Topic: A Team

 Topic -A Team

Dad lived for eight days after the hospice nurse said he had started the process of dying from his end stage prostate cancer.  

On day one, Thanksgiving Day, they directed me to give morphine every four hours.  I used a little syringe and squirted it into the sides of his mouth.  I set an alarm so I wouldn’t miss a dose—getting up at 1 am and 5am was rough but it would just be for a day or two I told myself.

On day two the nurse came out and told him that he was dying.  After she left he told me, “Well, I may be dying, but I’m not gonna die today.”  They directed me to add crushed anti-anxiety medicine to the every four hour regime.  

On day three I was getting weary.  I’ve been a nurse for 27 years, and it was hard for to accept help.  The hospice nurse suggested that maybe we should move dad to the inpatient unit so he could get medicine around the clock. I declined.  My husband, Jan, a physician joined the team, and started giving some of the doses.  We made a makeshift nurses station in the dining room.  We charted every dose in a notepad that became his “chart”.  

On day four even with Jan’s help things got tougher.  They increased his medication to every two hours.  The hospice nurse said that if we didn’t want to send him to the inpatient unit, they could send a nurse out to the house to give his meds, so I could just relax and “be the daughter.”  I declined.  I knew he wouldn’t want that. He couldn’t tell us, but we had talked about all of this months ago. For the past week I remarked multiple times how stubborn my dad was, how he fought death, and now it hits me that I might be just as stubborn as he was.  My cousin and best friend who we affectionately call “Dude” came in from Tennessee to join the team.  She had an active nursing license but wasn’t currently practicing nursing because she was busy raising her kids.  She insisted we go to our house for a few hours for a much-needed break-that we didn’t decline. When we got back to dad’s we had a team meeting and worked out a schedule.  

By day five dad had stopped talking, eating or opening his eyes.  We continued to give medication every two hours.  Each of us “worked” four hours at a time. I did 8pm- 12 am, Jan did 12a-4a, and Dude did 4a-8a.  Then it was me from 8a-12p, Jan from 12p-4p, and Dude from 4p-8p.  

On day six his pain and discomfort increased so the meds increased to every hour round the clock.  There was very little down time on the four hour shift.  Before giving the meds, you had to swab his mouth out and then there was the task of crushing the anti-anxiety pills and dissolving it in the liquid morphine.  By the time you got done with one med pass you had to get ready for the next one. We charted everything.  Dude found a dry erase board and put it on the “nurses desk”. She wrote the time and the name of the “nurse” on duty.  Then I got silly and wrote:  

Director of Nursing-Bridgid Cornell, RN

Medical Director-Jan Cornell, MD

Quality Assurance Nurse Sharon Snider, LPN

We felt bad that we hadn’t included our other family members so we dubbed my sister Tricia, Director of Hospitality.  My brother Marty was the CFO.  My brother Chris was IT/Tech Support.  My sister in law Vicky was the HR Director, and she fielded complaints from the QA Nurse that the DON was sleeping with the Medical Director, and wasn’t that a conflict of interest? Dad lived on a street called Hollywood so we decided we were Hollywood Hospice.  We were tired and slap happy and laughing through our tears.  It was the only way we could keep going.  

On day seven each of us was exhausted in every way that a person can be exhausted-emotionally, physically, and spiritually.  Dude had to get back home to her family soon.   Jan and I had to return to work soon.  So we had an emergency team huddle in ear shot of our patient.  “I know he wants to die at home, but we can’t keep going on this way,” I said.  We agreed as cold as it sounded that if he didn’t pass away by day nine, we would have no choice to move him to the inpatient unit.  The hospice nurses were amazed every day to find that he was still holding on.  Every day they had told us that they thought this was “it”, this would be “the day.”  

He must have heard it.  He must have decided that although he was scared he wasn’t going to that inpatient unit.  After hundreds of doses on day eight, dad finally let go. 

I’ve never been a big sports person, never played on a championship team or won a tournament.  This was the most important team I’d ever served on.  We won.  And I couldn’t have done it by myself, not for eight days.  It took a team.