and his or her family.  Unfortunately, this is almost always followed by, “If only we had known, we would have started months sooner.”  Hospice is never about “doing less” overall.  Like I have said so many times, the goals of care may change, but there is still a lot to do.

Larry Cox, a Solaris chaplain from Bowie, Texas, recently received Bowie’s 2011 Citizen of the Year Award. He is an amazing servant of God and always puts others first.

Larry moved to Bowie in the ’70s. Several years prior to that, he had married the love of his life and they started their family. Then he answered the call of God on his life. Once accepting God’s calling, Larry began to serve others young and old. In working with the older generation, he was blessed by another individual who strongly encouraged him to finish his college degree. Once he completed this goal, he then achieved his master’s and doctorate degrees in a career field that would open the door to helping others in an even greater capacity than ever before. The gift of helping others and the ability to serve with undying compassion and love are great reasons why this honor was given.

He has served as a leader among his family and congregation, as a board member of MHMR, on the city council and various other boards and committees. He also has the gift of hospitality and success in entertaining the soul and the pallate at a very unique restaraunt called Nostalgia. The award presenter summed up Larry well.

“He has a kind demeanor, unique charisma, and much compassion along with the ability to listen, to show empathy, and to care for the whole person. All of these traits are a part of the package that made him Citizen of the Year.”

He has spent a lifetime of “going the extra mile” for others. He is blessed by his wife of forty-one years, a daughter and son-in-law, and now grandchildren. Larry is someone who is currently fulfilling one of the most important duties of his lifetime as a chaplain for Solaris.  He is a former city mayor, a man after God’s heart, and a true citizen. He is instrumental in his desire to serve his patients, families, staff, and community. We, at Solaris, are very honored and privileged to have Larry as a part of our family.

Congratulations Larry!!

When patients are given a terminal diagnosis of six months or less to live it brings all of life into perspective. It makes you focus only on those things in life that are most precious and close to you, like family. In hospice, patients making memories with their families at the end of their lives are gold treasures that will be passed down for generations to come. At Solaris we call it celebrating life. Investing in those things that matter the most – people.

So what kind of memories am I talking about? In hospice, many patients and families make special memories for their loved ones. Sometimes it means a sweet letter from a father to his estranged daughter asking for forgiveness over past hurts. It may be a wife visiting her husband who has Alzheimer’s disease in the nursing home even though he does not know who she is anymore. Then one day a week before he passes away he tells her, “thank you for taking care of me all these years.” A precious family at the bedside of their imminent mother singing together as she passes away. A young dying father leaving his children a video of his life so they will always have something to remember him by when they grow into adulthood. These are just a few of those things that at Solaris we call, “planting your roots down in the tree of life.” Cherishing those moments with your family, friends, neighbors, even a stranger can make a difference.

Maybe in this new year in this passage we call “life” we will seek to not take relationships for granted and give value to what really matters most. Imagine in just one day all the people that cross your path. Is there anything we can do to make their lives better? We all have an impact that can change lives for the better. It is a servant’s heart, a willingness to invest in others.

The little girl in the lyrics will grow up one day and share those same memories with her children. What a treasure to pass along to others. Time is a tickin’ so what will you do today to make life worth living?

Cotton Perkins November 2010

The family was told and over the next several months all the children, grandchildren, great grandchildren, other relatives, and longtime friends made their way to his house to spend as much time as we could together. Trips to Lake Nocona for some bass fishing or up to Oklahoma for Dr. Peppers at his favorite little casino were the norm. In late October when he could no longer make those trips with us, we decided it was time to call hospice.

I had known Andy Milligan, an owner of Solaris Hospice, for some time having played with him on our church praise and worship team.  So when the choice was made, I let my parents know that Solaris came highly recommended. The nursing team of Dana Skinner and June Baker in Bowie were incredible. They were kind, caring, and kept us well informed of everything that was happening. They helped my parents, especially my step-mother, make the transition through one of the most difficult times of her life and for that I personally will be forever grateful.

When a position opened at Solaris for a new web developer, Steve Lorenz came to me personally and told me about it. Sometimes we in the IT field feel a bit of a detachment because we don’t always get to see the effects of the applications we develop. I knew that upon accepting this position that wouldn’t be the case. I knew the heart of Solaris and its staff and knew that no matter how small of an effect I could make on the web or an application, I would be contributing to the same caring culture that had impacted my family the year before.

My grandfather, Cotton Perkins, passed away in December 2010, peacefully, in his home in Nocona, Texas surrounded by family. I’m proud to be a part of the group of people that allowed us the opportunity to have those last few weeks with him.

When it comes to sports there is a clear line of distinction between professionals and everyone else. The professional level in any sport is something only a select few ever attain. The official term for those who never reach the professional level is amateur. Unfortunately, there is a widespread misunderstanding of exactly what the word amateur means. Most people associate the word with a lack of skill or a beginner; someone who’s not good enough to be called professional. But consider the true primary definition of the word amateur:

a person who engages in a study, sport, or other activity for pleasure rather than for financial benefit or professional reasons.

The biggest difference between an amateur and a professional lies in the heart. The amateur plays the game because of the love he has for it. He does so without the expectation or motivation of payment. The heart of an amateur drives him to be better, improve his skill level, or increase his knowledge because he simply love doing so. It is said that Bobby Jones, the famous golfer who still holds the record for winning all four major tournaments in a single year, refused to turn professional for this very reason. His love for the game had nothing to do with money.

The heart of an amateur can of course be present in a professional. I believe this to be the case with hospice professionals. Everyday you care for patients and their families with great passion. You relentlessly pursue a quality of life for your patients with the heart of an amateur, and that is a great thing. The vast majority of the time hospice professionals are paid and by no means am I advocating it should be otherwise. My hope is simply that you never get so wrapped up with being a hospice professional that you lose the heart of an amateur.

As with any great passion, sport or otherwise, there are elements of hospice work that are tedious, frustrating, and exhausting. The professional would rather avoid these less enjoyable parts of hospice care but the amateur knows they are part of what drives her love for what she does. Not because of the exhaustion or frustration itself but because of the end result of a comfortable patient or a peaceful family. Professionals who possess the heart of an amateur love what they do because they simply have a passion for it that can’t be quenched by occasional frustration or exhaustion.

As the hospice profession continues to mature in skills and knowledge, one thing remains sure. This very special area of care, of which we call ourselves professionals, will always require a strong passion and love for what we do. Always strive for the excellence of professionalism but never do so without the heart of an amateur.

Guest writer: Silvia Escobedo, Office Clerk

Let me start by saying this:

I love what I do!

From doing paperwork to answering the phone for a worried and scared patient or their caregiver and helping them feel at ease. But what I love most is translating for Spanish speaking only patients and their families.

Coming from a Spanish speaking only family myself, I did a lot of translating for my parents and family at a very young age and loved every minute of it! Although never in my life did I imagine I would be using this awesome blessing God gave me to translate for a hospice patient and their families in one of the hardest phases of their lives, the passing of their loved one. Never did I imagine that I would know some of the patients on a personal level. Patients who I grew up with and went to school with and patients who knew me since I was a child. Never did I imagine that I would have to translate the signs and symptoms of a patient that was actively dying to a loved one. I especially didn’t imagine having to tell a patient’s loved one that her husband had passed
away and hold her in my arms while she wept until she regained her strength to call her daughters to come home from school because their dad had just passed away.

Translating for a patient on hospice is never easy. No matter how many times I have the PRIVILEGE of doing it. To see the look of relief and appreciation of the patient and their family when they hear me speak their language is PRICELESS and overrides the emotions that come with translating for a hospice patient. Some patient’s family that see me after hours still to this day hug and thank me for being there for their loved one and their family. That also is PRICELESS; not the fact that they are thanking me…the fact that I helped them in their time of need. Yes translating isn’t easy but I would do it over and over in a heartbeat!

God works in mysterious ways and the way He brought me to the Solaris family still to this day is a mystery. He knows why He let’s things happen the way they do. It’s not up to me to discover the mystery but to do what God has brought me here to do. I thank God for my job and those families I have helped translate for because they have changed my life; the way I look at life and the way I appreciate the little things in life.

¡Gracias Solaris por dejarme ser parte de su familia y por ayudar a las familias que solo hablen español!

(I had to throw some Spanish in there!)

Translation:

“Thank you Solaris for letting me be a part of your family and for helping our Spanish speaking only families!”

I truly believe wholeheartedly in this bible verse:

“So we must not grow weary in doing good, for in due time we will reap, if we do not give up.” Galatians 6:9

And in Spanish:

“No nos cansemos, pues, de hacer bien; que á su tiempo segaremos, si no hubiéremos desmayado.” Gálatas 6:9

Lord, please don’t let the Solaris family grow weary but give us strength to help ALL those families in need! In the name of Jesus Christ! Amen!

What if you worked with hundreds of people who are at the end of life and ready to share wisdom with anyone who will listen? Many will tell you that they lived life with no regrets, but when you really listen to what people are saying, very few mean it. I have heard too many to list, but I thought it would be cool to talk about a few. I borrowed these five from someone who has been asking this question for years and came up with the top answers. Bonnie Ware has worked in palliative care for years and these are the five most common pieces of advice she heard from those facing the end:

1. I wish I had let myself be happier.

Happiness is a choice. I’m sure that there are a lot of unhappy people who would argue with me about that. I’m not talking about everything in your life being care free and going great. I’m talking about laughing with friends and family, enjoying the little moments that warrant being happy. During my trip to Africa a few years ago, I was shocked to see some of the happiest people on earth living in some of the most horrendous conditions I’ve ever seen. Some had lived through unspeakable horrors, yet still found a genuine happiness that produced the most contagious smile. For some of us, a smile would be a good start.

2. I wish I had stayed in touch with my friends.

It’s so easy to get caught up in our own busy lives and neglect relationships. As you read this, I know you can think of a few friendships you haven’t been nurturing. I’m not talking about acquaintances, but those true life-long friends that were there for you when it counted. We all take them for granted and assume they will always be there. These relationships are a valuable! Take care of them.

Oh! Poking your friend on Facebook doesn’t count! Make an effort!

3. I wish I’d had the courage to express my feelings.

I think this can mean many different things to people. For some, it could be honestly expressing feelings that we are suppressing in order to keep the peace in our relationships. We harbor bitterness, resentment, and unforgiveness as a result. For others, it may be sharing positive feelings. Maybe it’s telling someone that you love them, but you don’t because it’s uncomfortable for you. It’s hard to imagine that honestly and constructively sharing your feelings with people would be regrettable in the end. Again, ranting in the Facebook status box doesn’t count! There is no substitute for the audible word or physical touch.

4. I wish I didn’t work so hard.

I could write a book on this one. Almost every dying male expresses this regret. We live in a culture that places value on someone’s life work based on what it produced. We wear our careers like a badge, as if anyone cares about it except us. This is especially true during our 30’s and 40’s, which is even more devastating. These are the years our children are young and most of us are healthy. The very moments that seem like annoyances (playing catch with your son, tucking in your daughter for the third time, meeting a friend for lunch, or even helping your kid with homework) are the exact moments that you will someday long for, the moments you will want to go back and re-do. What if you knew that as you lay on your deathbed, you will care very little about your work? Now you know! The people who love you want more of YOU, which you can only give them by spending time.

5. I wish I’d had the courage to live a life true to myself, not the life others expected of me.

This is the most commonly expressed regret. When people realize that life really is ending, they look back and see how many dreams they left unfulfilled. We all tend to take the path of least resistance, the expected course. We may look at other paths, and even encourage others to walk them, but few of us have the courage to veer off course ourselves. I don’t think anyone dies having pursued all their dreams; just make sure you don’t bury all of them.

So there it is, a message to you from future you! I realize that almost everyone who reads this will nod in agreement, yet continue to live a life that will lead to the same regrets. Only now, you will have another regret! If only you had listened to that advice that came from the collective wisdom of those who see the beginning from the end.

While working as a clinician I made every opportunity to connect with my patients. Sometimes a soft touch on the hand or arm was just what I needed to build that connection. From my spiritual
point of view, I believe God was touching them through me so my touches always came with a smile.

Many of us have a natural instinct to comfort people when they are hurting. Touch can heal in the most simplest of ways. For example, while I was writing this blog, our Nursing Director came in
my office and gave me a hug and let me know he appreciates me. Guess what he got in return, a hug and a smile. Now we are both smiling. What about listening? Do you listen with your eyes? Someone grieving or emotionally hurting has a need to be understood and heard. It’s important for us to listen with our eyes by making good eye contact. Have you ever tried to talk to someone while they are busy looking at their phone? (I’m guilty…way too much) By not listening with good eye contact, you cause an immediate disconnect.

I have a colleague who has excellent listening skills. Maybe that’s why I like talking with her. Any time I walk in her office, she immediately turns in her chair and faces me, lays her hands on her desk and maintains eye contact. I’ve always admired that about her. She gives me her full attention and I always leave feeling “heard”. It totally takes any frustration away.

Do you have ideas on how to foster a good connection with your patients through thoughtful body language? We’d love to hear them.

Grief is a deep sadness caused by a loss, or remorse, and bereavement. Grief can be defined as a loss of a loved one, a divorce (loss of a marriage/spouse), a job, or even a body part. Grief is an expression of sometimes intense emotions like denial, guilt, anger, depression, and then acceptance. You may go through each of these at different times in your life. There will be certain things like smells or music that may trigger your grief. Cultures and traditions sometimes determine how we are going to grieve. Going through these trying times in life builds our character and shapes us to who we are as a human being.

By allowing yourself to grieve, you go through an experience that can be shared and to help others. If you are helping someone go through a grief experience, the most important gift you can give them is to listen. Dr. Elizabeth Kubler-Ross once said:

“There is within each of us a potential for goodness beyond our imagining, for giving which seeks no reward, for listening without judgment, for loving unconditionally.”

People love sharing stories about themselves, friends, and loved ones and just simply listening can help someone in the grief process. It costs nothing but your time. Do you have time to listen and walk the journey with someone today?

What in the world is hospice?

Being the son of a nurse I was somewhat familiar with the term. I’d heard it said in conversation numerous times but could not properly tie it to a definition. It was like one of those great character actors that you’ve seen in everything but can specifically remember from nothing; like knowing a face without knowing a name. What I knew of hospice seemed to fall in line with what everyone without firsthand experience knew of hospice: it’s for dying elderly people. Since I appeared to be neither, hospice was quite far from my daily thoughts. That is, until this particular winter day.

For the entirety of my two plus hour drive I struggled to come up with an exact definition for the word, under the fear that the job interview would start with a typical Do you know what we do here? kind of question. By the time I reached the Solaris parking lot my lack of an answer had me convinced the interview would end up an embarrassing mess. Literature in the waiting area further confused the issue by proclaiming the company’s desire to celebrate life. Everywhere I looked, from the pamphlets to the expressions on the faces of current employees, I was presented with a version of hospice that appeared to be anything but dead dying death.

Needless to say the interview went well enough for me to land the job. The last five years at Solaris have taught me an immense amount about what hospice is. I’ve learned that it is so much more than checking vital signs, administering medications, and dressing wounds. It is providing strength when people are at their weakest. It is giving friendship to people at times when they might feel ultimately alone. It is building relationships with families that extend well beyond the duration of our service. It is genuinely caring about people and not simply filling out paperwork for a paycheck. It is finding precisely the right words to say when words seem to be nowhere near enough. It is showing up to a midnight emergency call-out with an attitude of compassion regardless of the level of fatigue. It is offering dignity to those who may feel stripped of it. It is a level of caring that extends beyond the patient and affects every member of a family. It is the epitome of putting the needs of others before the needs of oneself. It is a shoulder on which to cry and a hug that is perfectly placed. It is a bright smile when things appear to be oh so dark. It is embracing life instead of fighting death. It is so much more than a job or a position…it is a calling.

Despite all that I have learned it would appear I am no closer to a proper definition of hospice than I was on that nervous drive. But after spending all this time around the amazing and passionate people at Solaris one thing is abundantly clear with regards to what I once thought about hospice: I was dead wrong.

It’s true that this holiday season will be the last time many families will have a particular loved one around the Christmas tree or at the dinner table. Countless families will celebrate deep rooted family traditions for the last time with the very one they’ve always looked to as the creator of those traditions. But to assume that these families and their loved ones will have a sad or depressing Christmas is a mistake.

People most often associate the word hospice with death, and for obvious reasons. Hospice care’s sole purpose is of course to care for the dying patient. But what people most often fail to recognize is that hospice is an opportunity, for the very first time for some, to truly live. Opportunity may seem an odd choice of word when staring death in the face, but just because you have life doesn’t mean you’re living. I’ve watched patients and their families live life to the fullest in the span of a few days while I see other people everyday who haven’t lived in years. Things like healing broken relationships and saying things to loved ones you wish you would have said a long time ago, or just more often, begin to rise to the top of the priority list. Children and grandchildren gather around with no regard to time as stories are told. Coffee with old friends takes on a sweetness that’s not confined by a single moment.

The truth is, this time of year for many families with loved ones receiving hospice care is not sad at all. These kinds of moments may seem sad on the surface, but they are filled with more life than most people will experience in 50 holiday seasons. Am I saying you have to wait till your a hospice patient to truly live life? Of course not. If hospice has taught me anything over the years, it’s that life is to be celebrated as often as possible. We spend much of our lives trudging through the same routines blinded to opportunities to celebrate. The holiday season is supposed to shine bright with celebration but is often the worse offender when it comes to routine.

So this Christmas season celebrate Christmas like a hospice patient. Create new family traditions or put a renewed emphasis on the old ones that are so special. Give the routine things less importance than the things that create lasting memories. Most importantly, celebrate the valuable relationships in your life. Say the things you should’ve said already (the good ones of course), even if it’s not comfortable. Then when the holidays are all over, decide to celebrate life all year long. You won’t regret it.

From our Solaris family to yours,

Merry Christmas!

Remember the game Mother May I? The mother tells a child to take one step forward. The child must ask, “Mother may I?” Mom then responds with “yes you may” or “no you may not”. If the child forgets to ask, he steps out of the game. Like it or not, hospice clinicians often have to determine, “can I” or “can’t I ?” 

OK, I get it. Guidelines must be set to keep us on the straight and narrow but whose do we follow? ZPICs, RACs, MICs, MACs, State, OCR, to name a few. Unfortunately, hospice doesn’t have a one stop shop to find all the answers and for that matter, clear answers at that. A compliance officer can be the one stop shop for the clinician. This means that compliance officer better keep his eyes on the regulations, who’s watching and what are they looking for. His job is to make sure we ALL follow those guidelines to best of his ability and understanding.

Now let’s get to the clinician and the patient. A hospice aide is working in a nursing facility seeing hospice patients. The roommate of a hospice patient asks the hospice aide to help her with her shower. The hospice aide complies. Sounds like a really nice thing to do wouldn’t you say? Not in the eyes of the regulators. This can be considered a violation of the anti-kickback statute.  The anti-kickback statute is defined as, giving anything of value in money or in kind, for free to a potential referral source.  By the aide providing a service for free, the government sees this as inducing that facility to refer patients to the hospice by providing free services.

Clinicians are natural caregivers. It’s a way of life and when someone is in need, the last thing they think is, “can I” or “can’t I”.

As I pursued my medical education, there was little emphasis on managing patients at the end of life. Once the focus shifts from cure to comfort measures, most people seem to want someone else to deal with it. In defense of modern medicine, the intense focus on managing and curing disease is a noble one, but at some point, all of us will succumb to an event where these goals are no longer relevant. Instead of leaving patients and families helpless at this vulnerable time, let’s meet the needs that are left! Many patients are told, “There’s nothing else we can do.” I despise this phrase, because until the last breath, and even after, there is a lot to do. Those last moments allow people time to resolve internal conflicts, examine and validate their lives, mend relationships, and make memories with loved ones that are forever cherished. In my experience, little of this happens unless a person is out of pain and is physically comfortable. That is why I have dedicated myself clinically to aggressively treating patient’s physical symptoms at the end-of-life. To be honest, that’s the easy part that then opens the door for patients and families to address than many more important things that the dying process brings.

This field continues to gain medical attention (Hospice and Palliative Medicine is now a recognized medical sub-specialty) and the research base increases monthly. It’s exciting to those of us who are committed to providing the most cutting edge medical care to the hundreds of patients we care for daily. The rewards of being in this field have been too numerous to count, and I feel privileged to be a part of these family’s lives. So why did I go into hospice? I don’t know, maybe you should ask my dad.

Dr. Tibbels is board certified in family medicine as well as hospice/palliative medicine. He has worked with Solaris full-time for over four years as the Executive Medical Director.

A job that meets every need that you have physically, emotionally, spiritually, and financially?

I have. And it is here with Solaris.

I have been in the healthcare field for 25 years. (I know what you are thinking; I look way to young for that, huh?). I graduated from Texas Christian University in 1996 with my degree in Social Work and have worked as a licensed Social Worker ever since. Solaris has been my home since 1999. If you know me, then you have heard me say that this is the best professional job I have ever had.

When I came here, we had 20 patients, my desk was on the tile floor, IDT was held at the kitchen table, and back then we visited patients and attended all deaths literally as a team at the same time! As a team, we not only saw our patients during the day, but at night very often providing continuous care. We also helped answer phones. Well, “helped” is a stretch. More like hindered as a Receptionist! From my very first day here we have had morning devotionals, praying not only for our patients and families, but for each other to have wisdom in caring for them as well.

Diving in to the learning and education about end of life care, Medicare/Medicaid hospice benefit, palliative medicine, psychosocial and spiritual needs, grief and bereavement of patients/families can be overwhelming. Well, actually frightening. But then it happens. You meet a patient or family that put your clinical skills and knowledge base to the test. They challenge you at every level. You are exhausted with giving your heart, soul, and emotions to help this patient and family experience the best possible death with comfort, grace, and dignity. And it turns out to be a complete success. How do you know? The family and/or community gave you the best words that you could ever hear, “Thank you.” Words that should never grow old to hear. It’s worth it isn’t it? How many jobs have you had that you never heard “Thank you?” Even better, how many jobs have you had where you still hear those words from the same people even years later. It happens in Wal-Mart, at the dry cleaners, or a hundred other places in the community. You may be having a bad day or looking your worst, but it all changes when you hear those words that never grow old.

Q: Have you ever had a job that you felt this strongly about?

It’s what Simon and many others in the entertainment business refer to as that special quality or characteristic that you can’t quite define but makes people huge stars. You may have heard of the triple threat (singing, dancing, and acting) but the x-factor is more than that. Maybe it’s charisma or likeability, or something altogether different but it’s present in almost all major stars.

I’ve come to believe that hospice professionals carry an x-factor of their own. There is no doubt there are stars that work in hospice everyday. They shine brightly and are adored by the patients and families they care for. Similar to entertainers, they have that special something that makes them the best at what they do. The truth is there is a triple threat in hospice too; leadership, clinical skills, and compassion. But these alone aren’t enough when it comes to being the best in hospice. The x-factor is what takes a skilled hospice team member and makes them invaluable both to the organization and to the people they care for.

Unlike Simon’s inability to define exactly what the x-factor is, I believe it is absolutely definable in hospice care. It’s passion. It’s easy to see when someone is passionate about hospice care because the proof of passion is in pursuit. My business partner and the founder of Solaris Hospice absolutely cannot rest if he knows a patient is living with uncontrolled pain and symptoms. His passion for hospice and palliative care drives him to relentlessly pursue a quality of life free from pain and symptoms for every one of our patients.

Passion leads nurses in hospice to work through emotional exhaustion long into the night, chaplains to help shoulder the grief and emotional pain of families, social workers to push other organizations to get patients the help they need, and hospice aides to fiercely guard the dignity of patients at their most vulnerable time. These professionals, and many others behind the scenes, give their all every day because they passionately believe that every person deserves the best quality of life possible. They believe that pain and suffering are unacceptable, and they make it their mission to remove it no matter where they find it. They are special people who’ve carried the X Factor long before Simon Cowell made it into a show.