Hospice NewsS P R I N G 2 0 1 4

VolunteersHow they impact hospice

patients’ lives

Prolonging Life Ethical choices and opting for

natural death

Advance DirectivesWhy you should have a living will and a durable power of attorney

brookingshealth.org

Brookings Health System Hospice would like to acknowledge with appreciation the following donations (received through 3/31/14):

Donation from Windsor Twp Charity Fund

Donation from FRC Women of Faith

Donation from Lynne Stark

In Memory of Ron Aho David & Susan Karolczak Ann Westbrook Mildred K. Hugghins Peg Lippert & George Lippert

In Memory of Dick Fergen Laurie Austin

In Memory of Linda Girard Barry & Marlys Christensen

In Memory of Karen Gries Gloria Pike

In Memory of Genevieve Hegerfeld Shirley Hegerfeld

In Memory of Howard Schlobohm Luella Schlobohm Gloria Pike

In Memory of Habe Suhr Nancy Gries

In Memory of Jeanette Waage Jonetta & David Negstad

Hospice Volunteer Luncheon

The Hopeful Spirit Chorale Hospice volunteers

2

spring 20143

S P O T L I G H T o n O u r V O L U N T E E R S

Activities Our hospice clients are fortunate to have 10 volunteers who spend time with them. The volunteers have different talents and experiences, are different ages and thus bring a range of interests and interactions to our clients. Some have special musical talents which they share with clients; some sing to clients, and others read to clients, play card games or put together puzzles with them. Sometimes our volunteers just sit with clients holding their hand and listening to music. They may massage a client’s hands with lotion, comb their hair or take them for a ride in their wheelchair.

Volunteers receive training and learn how to be present with clients without feeling the need to interact or be

“doing something” with clients. They learn about hospice philosophy, their role as part of the hospice team and how to be with our clients in a professional capacity.

Volunteers frequently find they receive something special from being a volunteer. We have volunteers who are SDSU students and they enjoy hearing stories from our senior clients about days in the past on the farm or about our clients’ various occupations, whether telephone operator, soldier or teacher in a small rural school. Some find they have mutual acquaintances or interests. Most find they develop a special relationship with clients as they each look forward to their regular visits.

Recognition Volunteers are recognized each year for the work they do at a special luncheon. This year the theme revolved around music and the impact it has on individuals. Brookings Hospice may not have a music therapist, but we do have music makers.

Music MAking Dr. Holm and his choral group sing for hospice clients, bringing them much pleasure as they listen to voices of 16 to 18 enthusiastic men and women who enjoy singing. We also have a volunteer, Nancy Gries, who plays her keyboard for clients. The keyboard is very mobile, allowing Nancy to take her music to clients whether they are at home or in one of the nursing homes. One of our volunteers has played her flute for a client.

Music that is soft and has a slow beat can be very soothing for clients. Some music can bring back pleasant memories from the past. Sometimes an upbeat piece with a quicker tempo can be just the thing to energize a client and create a bit of happiness for them. Research has shown that live music has a greater impact on an individual than recorded music.

Because of the donations given to the hospice program, we have been able to purchase a reverie harp. This instrument is basically a beautiful wood sound box with 22 strings. The instrument is tuned in such a way that no matter which strings are plucked, a lovely harmonious sound is produced that is rather enchanting. You may learn more about the harp and hear it being played at www.harpkit.com. We are looking forward to this new musical addition to what we offer clients.

gRAtitude All of us who work in hospice are grateful for our volunteers and the special time and talents they bring to their relationships with our clients. One of our long time volunteers resigned this past year. Delores Koepsell had been volunteering for about 17 years. We thank her for her many hours spent with clients over that time and her contribution to making hospice services special. Best wishes, Delores!

A number of SDSU students are leaving this spring as they graduate and move on to graduate school or careers elsewhere. They include Erin Dunlap, Emily Giza, Alex Heard and Lee Opdahl. Thank you, congratulations and best wishes to all of you!

Fortunately there are more individuals who have chosen to join the hospice team as a volunteer. Several new volunteers will soon be trained and will also bring compassion and various talents to their interactions with our clients. We look forward to their time with us and their help in creating the special services we provide hospice clients.

The second part is a living will, that is a written document that specifies what medical care you want and do not want at the end of your life. Both are important. Both decisions can be written down and notarized so your wishes are clear and have legal status. Doing so does not require the services of an attorney.

An Advance Directive specific for South Dakota may be downloaded from the following website: www.caringinfo.org. There you can also learn more about an advance directive.

A helpful booklet, Five Wishes, may be ordered from www.agingwithdignity.com. This booklet is very comprehensive and talks about personal, emotional and spiritual needs as well as your medical wishes at end of life. The booklet can be previewed at the site. Cost of a copy is $5.

Once you have an Advance Directive in place, make copies. Take a copy with you to your next physician visit and discuss it. Give copies to family members, especially your DPOA for health care. Keep one available for you to take with you should you be hospitalized.

You can always change your mind about an advance directive. It is not used if you are able to speak for yourself. It is simple to fill out. It provides your family and physician with important information about your wishes. An Advance Directive can provide peace of mind for yourself and for your family.

““

If you are reading this newsletter, you have probably lost

a family member in the past year. Perhaps you were the

durable power of attorney for health care.

MAybe youR fAMily MeMbeR could no longer make decisions or speak for him/herself. You were in the position of needing to speak for them with regard to medical decisions, to say yes or no to treatments and care measures. Perhaps being in the position to make medical decisions for them was easier because you two had had conversations about what it was they wanted at the end of life. Your family member told you what he/she wanted and did not want.

Had you been in the position to make decisions but had not had that conversation it may have been more difficult. If you had some thoughts about what medical care would be appropriate but someone else in the family voiced opposing thoughts, making the final decision was probably even more difficult.

If you are not able to speak for yourself about what care you want, would your family members know what to do? To ease the burden for your family, you can have the difficult but important conversation about what medical intervention you do and do not want and you can write it down.

This is called an Advance Directive. There are two parts to it. One part is appointing someone to be your Durable Power of Attorney (DPOA) for Health Care. This is a person named by you who will make health care decisions for you if you are not able to speak for yourself. Having a conversation with that person is important to be certain they are willing to speak for you and follow your wishes.

Mavis GehantHospice Social Worker

An Advanced Directive can provide peace of mind for yourself and for your family.

brookingshealth.org4

““

DeserveIn my visits with hospice patients I have heard them say things like, “I have done

this to myself. I knew that smoking (insert your preferred high risk behavior) could

kill me. I knew about the risks. And yet I just kept doing it.

“you AlwAys think it will happen to someone else, not you. Now I have lung cancer. And I’m dying. I’m just getting what I deserve.”

Isn’t that how we often think of cancer? The person must have done something wrong. They must have done something to deserve it. I wonder why we think the way we do. I wonder if such thinking doesn’t sooth our own sensitivities. Someone getting what they deserve makes sense. There’s an element of justice to it. And because it makes sense, we feel better because our world is a safer place. The problem with judging is that there’s always an exception to the rule. For every patient that

“deserves it,” there is another who has done nothing wrong. Consider the young father of small children for example, who has lived a healthy lifestyle. He exercises, eats right, and doesn’t smoke or drink. He’s done everything right. And yet somehow he receives the same cancer diagnosis. How do we process that? How can a seemingly healthy young person who does all the right things have cancer? It doesn’t make sense or seem fair. There has to be a reason. There has to be guilt.

Isn’t it interesting that “illness” and “cancer” are not synonymous in our thinking? Illness is something you get; cancer is something you have (or more realistically, “are”). Illness is something you treat. Cancer is something you “fight.” Obituaries often speak of a “valiant battle with cancer.” You never hear, on the other hand, of patients fighting heart disease. There is a stigma attached to cancer. A stigma is “a mark that detracts from the character or reputation of a person.” As such, cancer suggests guilt and blame. There’s a demeaning, even dehumanizing, quality to it. And the patient becomes objectified through it. We would never dream of suggesting that the ALS patient did something to deserve their illness. That would be cruel. And yet we judge cancer patients all the time if even subconsciously.

I would imagine at this point that some of my readers doth protest. I hear them say, “Don’t you know that smoking dramatically increases the odds of lung cancer?” Yes, I am aware of that. I have witnessed its ravages on a personal level. Smoking increases the risks of other cancers, too. So I would recommend that smokers do everything in their power to quit. But the truth of the matter is that we don’t always know why people get sick. Perhaps people get sick and die because it’s a natural part of life. A wise person reminded me recently: “None of us are getting out of this alive.” We are all going to die someday from one thing or another.

So what do we do with illness? What do we do with cancer? Well, as one cancer patient has said, “I am not powerful enough to feel either guilty for getting sick or proud of getting well. I can only take what happens to me and continue to look for possibilities of how to live.” Perhaps the key to living with illness (including cancer!) is to continue to live! Perhaps the lesson of illness is to pursue things that are meaningful to us and give us joy as long as we are able.

Gregg TeBeestChaplain

A wise person reminded me recently: “None of us are getting out of this alive.” We are all going to die someday from one thing or another.

spring 20145

F R I E N D S G I V E I N M A N Y D I F F E R E N T WAY S

Thank You for Being a Friend!Thank You for Being a Friend!

V O L U N T E E R L O C A L

> Give your time to Brookings Health System Hospice. Contact Mavis Gehant: 696-7700.> Become a doula helping parents at New Beginnings Birthing Center. Contact Emily Delbridge: 696-9000.> Help out at The Neighborhoods at Brookview. Contact Amanda Uecker or Joyce Krein: 696-8700.> Be a hospital patient companion or help with swing bed activities. Contact Amy Christensen: 696-8846. > Join Brookings Health Care Auxiliary. Contact Nadine Pollman: 696-8827.

D O N AT E L O C A L

> Participate in local health care philanthropy.> Perennial Club $100/yr+; Pioneer Club $1,000+; Prairie Nightingale Society members $10,000+ and Pathfinders $25,000+. Members are acknowledged in our newsletter, honored on the donor wall and are invited to social events each year. > “Aiming to Inspire Health” event sponsorships or shooting teams. Over 100 shooters compete at sporting clays.

C R E AT E A L O C A L L E G A C Y

> Various options available through charitable remainder trusts and gift annuities can provide you with steady payments during retirement as well as tax advantages while also providing a gift to Brookings Health System Foundation.> Name the Foundation as the beneficiary on your life insurance, IRA or 401(k).> Talk to your financial advisor or tax consultant about these and other options today.

Sponsored by Brookings Health System Foundation,

your local 501(c)3 health care charity.

Email: foundation@brookingshealth.org

Phone: (605) 696-8855

WA L K B E S I D E U S A N D B E O U R F R I E N D

> Learn about Brookings Health System and its impact on local quality of life and economy.> Visit the website, www.brookingshealth.org, or “Like” the Facebook page, www.facebook.com/brookingshealth, for current news, videos and testimonials. > Watch for your Inspiring Health newsletter mailed direct to your home four times per year.> Track Brookings Health System’s quality performance at www.brookingshealth.org/Quality.> Read the 2014 economic impact study at www.brookingshealth.org/Impact.> Come to know the current staff, services and efforts of Brookings Health System.

brookingshealth.org

The American Medical Association’s (AMA) Code of Medical Ethics says it plainly:

physicians are to sustain life but also to relieve suffering; and where one duty conflicts

with the other, then the preference of the patient or his representative should prevail.

like the ceo of McKennan hospital recently said, “The person or the person’s representative should have the last say.” That conflict plays out in a newspaper story of a young man who had severe brain injury some 14 years ago and is still in a persistent vegetative state. The despondent mother reportedly now wants to stop artificial hydration and let him die a natural death. This dilemma brings up several ethical questions.

Would stopping fluid feedings be more merciful than keeping him alive for years in a vegetative state?

The paradox of fluid replacement meant to sustain life is that it can also prolong pain and suffering. In this case, there is a significant burden of suffering from severe muscle spasms not to mention the consequences of total bed rest and complete dependency.

Would stopping fluid feedings cause him to suffer?

Scientific experience shows us that during the dying process, if dehydration occurs, the brain produces natural endorphins that reduce pain, and provide comfort. This allowed, a human being will slip away gently over an eight to twelve day period of time, just like nature has done it for as long as humans have walked this earth… that is until we interrupted the natural process less than a century ago with artificial hydration.

Is there a difference between not starting fluid feedings in the first place, and stopping them at any time?

The AMA Code of Medical Ethics, and the law of the land, both state that there is no ethical or legal difference between not starting treatment and stopping. Any treatment, started to enhance health and diminish suffering can be stopped, especially if the situation changes and treatment is no longer helping or is causing harm.

Do I, as an individual, or someone acting on my behalf, have the right to ask for the tube to be removed?

Yes, especially where sustaining life might cause suffering. Further, the physician should either honor those wishes, or, if the physician believes this is not consistent with her or his personal ethics, then the physician should transfer the patient to the care of another doctor.

What is the most important lesson from this story?

We should all talk to our family in advance about our wishes regarding vegetative states and feeding tubes. It may prevent a lot of suffering.

Richard P. HolmMD

spring 20147

This is arecyclable product.

Hospice News is published by Brookings Health System. This publication in no way seeks to serve as substitute for professional medical care. Consult your physician before undertaking any form of medical treatment or adopting any exercise program or dietary guidelines.

300 Twenty-Second AvenueBrookings, SD 57006

ADDRESS SERVICE REQUESTED

We Extend Sympathy to the families of patients lost through March 2014:

Floyd Abrahamson 10/21/19–2/10/14

Norma Basmajian 10/27/19–3/30/14

Sherwood Berg 5/17/19–2/16/14

Marie Bozied 11/20/11–1/19/14

Mary Hayes 6/20/29–1/15/14

Genevieve Hegerfeld 5/15/27–3/16/14

Hannah Jensen 7/10/19–2/14/14

Michael Lother 8/25/54–1/24/14

Betty Nagel 5/16/25–2/8/14

Robert Nielsen 8/31/36–1/10/14

Howard Schlobohm 12/30/26–1/1/14

Dolores Stedman 8/5/26–3/11/14

Habe Suhr 1/11/15–1/31/14

Margaret Ullery 10/8/21–1/28/14