It is not uncommon for members of a hospice team to have personal experience with hospice; in some cases it is the death of a loved one that leads them to hospice work. But the line between professional and member-of-the-family is difficult to traverse. Four registered nurses with VITAS Innovative Hospice Care® of Greater Pittsburgh can tell the story from both sides of that line.

Joyce Blasko, RN, of North Huntington wasn’t always a team manager at VITAS. When her mother was diagnosed with lung cancer, Blasko was a critical care nurse. The cancer metastasized and the doctor recommended hospice, but Blasko dug in her heels. “I spent my day delivering aggressive treatment,” she reasons. “I knew nothing about hospice. I just knew I wanted her to live, even on a ventilator.”

Fortunately for Blasko, the doctor persisted. Blasko’s mother lived another year—at home and comfortable on hospice care. Although all three daughters were nurses, the hospice staff saw them as daughters. “They taught us what to do and how to do it,” recalls Blasko. With portable oxygen and a wheelchair, her mother went on picnics and even on vacations.

So Blasko and her husband sought Hospice of Greater Pittsburgh Comfort Care (now VITAS) when his mother suffered heart failure. She was losing her mental faculties, had been hospitalized multiple times and was diabetic with neuropathy and pain in her lower extremities. The doctor suggested open heart surgery. The Blaskos said, “Enough.”

“She enjoyed three months of wonderful care, and she passed peacefully,” says Blasko. “Doctors need to think quality, not quantity. Would your patient want a year of bad health, or 30 days of dignity and comfort?”

Karen Thimons, RN, of Plum says her grandmother, a dementia patient, did so well on hospice that she no longer met Medicare standards and was discharged. “She thrived on hospice,” Thimons quips. Early in 2005 Thimons’ grandmother was readmitted and died within six months.

“Through it all, I was able to be objective and participate in her care,” Thimons says. “Until she was actively dying.” When the hospice team recognized Thimons’ need to become the grieving granddaughter, they insisted their coworker take time off. She called family and urged them to come to the bedside. Her grandmother’s death was filled with soft music and loved ones saying goodbye. “It was a wonderful experience,” says Thimons. “But there’s no way I could have continued as part of the team. The VITAS pastors, the social worker, the bereavement coordinator, all helped. I ended up being ill I was so depleted.”

Terry Loughrey, RN, of Kittanning says patients thrive on hospice frequently. Her own grandmother did. “It’s not a one-way ticket,” she says. “Patients are revitalized on VITAS. There’s a nurse conferring with her doctor, there are aides to assist with her care, there are social workers and counselors offering one-on-one attention. She’s interacting, telling her story, and she begins to thrive.”

A nurse since 1985, Loughrey hasn’t always been comfortable with end-of-life issues. “How do you tell someone she’s dying, and how do you help her through that?” she once worried. Today, as a VITAS intake manager, she conducts in-service training for healthcare professionals. “‘We’re end-of-life specialists,’ I say. ‘Just as you refer a patient to a cardiologist or a gynecologist when you can no longer help her, you refer her to VITAS for end-of-life care.’”

As a nurse, Loughrey was her dying grandmother’s advocate. As a granddaughter, she continued to hope. Eventually her grandmother stopped eating, began to lose weight, and was readmitted to hospice. But at 92 she did not want CPR or artificial respiration. “Hospice offers hope in a different direction,” Loughrey says. “Not for another 10 years of life maybe, but for comfort, for symptom relief, for a chance to heal relationships.”

Loughrey believes those are the benefits of hospice, and that the challenge to healthcare professionals is to initiate conversations about the likelihood of impending death with patients and families sooner so they can receive those benefits.

Terri Simco, RN, of Penn Township was a hospice nurse when her grandmother, 89 and suffering from Alzheimer’s, began to decline. Like the rest of her family, Simco believed family should take care of family.

“They looked to me to be the nurse,” she says. “They called 10 to 30 times a day. I knew what was happening with my grandmother, but they didn’t believe me. They didn’t see me as a professional—I was just Terri.”

For months, Simco tried doing it alone. “You always have hope. When do you say it’s OK not to get out of bed, it’s OK not to eat?” she asks. “I needed someone to tell me what I already knew.”

Exhausted, Simco convinced her mother and siblings to try hospice. When the hospice team said the same things she had said, the family believed them. The social worker recognized Simco’s mother’s denial. The chaplain said what her mother needed to hear. The aide bathed the patient three times a week.

“In the end, our whole family was at the bedside. The hospice team had called meetings, given us jobs, made a schedule. We had a purpose and we were coming together to make it happen,” Simco recalls fondly. “That’s what hospice can do that clinicians can’t.”

This article was originally published in Western Pennsylvania Hospital News, July 2005.