Ugh! What a way to start the week. Expected snowfall for this area is upwards of 6″. I didn’t relish the thought of driving around visiting patients today, but driving around I nonetheless did. But not before stopping to see a patient in the inpatient unit of our hospice organization. Having seen him before, I knew he was struggling with what the future holds for him. Unfortunately, he is not symptomatic enough to stay in our inpatient unit because – in his words – he’s “not dying quick enough.” I have encountered this scenario many times, and I am always saddened by it.
Many, if not all, hospice organizations are beholden to Medicaid/Medicare and organizational guidelines, which have specific rules regarding what qualifies a patient to a) be on hospice; and b) stay in an inpatient unit. The organization may not be designated as a “nursing home” or other extended care unit, so patients are only able to stay in the unit if they are symptomatic (and don’t get me started on the difference between symptoms and disease processes). So, once symptoms are under control, a patient may need to be returned to their home or care facility. That is often difficult for patients and families to understand.
In the case of my patient today, that’s precisely where he landed. He was under the impression he was coming to the inpatient unit to die and now because his symptoms are under control, he will now not be able to stay. He can still remain on hospice, but just not at the inpatient location. What a disappointment to him! I can’t imagine having to come to terms with the idea of my own death, but being moved around from facility-to hospital-to hospice-back to facility has got to be maddening. Quality of care notwithstanding, that sucks!
Yet, my patient is trying to take it all in and not let things get to him. He is attempting to just accept his circumstances the way they are and is giving everything over to God to take care of. I am always amazed at the strength of faith I see in some of my patients. It makes me wonder if I will have the same strength or if I will be a blubbering idiot when my time comes. Our whole healthcare/government system is so complicated, it seems like we just throw up our hands in defeat most of the time. I’ve seen several of my social worker colleagues spend hour upon hour upon hour trying to secure Medicaid for a patient in order to get them into a facility for care, just to secure said Medicaid 2 days prior to the patient dying. Hundreds of hours lost because of a slow system that ultimately may result in placement in a facility with staff shortages and sub-par care. This is also precisely what my patient today was worried about. He came from such a facility and has no desire to return. Ugh. And I thought the snow falling today was a downer.
To my utter surprise though, my patient had a wonderful sense of humor and was a delight to talk to. Despite all of his concerns – not to mention his physical issues surrounding his disease – he was able to laugh, smile, and even make me blush. Yes, flattery will get you everywhere. At one point in our conversation, he asked me, “So how old are you, late 20’s?” Be still my beating heart! I almost fell off the chair in laughter. “Nope,” I said, “Turned 43 two weeks ago.” His eyes widened and he said, “Your skin is lovely, you look very young.” My cheeks reddened and I, of course, said Thank You.
Amidst the pain he has, the dark cloud of death hanging over him, and the uncertainty of where he will be in his immediate future, this man offered a gift of kindness and love to me. He was showing Jesus to me by making me smile and by understanding that, despite all he was going through, he is still able to bring something wonderful to this world.