Issue link: https://tmcpulse.uberflip.com/i/845136
t m c » p u l s e | j u ly 2 0 1 7 21 "Yep. It relaxes me. And I was taking the neb- ulizer and the lorazepam. I found that sometimes adding the morphine helped." "Perfect," Karen said. "And you can do that anytime during the day, too. It's a good cocktail for the evening; it opens up your airway." Alan tilted his head back and laughed. "Wheeee!" There was a note of innocence in his voice, unexpected for someone who used to drink a 12-pack of Milwaukee's Best Light every day, who had lost a grown son to leukemia. — IV — Despite a full night's rest—the first in weeks— Alan appeared exhausted when Terrie arrived at Brad's house on April 5. She'd set up a brief meeting at Brad's to go over legal documents, but had been cornered by Matthew at the dining room table. He rattled off his encyclopedic knowledge of snakes and sharks. The Megalodon was his favorite shark, if extinct ones counted. Terrie's big news was that one of her colleagues had found a future home for Pal with a woman named Ann, a retired VA hospice nurse who summered on 20 acres in Washington State. Alan was pleased. Brad told Matthew it was time to practice the piano and Carol ushered him into the front room. Terrie flipped through her paperwork, explaining in detail medical power of attorney and durable power of attorney. "The other thing," Terrie said, looking at Alan, "is that I really want you to have a medical alert system, so that if something happens and you can't get to the phone, you have something around your neck or on your arm that will notify somebody that you're in trouble." "I don't know," Alan said quietly. "I'm not too keen on it, but I guess it's probably a good idea." "Why aren't you keen on it?" Brad asked. "I don't know." Alan looked down at his hands. "Is it a cost issue?" Brad asked. "You living alone I think it's a great thing to have." "Yeah, probably should have it." Alan did not look up. Terrie interjected. "But what are your concerns?" "He's cheap. The money," Brad answered. "And it's probably acknowledgment, too." Terrie nodded. "This is all scary stuff. It's a recognition that you are reaching a point where we at Houston Hospice have to keep a closer eye on you. You just keep getting more tired, and that's all part of it." "We're there to support you and you won't be alone, you know that," Brad said. "And I think the backup plan is if he needs to come here…" Alan interrupted Terrie. "I'm not too keen on coming here." The conversation turned contentious. Brad's voice rose above the pings of the piano. "You can't just push people away. We have to think about it practically." "So what's the alternative?" Alan asked. He was barely whispering. Terrie explained that, for the most part, the hospice team was able to manage symptoms in the home, but that caregivers were a critical part of the process. Sometimes, care could be arranged in an assisted living community. If inpatient care was required for severe symptoms, Houston Hospice had beds available. Matthew skipped into the room. It was time for him to leave for swim lessons. "Does anyone want a jellybean?" "Say goodbye," Brad told him, ruffling his hair. "Say it was nice meeting you." Terrie waved to Matthew as Carol shut the door behind them. "At our next visit, we'll have a really hard conversation about what end of life looks like and what your caregiving will have to be," Terrie told Alan. "Because you will reach a point where you cannot communicate. You will reach a point where you can't take care of yourself, and we do have to make plans for that, OK?" (continued) The tiny girl in the jumper, his sister Gale, may have been the only person he didn't keep at arm's length. Apartment 1513 was not a home, not really. There were no dents in the walls from rambunc- tious sons, no stains on the carpet from Super Bowls past, no memories of when his marriage was tender. But it suited Alan just fine. During the day, he would draw open the shades and sit in the sunlight to watch television, mostly shows about wilderness survival and living off the grid. Apartment 1513 was a place for him to crash, to drink beer or the occasional nip of Jim Beam, to spend time alone with Pal. But Alan's terminal diagnosis soon made it clear that he would have to open his doors to fam- ily members, and to hospice. Terrie was assigned to Alan in January, and hospice nurse Karen Hoover soon after. It was important, Alan told them both, that he and Pal be together until the very end. — III — Hospice care requires that a patient have approximately six months left to live, although there is no exact science to the timing of death. For nearly 1.65 million Americans each year, death through hospice has become a preferred antidote to the beeping machines and invasive therapeutics of modern medicine. Recent statistics show that nearly 45 percent of all deaths in the United States occur under the care of a hospice program. In 2016, Houston Hospice alone served 2,169 patients. Once patients enter hospice, they relinquish treatment and concentrate, instead, on pain management, symptom control, and spiritual and emotional comfort. When Alan still had an appetite, he stocked up on shepherd's pie and butterscotch pudding. But by March, his hunger had already begun to wane. He could feel his energy drifting as he tried to keep up with regular outings, including walk- ing Pal, a Tuesday bridge game and short trips to the supermarket. He often found himself over- whelmed by loneliness, and when members of his hospice care team paid him a visit, he would delay their schedules with stories of his past—growing up on San Diego Bay, working at his father's dime store, a trip to the Philippines decades after he'd been stationed there with the Navy. Alan loved to sit at his computer and click through photos of his travels with Pal in an old pop-up camper. It had been just the two of them, snaking their way across the country's northern border, staring up at the flecked black skies of national parks. "How often are you using the morphine?" Karen asked, during a March 20 visit. The hos- pice nurse put a stethoscope to Alan's chest and listened to his lungs. "Probably about once a day, at night," Alan answered, his voice gruff and gravelly. "So that's helping with your breathing?" " At our next visit, we'll have a really hard conversation about what end of life looks like and what your caregiving will have to be. Because you will reach a point where you cannot communicate. You will reach a point where you can't take care of yourself, and we do have to make plans for that, OK? " — TERRIE ADCOCK Houston Hospice social worker Karen Hoover, Alan's hospice nurse, checks his vitals.