Hospice Volunteer Training - Day One

Yesterday was my first day of training to be a hospice volunteer. It was really interesting, and I think it's going to be a very rewarding volunteer experience. Some people have asked me why I'm putting energy toward this. It sounds very cheesy, but it feels like a calling. My father died painfully of multiple myeloma, and his doctors at the Mayo Clinic referred him to hospice when he exhausted his treatment options. Unfortunately, his wife had strong cultural prejudices against hospice, and refused his admittance. I believe that hospice would have made a difference in his death. I admire the whole-family approach to hospice: the people who receive care are the hospice patient and his/her family. I also admire the hospice philosophy, which addresses the physical, emotional, social, and spiritual needs of the patient.

Unfortunately, I have a lot of recent experience with grief and dying, and I think I can put that to use being of service to hospice patients and their families. It was meaningful for me to help my father die; it felt like critically important work. My experience grieving my pregnancy losses and informally counseling other couples dealing with the same issue is another thing contributing to my desire to do hospice work.

One of the coolest things about hospice volunteer work is that it is taken very seriously by the hospice agencies: any hospice that receives Medicare funding (most of them) must fulfill five percent of patient care hours through volunteers. Therefore, Medicare requires this 20 hours of volunteer training that I am going through. I also had to provide three references and consent to a background check. Since the nurses only start visiting patients very frequently as they near death, the volunteers provide eyes and ears on the patients in between clinical visits. When I complete my training, I will be matched with a home hospice patient whom I will spend at least two hours a week with. You are there for them, so they guide the activities. Many want to be read to. Some want to sing with you, or listen to music. The volunteer coordinator was happy that I knit, because some patients want to either knit with volunteers, or watch them knit if they can no longer craft themselves. The volunteer coordinator's dad was also a hospice patient, and all he wanted to do with his volunteer was argue about politics! They match you up. 

The first day of training covered the history and philosophy of hospice. It was pretty inspiring to learn about Cecily Saunders, who founded the first hospice in London in 1967. Saunders was a nurse who was bothered that dying patients weren't getting the specialized care they needed. She recognized she wouldn't get the respect she needed to make significant changes to the system without a medical degree, so at age 33, she went to medical school.

The volunteer training covered a lot of topics, including the need to be non-judgmental, because patients and families react to dying differently, and because people run their households differently. An interesting point they brought up was patient use of marijuana. They said we can't touch it, but basically, they look the other way. Really, how cold would you have to be to call the cops because a terminally ill patient was smoking weed? If you would, you're probably not a good candidate for hospice volunteer work!

Because I have an interest in medicine, the most interesting part of the training for me yesterday was when a hospice nurse came to talk to the volunteers for an hour. She got into a lot of the clinical issues she handles and how the volunteers play into the care team. The nurse shared stories from her 20 years working in hospice, and talked about the satisfaction she gets from her job. She said that one issue she sees a lot -- especially with Jewish hospice clients -- is food issues coming up when someone is dying. It is natural for dying patients to eat and drink very little, which alarms families. Apparently, it really alarms Jewish families, which have internalized the message that "food is love." The nurse described how this comes up and how they handle it, and she told volunteers how to address it if the family is distressed that the patient isn't eating. Forcing food and liquids actually makes the patient's death more painful, as the body can't process the waste products efficiently.

The primary goal of physical care for the hospice team is making the patient's death journey as painless as possible, so the nurse discussed pain management and people being freaked out by hospice's use of morphine. As someone who believes pain is under-treated in this country, I was totally on board with this.

Unfortunately, the second and third days of volunteer training were delayed due to Hurricane Sandy, so I will have to fill you in on those mid-November. I'm eager to have it done so I can be assigned to a patient. I really look forward to being of service in this capacity.