Hospice: Angels at Work

My Dad just died. It's okay; he was 96 and lived a good and productive life, rising far beyond, I suspect, what he ever thought he could do. He died naturally without the burden of cancer. Of course, I knew his transition would be easier with the help of hospice. So we called them in when the time was right. Watching them work with Dad's comfort in mind made me reflect on the importance of end-of-life care.

Many of you cannot remember a world without hospice. I can. Patients died, often alone, in hospitals or nursing homes. Their comfort needs were known and considered but placed in balance with the competing demands faced by busy nurses. And there were no entities such as comfort care units or palliative care teams with expertise in managing pain and other symptoms. It was not a good way to exit life, and we knew patients would be happier spending their last days in a familiar place, with people they love.

I still remember our earliest attempts to provide home care before hospice was a real deal. With the help of nurses in our practice, we ordered the needed supplies, including the hospital bed and commode. We instructed family caregivers how to give morphine, lorazepam, and atropine. We taught them how to prevent decubiti and helped them navigate the bodily changes that precede death. It was rewarding but a heck of a lot of work.

Now, with the stroke of a pen—oops, with the click of my mouse—I can order an expert team who will do all of this. And as our emphasis on and skill in supportive care has improved, they do it a lot better!

It takes a special person to work in hospice care. They need to come equipped with extra kindness and patience, not only for the patient but also for the family. Over the years, I can honestly say I have never met a hospice worker I didn't like.

Back to my Dad: I hope you will indulge my sharing a bit about him. He grew up in the depression in a broken home. Eventually some financial stability was restored, but throughout his childhood Dad always had a job to make ends meet. He often said he never would have amounted to anything if not for a special high school teacher who recognized his potential. A trombonist during the “big band” era, he worked gigs every weekend to put himself through college. He was pretty good and played well into his later years.

World War II was a significant period in Dad's life. He worked as a meteorologist in the Air Force and was responsible for getting pilots safely over the Burma Hump. After the war, he met my mom, now aged 91 years. The Air Force helped him get his PhD in nuclear physics at Ohio State University. He went on to design missiles and moved up the ranks to full Colonel. He then became one of Howard Hughes' (yes, THE Howard Hughes!) Vice Presidents at Hughes Aircraft Company. One of his greatest achievements there was convincing the government to buy the lunar landing module that successfully made it to the moon in 1969.

Even though he was a pretty busy guy and traveled a lot, Dad always found time for me and believed I could do anything. He gave me much needed strength and confidence. As he died, we said goodbye to another hero of the “Greatest Generation,” described so well by Tom Brokaw. Thank you, Dad, for all you did. And thank you to his hospice team for helping make this transition easier for all of us.

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Margaret Tempero, MD, is a Professor of Medicine and Director of the UCSF Pancreas Center and editor-in-chief of JNCCN. Her research career has focused on pancreatic ductal adenocarcinoma, especially in the area of investigational therapeutics. Dr. Tempero has served on the ASCO Board of Directors and as ASCO President. She currently serves on the ASCO Conquer Cancer Foundation Board. She codirected the AACR/ASCO Methods in Clinical Cancer Research and taught this course and similar courses in Europe and Australia. She was founding Chair of the NCI Clinical Oncology Study Section and served as a member and Chair of the NCI Board of Scientific Counselors Subcommittee A. She is a member of the Scientific Steering Committee and Chair of the Clinical and Translational Study Section for the Cancer Prevention & Research Institute of Texas. She is or has been on the Scientific Advisory Boards of the Lustgarten Foundation, the Pancreatic Cancer Action Network, the V Foundation, The Alberta Canada Cancer Board, and the EORTC. She served as a member of the Oncology Drug Advisory Committee for the FDA. She has served as Deputy Director and Interim Director for the UNMC Eppley Cancer Center. She is Chief Emeritus of the Division of Medical Oncology at UCSF and served as the founding Deputy Director and Director of Research Programs at the UCSF Helen Diller Family Comprehensive Cancer Center.

The ideas and viewpoints expressed in this editorial are those of the author and do not necessarily represent any policy, position, or program of NCCN.

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