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Putting Control Where It Belongs
Originally published in South Florida Hospital News, January 2006
When things are out of control, Eileen McDermott hands control right back to the patient and family—“where it belongs,” she says.
McDermott is an admissions nurse for VITAS Innovative Hospice Care® of Broward, which means she’s usually the first hospice professional on the scene after a patient and/or family receives bad news. “When you hear bad news, everything feels out of control,” she sympathizes. “They may have just received a new diagnosis, and they’re shocked. Or maybe it’s a chronic condition; I can assure them that nothing has changed.
“I tell them if they want treatment, they can opt for treatments. I tell them patients can be on hospice for quite awhile with things like end-stage heart disease or COPD—they live a long time. I tell them there is no way they can make a mistake because they can always change their minds. I tell them this admissions visit can be purely a consultation. Everything I say is meant to give control back; that’s the prime thing for me.”
Slowly, McDermott introduces the family to hospice. “I really listen,” she says. “I let them vent, then refocus the discussion to the task at hand.” Once they are comfortable with the hospice concept, McDermott talks to the patient.
After 25 years of ER experience, McDermott is unflappable. But just as important is the fact that she’s walked the walk; her father died on VITAS service. “I reassure them that we can anticipate their future needs. I might order a wheelchair, and the patient hates the idea of getting into a wheelchair. I share my father’s experience. I can tell her, ‘A wheelchair is freedom; it’s a walk in the mall with your family at Christmas. And if you never need it, that’s OK.’
“Or maybe she’s been in and out of the hospital with congestive heart failure. She doesn’t want that anymore, so she waits until it’s a crisis and she needs a ventilator. I point out that on VITAS you just call if you don’t feel right, if you feel agitated. It’s no trouble to call us, and we’ll get you a respiratory therapist, or increase your medication.”
By the time the admissions paperwork is completed, she says, there is a knock on the door; the VITAS team is there. “It’s amazing how fast we are,” McDermott marvels, even after five years with VITAS. “It’s like an umbrella opens over their heads. And the family is amazed. In this age of HMOs, managed care, referrals and lots and lots of waiting, VITAS comes in and things happen.”
But as the behind-the-scenes admissions nurse, McDermott will be gone by then, helping another family wrestle with the issues of end-of-life care.
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