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Doing the Neighborly Thing

Gila Regional Medical Center's hospice program marks 15 years of supporting people who want die at home with dignity, and helping their families. For volunteers and staff, it's what good neighbors do at the end of life.

By Prashant Ziskind

Dying at home isn t a new thing. When I was five years old, I stayed all night with my grandma and my grandma died, recounts Wanda Hall, one of the pioneers in the Gila Regional Medical Center s Hospice Program and current Bereavement Coordinator with the agency. My aunt came home from work and found me wrapped around my grandma. Wanda, she said, You need to get up, your grandma has died. I said, Well what did she do that for? They called the coroner, the coroner took her out and the next thing I remembered, she was back in her home in her casket. This was in '52.

Diana Gaska-Mares with a portrait of her late father.

"We've gotten away from doing the 'neighborly thing,'" Hall continues. "I was raised doing the neighborly thing. In our part of rural America, when anyone was sick in the neighborhood, my mother and I would go and take meals and sit with the family. I wasn't raised to fear death. I've never feared death because I've been around it."

November is National Hospice Month, and 2006 is the 15th anniversary of the hospice program in and around Silver City, helping and supporting patients who wish to die at home and their families. "Our first patient came on Jan. 2, 1991. I didn't join in until September of that year," says Hall. She credits two Registered Nurses, Michael Holmes and Barbara Elder-Owens (then the Home Health Director), and Barbara Guber, Certified Nursing Officer, with being instrumental in getting the program going.

Hall, whose background is in mental health, moved into hospice after a stint working at the mental-health unit at GRMC and then at the mines in the area. "That really helped prepare me for hospice," she says. "We had some serious accidents out at the mines. I would work with the families. One year lightning struck the football team down in Cobre. There were five seriously injured. They all survived but you can imagine the families being really upset."

In the early days the program was plagued by all kinds of misconceptions about what hospice was. "Our main goal back then was to assure the public that hospice was doing the 'right' thing and not doing anything illegal," says Hall. "So Michael and I met with the police, the fire department, all the doctors. We did a lot of community in-services. It was a difficult stepping stone because people weren't ready for that here in 1992-93.

"The first couple of years when we would go out to do admissions, it was pretty rough. I remember one lady said, 'Now just how long is this going to take?' She thought we were going to take her life. It took time for the community to understand that we were doing a good thing and not harming people."

Valerie Duntz, who has been the hospice's Director since December of last year, says that although 15 years of work in the community and word-of-mouth have gone a long way to dispelling old myths about the program, some misconceptions remain. "Some people feel that if they go into hospice, it's a time of giving-up, giving-in and dying," she says, "where, in fact, hospice is all about living life to the fullest in the time you have left."

"There are a lot of choices to be made at the end of a life," adds Kimberlee Chase, a five-year veteran of a hospice in California and the new Community and Nurse Educator with the GRMC program. "Because we get a terminal illness does not mean that living stops. The person is alive until they've taken their last breath and their heart stops.

"We don't tell people what to do. We look at what their goals are at the end of their life and work very hard to help them reach those goals. Our vision is to facilitate, to the very best of our ability, for a person to die peacefully, with grace and dignity—whatever that means to them."

To accomplish this, hospice provides an interdisciplinary team to help the patient and family in their home. The team is composed of a medical director, nurses, a certified nursing assistant, social worker, chaplain, bereavement counselor, home health aide, volunteer coordinator and volunteers. The focus is on palliative, not curative care and specializes in pain control and comfort measures on all levels: physical, emotional and spiritual.

Dr. Gilbert Arizaga, the Medical Director for GRMC's hospice, sees treating physical pain as the doorway for treating all types of pain. "If hospice assists the family in dealing with physical pain, that gives the patient and family space to process the healing of social, psychological and spiritual pain. For that you need a companion. That's perhaps the greatest value of hospice right there."

Dr. Arizaga acknowledges the hospice volunteer as one such companion. "You have a volunteer because they're called, emotionally, spiritually. They are instruments and they bring in divine love through them to their patients. That's a critical part to the process. We can give opiates, morphine and that's fine, but without this other element, the pain medicines aren't going to work as well."

"People are scared of loss, not death," contends Jess Loflin, a 24-year-old home health aide. "Most people run from sadness, anger. The first step in dealing with fear is not running. The second is to allow yourself your own humanity, your feelings and emotion and to know that by doing this, you will be growing into something better."

Gale Green, a recent addition to the team as Chaplain, although with 13 years of hospice experience behind her as well as a master's degree in counseling, deals with those spiritual questions. "Most people who are in the end stage of their life are aware of what is happening and often eager to talk about it," Green says. "For many, their fear is for their family or loved ones: 'How are they going to cope without me? What is it going to be like for them after I'm gone?'"

A lot of questions come up around unresolved family issues and forgiveness. "There are patients who are very disturbed if there is a person they have not resolved some disagreement with," Green explains. "Others might need to affirm that their life had value, exploring the questions of 'What was I here for? What did I do that made any difference?'

"I've dealt with many people, of every imaginable belief and no possible belief," she goes on. "If they would like, I sit and talk with them about the events and people in their life that have been meaningful to them, what their values are, how they have lived their life either in accordance with their values or in conflict with some of the values they've been presented with. I am there for the individual in whatever their spiritual location happens to be."

"I absolutely had fears about the dying process," Diana Gaska-Mares says over tea in her dining room. Her father, Matthew Gaska, 84 years old with Alzheimer's and metastatic prostate cancer, recently passed away. She and her seven adopted children, ages 7-18, took care of her father with hospice's help. "It helped just having someone to call if I had questions or things went a little weird, because I've never gone through the dying process with anybody before."

She took a giant box of Knex toys and the Playstation and put them in her father's room. "So the kids were used to sitting next to Grandpa, playing with their favorite toys. It was an extension of normalcy. It wasn't treated as anything weird.

"If you think about how you would want to die and what kind of care you would want to have, hospice would probably be one of your first phone calls," adds Gaska-Mares. "This is the last thing you can do for someone that you love. I feel honored to have been able to have been part of that process."

Gaska-Mares' feelings are shared by many of the team members. R.N. Shauna McCosh came to hospice after being a midwife for 10 years. She sees no conflict in that unusual pairing of experiences: "They're both part of the miracle/mystery transition in life. We're all going to die and we don't get to prevent that. We'll put it off for a while, sometimes, with medications and interventions, but ultimately, we're all going to die. When you get to see somebody die peacefully, it just feels right. It's their time to go. So to be able to help with that transition, to watch somebody slip out of this realm into whatever is next, is really an honor."

Volunteer Alan J. Mong says he was in church when God urged him to volunteer for hospice. Mong says he replied, "'Me? Me who has trouble with death and dying, who can't go to funerals?' And God said, 'I want you to be in service.' So I answered the call. Once I got on this path, I've just gone deeper and deeper. I've learned so much about myself."

"It's something selfless that you're doing," offers Brandi Evatt, an RN who came to hospice last year. "As a nurse you become a part of their family. They trust you and they look to you for answers. Some of them will also touch me and they're part of me. It's one of the most rewarding things I've ever done."

Hospice is a passion for Kris Walters, a hospice nurse off and on for five years. Walters says, "If you can lead a patient and their family through a dark forest with your own eyes closed and heart open and make it to the other side, how amazing is that?"

Jealyn Cleveland, a hospice volunteer for five years, says, "I once had a patient who was very engaging. We could talk forever. She told me, 'You're more interested in my stories than my family is.' That made me feel good because I could see that's what she wanted to do. She wanted to tell me her stories."

McCosh says, "My inspiration comes from being with these wonderful people who have incredible stories that they can share about their lives. And just watching the love that they have with their kids and grandkids and spouses they've been with for many years, hearing what life was like during WWII. . . . Some of the poorest people at the end of their lives still give and it's so powerful. What I do from day to day is become part of the family. Again, it's just such an honor to be a part of it. The deaths can be powerful also but it's the life that's leading up to the death, the saying goodbye, the realizing what's really valuable about life. . . about love and relationships and the people in your life. That's what really matters. People really get that at the end."

The GRMC Hospice has been "getting it" for 15 years now, touching with gentleness and compassion a process that so many of us fear. It is about connection, about walking a path with others that someday we will walk ourselves. Hospice gets that we need to listen to each other's stories, that in a culture that seems to be hurtling along at breakneck speed, we are enriched by slowing down long enough to listen and be a witness, to share, if only for a short while, the successes and failures, the hopes and dreams of a human life coming to a close.

For more information about the GRMC Hospice program, which serves Grant, Luna, Hidalgo and Catron counties, or about volunteer opportunities, call 574-4934.

Prashant Ziskind recently became the
Volunteer Coordinator for GRMC Hospice.


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