Sunday, February 07, 2010

Unexpected

I've written before when a patient "surprises" us by not following the normal end of life trajectory. There are signs and symptoms that death is getting nearer, even up to a few months before a person dies. We, as hospice professionals, note these changes each visit and prepare the patient and family for what is going to happen. Every once in awhile, the unexpected happens. You may be talking to the patient, nothing appears amiss and two hours later, they're dead. My experience Friday takes the cake, however.

The lady had only been on our program for a couple of weeks. In fact, I hadn't met her yet because her POAH was going to be out of town and they wanted to delay our first visit until next Tuesday, when another friend would join us. The patient had no children but had a group of friends that were like family to her. On our first visit we were going to talk about Advance Directives, long-term care planning, and all that good stuff. She was in no way imminent and was living at home independently. I happened to be with the hospice RN when she got the call from the office. The patient's POAH "June" was back and supposed to take the pt. to a doctor's appointment that morning but "Magda" wasn't answering the door. She had gone around the back of the house and could see that Magda was slumped over in her chair. While June waited for her husband to bring the spare key, the RN and I headed over. When I arrived, it was confirmed that Magda had died. Her friends had spoken with her the night before and nothing was different. They expected this morning would go smoothly with the doctor and then they were going to finish taking down the Christmas tree decorations, which Magda decorated magnificently and always kept up through at least the end of January. June could not have guessed that the last time she would see Magda face to face would be before she went out of town last week.

Magda looked absolutely peaceful. She had her make-up on, which her friends said was a daily custom. She was drinking her morning coffee. We won't ever know what she died of but it didn't appear to cause her any pain or discomfort. June and her friend "Betsy" found comfort that Magda died so unexpectedly. They said Magda would have had a hard time letting a hired caregiver take care of her whenever it became necessary. Magda always took care of everyone else and could be private about her own business. We sat and talked about Magda's life while we waited for the funeral home, which Magda had pre-arranged several years ago. She sounded like a firecracker of a lady. I would have enjoyed getting to know her but for her sake, I'm glad we'll never get to meet.

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