Hospice: The Lesson - Chapter 4: A Return To Hospice
By Joan Morris
TIMES STAFF WRITER
Published Wednesday, May 23, 2001, in the Contra Costa Times Newspapers.
Orginal Link Addresses:
http://www.contracostatimes.com/health/hospice/
http://www.contracostatimes.com/health/hospice/stories/dayfour_20010523.htm

SFBAPPA.ORG Award of Excellence:
Bob Larson, Contra Costa Newspapers, "The Lesson" - Corresponding Photos.

the lesson

CHAPTER IV: A Return To Hospice

A turn for the worse dismays Diane, family
Back at hospice, she seems groggy, about to give up, but then rebounds

By Joan Morris
TIMES STAFF WRITER

---

Diane Sheffield's voice sounds weak and worried. Things are not going well.

Just a month before, in October 2000, Diane had been upbeat, planning a trip of a lifetime: a journey to the Holy Land.

Unrest in the area was growing, but Diane had been defiant. "I'm not going to let some idiot people throwing rocks stop me," she had said. But the rocks became bombs and bullets, and Diane's friend, a Tel Aviv resident who had planned to escort Diane, finally told her not to come. It was too dangerous.

Now, in mid-November, Diane is preparing to return to hospice. Diane denies a connection between the canceled trip and the sudden dip in her condition. But she knows that time is starting to run out on this remarkable reprieve she's been living. Diane is dying, and this time, it feels like it's for real.

In recent days, Diane's pain level has increased to intolerable levels. Her doctor doubles her pain medication, which leaves Diane groggy and fearful.

"I don't know what's going on," Diane said. "Lately, it's one new wrinkle after another, and I don't need any more wrinkles."

It is a different Diane who sits in her living room. She is quiet, in a fog. Her friends and family, as well as the hospice workers, suspect Diane has finally tired of the struggle and is beginning her surrender to death.

Robert and Daniel, Diane's sons, come for the family meeting with hospice workers. It is apparent, however, that Diane's thoughts are elsewhere. She moves in slow motion and her voice trails off as she speaks. There is a vacant look in her eyes.

She jokes that her 60th birthday present was a walker and that while Courtney, her 2-year-old granddaughter, is moving on to a real cup, Diane's going to be using the "Tommy Tippy" cup. But her laughter is haunting and hollow.

The workers arrive and begin to take down the basic information. Because Diane has been in the full hospice program before, there is very little to explain to her. But Diane asks them to talk about bereavement counseling available to families now and for an entire year after the hospice patient dies. She says she hopes Bob, Daniel and Robert will take advantage of it.

Robert stops her.

"I'd appreciate it if you'd focus on you, not on us, not on me," Robert says. "You don't need to tell me to see a social worker. When it happens, we can talk to each other, and I can talk to my spouse, and if we need help, we'll get it. You need to concentrate on yourself."

Sheepishly, Diane nods. She has been taking care of others all of her life, and she wants assurances that her loved ones will be taken care of when she's gone.

Daniel, about whom Diane worries the most, sits quietly through the meeting. But when asked for his phone number, so he can be reached in an emergency, he begins quietly to cry, which triggers Diane's own choked tears.

Later, she says she hates that her illness is causing so much pain for her sons and for Bob. All of her worries about death are based on how it will affect her family. She has tried to make it as easy as possible for them, even to the point of planning every detail of her funeral.

She wants two guest books because "no one should have to stand in line to get into my funeral," and she asks that her mother's priest, the Rev. Francisco Vincente, explain the Mass for any non-Catholics in attendance. Diane has known Father Vincente for years, and through him, she feels a closeness to her mother.

Everyone begins to steel themselves for Diane's death, but within a week of her re-admittance to hospice, she rebounds. Sue Stewart, Diane's hospice nurse, suspects that the fogginess Diane is experiencing is related more to the medication than to the cancer.

Sue reduces Diane's medication and, working with the hospice pharmacist, medical director and Diane's own doctor, changes Diane to other pain medications. Within days, Diane is more her old self. She remains gravely ill and uncharacteristically tired, but the spark has returned to her eyes.

"Word is spreading through the neighborhood," she says. "Diane's not croaking yet."

Thursday, Chapter V: The difficult patient

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