“People die completely different here.” That was the epiphany Ginny Heinitz experienced working in a hospital after years as a Hospice volunteer providing home care for patients before they died.
Heinitz, https://www.facebook.com/ginny.heinitz?fref=ts, began her career as a nurse in oncology in 1982 and became a Hospice volunteer in 1987. She later became an Eastmont school nurse before starting work at Confluence Hospital in 2010 to counsel people in the final stages of their lives. Asked if she was anxious about working in the hospital setting, she said, “I absolutely went with trepidation.”
She saw people brought into emergency and then to Intensive Care Units for aggressive treatment even though “The staff and I staff knew was not going to be helpful. People don’t realize it causes stress for the physicians and nurses” when people die with plastic tubes in sterile cubicles.
Heinitz said by 2000 growing concern about the problem led to development of palliative care to provide cancer patients with counseling and education aimed at the psychological, social and emotional well-being of the patients. Studies showed the combination of palliative care plus the best cancer care provided a better quality of life than just the best cancer care. Patients had fewer problems dealing with symptoms, less depression and less chemo-therapy. They also were more likely to die at home and lived several months longer.
At the hospital she and an MD trained staff about palliative care and requested referrals. After successful pilot tests at her hospital and Columbia Valley Community Medical Center, they adopted a training program called Having It Your Own Way: Getting the Right Care When it Matters Most. (See other programs in Conversations Before Knocking on Heaven’s Door on this blog and in the Clear Skies column on June 19 in the Douglas County Empire Press).
Palliative caregivers listen to patients and families share their wishes before or during treatments. The team describes options and prepares families to advocate for treatments and lifesaving efforts they prefer. Her initial consults take about an hour, which is more time than doctors usually spend with patients.
They hoped for 200 referrals in the first year, but staff referred 400 and two years later, 1200. Their department grew larger than any other department in Washington, a testament to the quality of local healthcare.
Heinitz realized patients need to understand palliative care before they come to the hospital. In 2013 she became the outpatient palliative care coordinator at Confluence Health, where she promotes palliative care in the community and works with out-patient referrals, some of whom eventually come off of palliative care.
Before our interview, a patient called her who’d been in agony after surgical treatment. She’d treated him to overcome his poor symptom management for pain. He had called to say, “You’ve helped me continue on and I don’t have as much pain as I had before.”
She said, “Eventually, I may have to say, ‘What if down the way, no further aggressive treatment is offered, would you like some information now?’”
Barbara Robinson, East Wenatchee, experienced palliative care from an oncologist at Confluence before her husband, Forest, died last December. She said the final stage started when “we found out the CAT scan showed his cancer had blown up in his body. He had three to six months and it was not going to pretty.”
They told their oncologist they had already talked about they wanted, and what they chose not to go through, and that he wanted to enroll in Washington’s Death with Dignity Act option. “Oh my God, it was very easy,” Robinson said.
The oncologist gave them a ‘do-not-resuscitate’ folder to post on the refrigerator. Hospice was notified immediately. A physical therapist “was on it right away, replacing his wheel chair and getting the right pads.” Forest died exactly as he wanted, peacefully at home with family present.
Heinitz and local medical staff provide palliative care. Prepare for it and plan on it.