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Peaceful Dying

We the People

I don’t remember the first election I voted in.

Dave asked me that question one day, but I couldn’t come up with either the candidates or the year.

Being much more history- and civic-minded than me, he can cite all kinds of details about the issues of an era and what each candidate stood for at any given time.

But me?

Not so much.

After I stepped out of Mr. Lamatrice’s government class in my senior year of high school, I didn’t give the political process much thought for many years.

It’s only been later in life that I became interested in political affairs and understanding exactly what my vote for any given candidate or issue would mean if it had an impact when tallied with all the rest.

That’s why I now take the time to conduct research prior to filling out my ballot.

And why I drove to the Supervisor of Elections office last week to deposit my signed and sealed mail-in ballot directly into the secure drop-off box waiting for me there.

Doing so brought tears to my eyes as I watched people from all walks of life file into the building to cast their votes early, or do the very same thing I did and drop their envelopes into that slot.

Great equalizers

One of the things I know from working so many years with individuals at end of life is that death is the great equalizer.

That old saying that “You can’t take it with you” certainly applies—since everyone faces their final moment on this earth equally, and what ultimately matters then is whether we have a relationship with Jesus.

Of course, the status of our relationships matter too, in terms of experiencing peace during that final time.

But no matter what level of prosperity, social status, or education we may or may not have, we’ll all face that final moment on this earth.

I know it might seem a bit of a leap, but that’s what I was thinking about when I watched all those people embracing the privilege we have in this country to cast an equal vote.

That’s what our democracy is all about and one of the many reasons I love this country.

Because it doesn’t matter who you are or your station in life—in America, voting is also a great equalizer.

As a result of the many who have sacrificed so much to make it possible, it’s We the People who get to decide.

And for that, I am grateful.

This post is adapted from Sue’s Perspectives column in the latest edition of The Empowered Traveler™ Newsletter. If you’re not already a subscriber, you can do that here: Subscribe to Sue’s newsletter.

Feature photo by Jordan Rowland on Unsplash.

Angels and Butterflies

Five years ago, on May 30, I woke up with a single, foreign thought running through my mind: “This is the first day of my life learning to live without my mom.”

Mom had died the night before at 10:50 pm.

For the previous few weeks she had traveled her end-of-life journey in her apartment at one end of our home.

We were so blessed to experience this sacred time in this way—with Mom peaceful and comfortable in her own bed and me getting to care for her with the support of my wonderful husband and fabulous family and friends.

As her health gradually declined over time, it’s exactly what she and I had envisioned together.

Mom had remained in control of her healthcare decisions and out of the hospital for many years, and I’d promised that I would always help and support her wishes to do so.

In the last weeks of her life, we continued in the same manner as she made her way Home. She’d been enrolled in a community-based palliative care program for several months and transitioned into hospice in the last three weeks of her life.

At Mom’s side that night, as I watched her breathing begin to change, I told her it was okay to go.

After all, whether I was ready or not, Mom certainly was.

In fact, at one point within the previous two weeks, she’d looked at me with excitement in her eyes and said, “I think I’m getting closer!”

I smiled and assured her she was right, she was indeed approaching the new Life awaiting her—where she would join her Savior, my dad, her parents and sisters, and all the cherished family members and friends who had gone Home before.

When angels drop by

One night during this time, I had been in her room taking care of her and went out into the kitchen to get something.

When I returned, she looked at me and said, “Did you see those two men?”

“What two men?” I asked.

As lucid and matter-of-fact as if the neighbor had just dropped by, she said, “There were just two men here. While you gone.”

Having been a hospice nurse who’d worked with the dying for many years—and a firm believer that there is heightened spiritual activity at end of life—I knew this was real.

“What did they say?” I asked.

Mom kind of shrugged. “Something about it not being time yet.”

I nodded calmly as the hair stood up on my arms—then rushed from her room in excitement to go find Dave. “Honey, there are angels in the house!”

On my way back to Mom’s apartment I fell to my knees in gratitude that Jesus was reminding us that we weren’t alone during this difficult time and all was proceeding according to plan.

And loved ones stop in

Like many of my hospice patients, Mom also had visions of loved ones who had died before her.

I remember her sharing about seeing her mom and dad, though quite honestly, those last few weeks were such a blur that I don’t recall the specifics.

She may have said it was in a dream while asleep or during a time when she was more awake.

While some may believe such visits are hallucinations of some sort—as was suggested by a never-invited-back member of her healthcare team—I instead view them as comforting gifts commonly experienced by the dying.

A glimpse of Heaven

When Mom’s breathing began to change that night, I put my hand over hers and leaned in to whisper what I’d said all along, “I’m right here. I love you. Go when you’re ready. I’ll be okay.”

And in those last seconds of her life here, as I felt her preparing to step across the threshold for Home, I almost felt like I got a glimpse of Heaven by being there with her—as if I was looking over her shoulder, a child peeking with anticipation at what lies ahead.

Mom, one foot in Heaven and one foot on Earth, eager to move forward.

Me, excited for her and grieving for me—knowing I was about to lose her as she stepped into Jesus’ arms.

When she took her final breath, I fell to my knees by her bed—grateful to know she was already savoring the incredible love and perfection of her eternal Home.

When butterflies show up

After my dad died, Mom said she was always comforted when she saw yellow butterflies, because they reminded her of Dad and gave her a sense of his presence.

In the same way, although Mom isn’t physically present with me anymore, I take comfort in what her hospice chaplain told us as we were both struggling to imagine a world in which we’d be apart.

He said that once she died, she could be more present with me than was possible in the limitations of living on Earth.

I don’t know if that’s actually true, but it’s certainly a comforting thought.

Which is why I’m going to hope she doesn’t mind when I say, “Hi, Mom!” to the yellow butterflies that show up just when I need them most.

And when two butterflies are diving through the air and playing together, I greet both Mom and Dad, knowing they’re enjoying Heaven together.

I’m so grateful for the comfort of such powerful gifts.

For the angels and butterflies God sends to remind us that we are not alone.

That my loved ones are happy and secure with Him.

And that they’ll be waiting to greet me when it’s my time to come Home.

This post is adapted from Sue’s Perspectives column in the latest edition of The Empowered Traveler™ Newsletter. If you’re not already a subscriber, you can do that here: Subscribe to Sue’s newsletter.

Feature photo by Alex Kelleher on Unsplash.

Dying Talks: What’s Your Understanding of Your Diagnosis?

The following is adapted from the transcript of the second in my series of Dying Talks ™ videos—geared toward individuals who are facing end of life.

In today’s episode of Dying Talks, we’re going to talk about your understanding of your diagnosis.

When I was working in the field in hospice and visited a newly admitted patient, one of my first questions was, “Tell me what your doctor told you.”

I did this because I wanted to make sure the patient and I were both on the same page.

Too often, I found that the information we’d received on the patient’s records was either not what the patient was told, or it wasn’t what the patient heard.

The latter is common because there’s so much stress involved when someone is sitting in the doctor’s office and receives such difficult news.

Bad news is hard to hear.

Many times, after bad news is received, a person’s hearing turns off somewhat.

As a result, it’s not unusual for an individual who is starting the end-of-life journey, or who has been admitted to a hospice program, to be confused about exactly what’s going on.

So, I want to start with that.

If you have any questions about why you’ve been referred to a hospice or palliative care program—of if you just have questions that came up after you left the doctor’s office, then be sure to ask.

Because this season of your life is not the time to lack clarity.

You should have all the answers you need, and I encourage you to contact your provider and ask questions if you or your loved ones need something explained further.  

Own your power.

Many people are too intimidated by the healthcare system to find the answers they need.

Please don’t be.

Your provider cares about you, but may not realize that you don’t understand all the information you’ve been given.

This is your journey.

So I encourage you to own your power within this season to clarify things if there’s something you don’t understand.

Clarify the plan.

Ask what the plan is going to be if you’ve been referred to a hospice or palliative care program.

Perhaps you haven’t had the chance to ask your provider about your prognosis or life expectancy.

A simple question to ask in that context is “What do you think my life is going to look like in the next six months or so?”

Don’t be afraid to ask hard questions.

Of course, the answers may be difficult, so be sure to have the support you need when you do.

Plan ahead.

Write down your questions before you go to your visit, and try to take someone with you who can take notes and be a second pair of ears.

Don’t let anybody rush you.

Make sure when you leave the office that your questions have been answered to your satisfaction.

This is a sacred season for you.

And it’s a difficult one.

That’s why you need all the support and clarity you can get.

Please make sure you ask for it.

This is general information for educational purposes and should not be considered medical advice. You should always talk to your own healthcare provider about your individual needs.

Welcome to Dying Talks™

The following is a transcript of the first in my series of Dying Talks ™ videos—geared toward individuals who are facing end of life.

Welcome to Dying Talks™.

If you’re facing end of life, you may find that you don’t have anybody—or very few people—who are willing to talk with you about that.

Even though research shows that many people want to talk about death and dying.

I’ve been a nurse for a very long time, and I used to be certified as a hospice and palliative care nurse (Note: in the video I say that I’m still certified—and at the time I was. However, my certification has since expired).

I worked in hospice for 15 years, I worked in critical care before that, and I was with both my mom and my dad when they died.

I took care of my mom for many years and then through the last months and weeks and days and minutes of her life.

So, I have been with many people through this final season—and it’s such a sacred time.

The reason I want to have this series of Dying Talks™ is to provide those of you who are facing end of life with a place to receive some “in-person” encouragement.

Here, we’re going to cover some basic topics—which I’ll couch in the fact that every person’s situation is unique and that you should speak with your own health care team about your specific needs.

So, this is general information—not specific advice for you.

I just want you to know that you are not alone and that you don’t need to take this journey alone.

If you’ve been told that you have a terminal diagnosis—and if you’re not yet with a hospice organization or with a community-based palliative care program—I encourage you to seek those resources out.

Both offer fabulous support—physical, psychosocial, and spiritual—for you and for your family members.

You know, many people don’t want to talk about end-of-life because they’re not sure what’s next.

In that light, I have to share that I’m a Christian and I look forward to the day when I get to go Home to be with Jesus and with my loved ones who have gone before me.

If that’s something that you want to know more about, I would love to talk with you.

But I’m not going to beat you over the head with the Bible in these talks, I promise, because I respect everyone’s different belief systems.

I just want you to give you that invitation, so if you want to connect with me, please do.

These talks are going to be on specific topics for general information.

And they’re going to be short and sweet.

Because depending on where you are in your journey, you might not have much energy.

Which is my cue to wrap things up.

This is Dying Talks™ and I’m Sue Montgomery.

I’m so glad you’re here and am looking forward to this journey with you.

And remember, God loves you, and so do I.

Hospice care vs palliative care: 2 key differences you should know

With Thanksgiving behind us, we’ve been reminded of the many things for which we’re grateful.

For me, that includes hospice care and palliative care—since both have played such a significant role in my life.

Since November was also National Hospice and Palliative Care Awareness Month (aka National Hospice Month), National Home Care and Hospice Month, and National Family Caregiver Month, it’s a great time to talk about the differences between hospice care and palliative care.

This information is important for individuals in need of care and the family caregivers who are caring for them.

Dear to my heart

I’m both a former hospice professional and a former family caregiver, so raising awareness about the benefits of these offerings is a passion of mine—which is why I continue to write and share about these topics in a variety of ways.

When my mom’s health started a steep decline toward the end of her life, hospice wasn’t yet an option for a variety of reasons. Though I was able to provide most of her care, she still needed to see a doctor on a regular basis.

With her mobility a growing challenge, we faced limited options since she could no longer ride in the car. This is a common scenario for those living in the community with serious illness, where gaps in care options can be a big challenge.

Hospice vs palliative care: younger person holding older person's hands

Just as I was starting to wring my hands, a friend told me about a new community-based palliative care practice that had opened in our community.

I contacted them and the doctor came out within the next few days to admit Mom and care for her needs. This service continued until she was ready for hospice in the last three weeks of her life, at which time a smooth transition between the two services took place.

Hospice care and palliative care lingo

When we talk about hospice and palliative care, the two terms often exist within the same breath. But they’re not the same.

Palliative care is often referred to as “comfort care” and it’s an essential component of the care that patients receive within the auspices of a hospice program.

However, this service can also stand alone—separate from hospice—providing a critical bridge across the gap of care that exists for many with serious illness, like Mom.

Although palliative care programs have existed within hospital settings for some time, community-based programs like the one we accessed are fairly new to the scene. Fortunately, they’re becoming increasingly available for those who need them.

2 ways hospice care and palliative care are different

Here are two ways hospice care and palliative care are different:

  1. Timeframe: Hospice care is appropriate for those with a life expectancy of six months or less, but palliative care is appropriate for anyone with serious illness.
  2. Treatment focus: Hospice care focuses strictly on comfort care, but palliative care allows an individual to continue to pursue curative care while receiving comfort care.

In both:

  • A primary focus is the relief of pain and other symptoms to optimize quality of life.
  • Care is provided through an interdisciplinary approach to address physical, spiritual, and psychosocial needs.
  • Care is provided by practitioners skilled in a holistic approach to care that focuses on identifying patient and family goals to make sure the type of care provided is that which the patient wants.

Hospice care is paid for through the Hospice Medicare/Medicaid Benefit or traditional insurance, but palliative care is typically covered through traditional Medicare/Medicaid or insurance.

The National Hospice and Palliative Care Organization (NHPCO) provides a concise comparison of hospice and palliative care in their handout, “Pallative Care or Hospice? The right service at the right time for seriously ill individuals.”

Is palliative care right for you or your loved one?

If serious illness is involved, the answer is often a resounding “yes.” This is especially true if pain and symptom management is an issue—since palliative care professionals are experts in this area.

They’re also experts in helping patients and families look at the “big picture” and plan accordingly, instead of getting caught in the siloes of care that often occur when numerous specialties are involved. When this happens, patients are too-often placed on a treatment treadmill that doesn’t align with their goals.

Through its consumer site: GetPalliativeCare.org, the Center to Advance Palliative Care (CAPC) offers a five-question assessment to help you determine if palliative care is right for your situation. You can access the assessment here:

Is Palliative Care Right for You?

Finding a palliative care program in your area

Many hospitals—especially in urban areas—have a palliative care team. So if a hospitalization is involved and you would like to be connected with these experts, ask for a consult.

CAPC recently published a summary of America’s Care of Serious Illness: 2019 State-by-State Report Card on Access to Palliative Care in Our Nation’s Hospitals, which you can access in its post, “Did Your State Make the Grade?“

However, finding a community-based palliative care provider may prove a little more difficult, since this model of care is still fairly new. I’ve had several friends who I tried to help access services in their areas, only to find they were not yet available.

Although Mom received her care from an independent program, community-based palliative care is often provided through a hospice program, so contacting the hospice(s) in your area to see whether this option is available can be a great place to start. In addition, CAPC offers a searchable directory of palliative care providers.

It’s often best to talk to your healthcare provider first to discuss your condition, concerns, and available options—which may include palliative care. Your healthcare provider can then help you find a palliative care program in your area if one is available, and make the referral you’ll likely need.

For more information, here are a few additional articles I’ve written on this topic, as well as links to organizations that can help:

Organizations that can help:

End of life can be peaceful in the hospital, too

When hospice is involved, peaceful dying often happens in the comfort of a patient’s home.

But with the right approach, death can be very peaceful in the hospital, too.

That was the reality for my dad, and I’m so grateful to the caring staff that took care of him and supported our family.

In this feature that I wrote for Working Nurse magazine, I talk about how difficult it can be for acute care nurses to make a shift in mindset toward “comfort measures only”—and some reminders about the special needs of the dying.

You don’t have to be a nurse to benefit from the suggestions offered here, take a look:

“When Med-Surg Nurses Care for Dying Patients”

 

For more resources about Peaceful Dying and other topics, please visit our page, Resources for the Journey.

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Can healthcare technology enhance quality of life for Baby Boomers?

When I wrote this article, “Digital Health: It’s About Quality of Life, Too,” I was in my former role as the senior content editor for a global digital health organization, and here’s the intro to provide a little context:

How can compassionate care be provided with a laptop in hand? Sue Montgomery believes it’s the only way to do it—if we want to give patients and families the care they deserve.

In the article, I talk a lot about using technology in end-of-life care, since I was one of the first hospice nurses to tote my laptop into the home and used it while visiting my patients.

I can assure you that when we started doing that many years ago, there was a lot of resistance to using technology that way, since many of my peers—and often the patients and families—viewed it as a barrier to care.

However, there have been many advances in the years since technology invaded the healthcare scene, and we Baby Boomers have a great deal to do with its rapid adoption.

As part of an increasingly tech-savvy generation of massive proportions (no pun intended—though Boomers do contribute to the obesity epidemic) with growing healthcare needs, we Boomers can help set the standard for making the most of technology to enhance our own quality of life.

Skeptical?

Here are a few articles for you to dig into that will help to prove my point:

Now that they are reaching retirement age at the rate of three million per year, baby boomers are poised to change the face of healthcare with technological advances that meet their demand for smart, savvy and easy solutions to cope with the issues of aging.

Applying technology to medical care will blur the lines between being a patient and being a consumer, and could yield benefits that improve baby boomers’ health…

…the boomers themselves have shown an inclination to adopt new technology, and may be asked to do so for in-home care. 

For more resources, please visit our page, Resources for the Journey.

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