I moved my 60-year old mother into hospice care yesterday.  It was one of the hardest decisions that I have ever been part of making.  She is still relatively lucid and shows none of the imagined signs of one who is on "death's door".  The decision was made as a result of her living will and medical directive that precluded a sixth cranial surgery due to its "extraordinary" nature and minimal outlook for recovery.  Aside from the mental and physical diminishment she has suffered, she has no terminal cancer or pulmonary disease.  My mother is merely fighting a loosing battle with a antibiotic resistant cranial bacteriological infection  she picked up during her skull reconstruction (cranial plasty). 

I had heard of Hospice Care, and even participated in making my maternal grandfather comfortable during the last stages of his lung cancer, but I had never truly contemplated the nuance or implications of placing a loved one in hospice.

Hospice care: Care designed to give supportive care to people in the final phase of a terminal illness and focus on comfort and quality of life, rather than cure. The goal is to enable patients to be comfortable and free of pain, so that they live each day as fully as possible. Aggressive methods of pain control may be used. Hospice programs generally are home-based, but they sometimes provide services away from home -- in freestanding facilities, in nursing homes, or within hospitals. The philosophy of hospice is to provide support for the patient's emotional, social, and spiritual needs as well as medical symptoms as part of treating the whole person.

Hospice programs generally use a multidisciplinary team approach, including the services of a nurse, doctor, social worker and clergy in providing care. Additional services provided include drugs to control pain and manage other symptoms; physical, occupational, and speech therapy; medical supplies and equipment; medical social services; dietary and other counseling; continuous home care at times of crisis; and bereavement services. Although hospice care does not aim for cure of the terminal illness, it does treat potentially curable conditions such as pneumonia and bladder infections, with brief hospital stays if necessary. Hospice programs also offer respite care workers, people who are usually trained volunteers, who take over the patient's care so that the family or other primary caregivers can leave the house for a few hours. Volunteer care is part of hospice philosophy.

The word "hospice" comes from the Latin "hospitium" meaning guest house. It was originally described a place of shelter for weary and sick travelers returning from religious pilgrimages. During the 1960's, Dr. Cicely Saunders began the modern hospice movement by establishing St. Christopher's Hospice near London. St. Christopher's organized a team approach to professional caregiving, and was the first program to use modern pain management techniques to compassionately care for the dying. The first hospice in the United States was established in New Haven, Connecticut in 1974. Today more than 3,000 hospice programs across the country offer comprehensive hospice care. Most insurance plans in the US include hospice as a covered benefit.

That definition gave me some comfort in making casting my "aye" vote in favor of honoring my mother's pre-illness wishes, but left me with a hollow and empty feeling that borders on betrayal.  I was raised to fight.  The honor was given, even in loosing, to the person who went down swinging and struggling until the final bell sounded.  There was no honor in giving up.  I see now however that only a fool goes down swinging when the opportunity for gentle surrender and thoughtful withdrawal is present.  There will be no chance to "live to fight another day" for my mother; I understand that and accept the finality, the eternal implications of that statement.

So as I pray through this season of my life, a season that all sons and daughters must some day endure, I am searching for comfort and solace as I reconcile the finality of surrender with the lessons my mother taught me about "over coming" and "enduring". 

Philippians 4 was always one of my mother's favorite passages, and when I failed in youthful folly, she would often recite, from memory, the following words to comfort me:

Rejoice in the Lord always; again I will say, rejoice!  Let your gentle spirit be known to all men. The Lord is near. Be anxious for nothing, but in everything by prayer and supplication with thanksgiving let your requests be made known to God.  And the peace of God, which surpasses all comprehension, will guard your hearts and your minds in Christ Jesus.

And today I add:

But I rejoiced in the Lord greatly, that now at last you have revived your concern for me; indeed, you were concerned before, but you lacked opportunity. Not that I speak from want, for I have learned to be content in whatever circumstances I am. I know how to get along with humble means, and I also know how to live in prosperity; in any and every circumstance I have learned the secret of being filled and going hungry, both of having abundance and suffering need. I can do all things through Him who strengthens me.

Please pray for my family and for that "peace of God, which surpasses all comprehension".



Grandma Carol with her husband and five grandchildren