At hospice, relief comes in all kinds of ways

Donna DiMartino, when she was a young, Hartford Hospital-trained nurse, worked for the Stop Polio Project in Ethiopia years ago. She taught people to recognize the disease and to avoid it. She immunized many of them, going door-to-door in isolated rural settlements.One day, behind one of those doors, she encountered a woman in labor. DiMartino stepped in to help, and as soon as the baby was born, she immunized it against polio. Then she immunized the mother, too.It all gets done.That’s the way she handles her job as hospice director of Salisbury Visiting Nurse Association. Whatever it takes, she does the job. And at hospice, that job requires patience, intuition and imagination: She helps people find a peaceful death.“Hospice is not a place,” she said. “It’s a concept, a philosophy.” It can be accomplished at home, in a hospital or a nursing facility. The idea is the same everywhere: Control pain, reduce stress, help people to see what lies ahead, to discover what matters most to them and then spell out the choices they can make about their treatment and their demise.“These are not things to fear. These are things to be talked about,” she said. “Each of us should have a say. We have the right to that.”So one of DiMartino’s jobs is listening, trying to help a sick person feel calm and in control. Do they want to stay at home? Do they want resuscitation? Do they need a lot of people around them or just a few? Do they want treatment to slow disease? Or do they not? And what kind of pain relief do they want: Often there’s a trade-off between relief and contact with the people they love. “Tell me about the room you want to die in. What does it look like? What does it smell like? “This is not a 20-minute conversation,” DiMartino said. “It’s a thoughtful, lengthy process. I’ve learned to listen to people, not just to what they say but sometimes to what they do not say. It takes time for people to articulate their wishes.“People want and need different things. Our job is to find out what those things are and then keep the wheels turning.”Many people work with DiMartino to that end. Among them, the Rev. Diane Monti-Catania.“Well, I call it heart work,” said Monti-Catania, the hospice chaplain. She is a forthright woman, quick and, like DiMartino, devoted to this work. “I have always been in service to people. Since childhood, I always believed I could make the world a better place.”So for years she worked in agencies caring for the homeless, the battered or the victims of HIV.Then, in her 40s she had surgery for a brain tumor and while recuperating she considered a change. She entered Yale Divinity School with the idea of teaching religion. “In the process I was slowly called to the ministry.” She was ordained in 2006 and she has served as minister of Salisbury’s Congregational Church for two years, now.When invited, she works with hospice patients, “entering this intensely private time in their lives. “At the end of life, people may ask where is God in all this. Some are afraid. Some have matters they wish to resolve. Some pose questions. The family members too. Sometimes they will say, ‘I don’t know why this is happening.’ I agree. This is awful, sad, a terrible thing. But I can help people forgive others, forgive themselves, forgive God.“It’s just the most remarkable, supportive program, but it pains me that people don’t contact hospice sooner,” a point DiMartino makes too. The program is open to people who appear to have six months to live or less. She said, “Hospice is not supposed to be for the last two days. There’s work to be done. It’s a process to help in the journey, to make the passage easier. And that takes time.“We have made death the enemy. But it’s just the next step.”DiMartino’s aim is to make that next step meaningful, peaceful.“A hundred years ago, people got sick and died at home. Now death is a foreign thing,” DiMartino said.Another one of the people like DiMartino and Monti-Catania who keep the wheels turning is Dr. Mark Marshall. He is the hospitalist at Sharon Hospital, the medical director of Salisbury Visiting Nurse Association and he is board certified in hospice and palliative medicine. He too regrets that many patients “wait until the end of life to seek hospice care.” There’s a lot to learn about illness and treatment.“All patients should be aware of these issues. I’ve always viewed death as a part of life. It’s important to discuss pain, relief of pain, the side effects of pain medication. It’s all very individual.“It’s better for family and patient to know what to expect, what decisions they can make. This is better to do in advance than in crisis.”Physicians, he said, have always had two jobs: curing illness and relieving suffering.“Some illness can be cured. Some cannot. We treat in the latter case just as aggressively to relieve symptoms, case by case.”That can mean radiation therapy, not to destroy a tumor but to subdue pain by shrinking it. It can mean morphine to reduce shortness of breath. “Unfortunately, I do not see well people. By the time they get to me in hospice they are ill, sometimes desperately ill. They need relief.”And relief comes in all kinds of ways. This is a team approach, DiMartino said, a team that includes doctors and nurses, social workers and physical, occupational and speech therapists, hospice home aides, a pharmacist, spiritual support and volunteers.And there is relief for the families, too.“We stay in touch with survivors for a year,” DiMartino said. “People die, but they don’t disappear. It’s about the living, even if it is the living memory.”SVNA’s Hospice Care serves North Canaan, Cornwall, Falls Village, Goshen, Kent, Norfolk, Salisbury and Sharon. It is covered by Medicare, Medicaid, private insurance plans and community donors. For information about the program, call 860-435-0816.

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