One of the reasons people choose hospice services is because they no longer want to go back and forth to the doctors office or to the hospital.  Hospice doesn’t prevent anyone from going to the hospital if they want to, of course, but we can assist patients with nearly anything at home so we teach them to call us instead of 911.  Each family has a set of bright pink stickers on which our number , 555-6840, is printed. The patients place the stickers on their phones to remind anyone who wants to call 911,  to call hospice first.

I was visiting with a nursing home patient one evening when my pager went off.  It was a distress call from the family of a patient named Bill, whom  I had met once before.  When I got Bill’s wife Denise on the phone, I could barely understand her through her sobs and her words all tumbled out at once.

“I’m sorry….I called 911.  I didn’t know what to do.  Bill fell. I think he’s gone.  The paramedics are here. I don’t know what to do.”

I reassured her that all was well and I could hear someone in the background saying ‘do you want me to do CPR?’ then louder, ‘ DO YOU WANT ME TO DO CPR?!’

“I don’t know what to do!” Denise said again.  ” Bill has a MOLST form.  He didn’t want that.  I don’t know what to do!”

“Denise.”  I began softly.  “It’s okay.  You can honor Bill’s wishes or override them as his health care proxy. Think a second and don’t let anyone push you.  You know what to do.  You and Bill talked about it.”  It was clear to me that the person shouting in the background was so worked up  that he was not thinking clearly.  I knew the bright pink MOLST form that stated DO NOT RESUSCITATE was on the front of the refrigerator in the home.  I was also surprised that a paramedic would sound that frazzled.  I later found out that the person performing CPR was a neighbor, not anyone from emergency services.

I told Denise that I would come out and see them in just a few minutes.  Fortunately, though our agency covers a three county territory, Bill and Denise were only a few miles away and in the evening, the traffic would be light.

The local police were still on the scene when I arrived.  Sargeant Cook introduced himself and asked if there was anything we needed that they could help with.  I have grown to love when police happen to be on hand during a visit.  It most often happens, like this one, when a patient has died.  We are privileged to have some professional and efficient officers in our territory and they are always helpful and compassionate with the families.  How much I appreciate police could be the subject of a separate post.

I found Denise, who had neighbors with her and was calm and focused.  She had already called the funeral home because the director was a friend of the family.  Usually, the hospice nurse does this and it happens after  officially pronouncing the patient dead.  However, another thing about hospice nursing is that you just have to go with whatever the family needs.

Sargeant Cook led me to the room where Bill lay in his bed.”We moved him to his bed,”  he said quickly. “I hope that’s okay. He was lying on the floor and didn’t look too good.  I hope that’s okay.”  His eyes were wide.  In their business, it probably wasn’t okay to move a body without permission.

“Yes.  Thank you.” I said.  “I am sure his family appreciates it. ”

I looked at Bill.  There was no question that he was gone.  He was a cardiac patient and I would bet that he had a heart attack or other event and died, then fell.  Not the other way around.  I placed my stethoscope on his chest to confirm no heart rate.  Sometimes the heart makes a discoordinated sound (a squishing sound, really) even after death for a short time.  This has been unnerving to me in the past and I have to listen much longer, but Bill’s heart had clearly stopped.  I then placed the stethoscope over his throat to be sure I did not hear any breathing.  I looked at my watch and recorded the pronouncement time. 8:15pm. Sometimes families look at the pronouncement form before handing it to the funeral home official and are concerned that the time of death is recorded as long after they know the patient died.  I explain that it is really the time of pronouncement and that they know in their hearts what time their loved ones left Earth.  I turned to Sargeant Cook.

“I am required to notify the medical examiner because a fall was reported within 24 hours of expiration.”

“Okay.  Then I will notify my supervisor also so we all record the same information.”

It was the first pronouncement in which I had to notify the medical examiner and I was pleasantly surprised that I remembered.

As expected, the ME declined the case because neither I nor the police felt that what looked like a fall contributed to Bill’s death.

I stayed with Diane after the police left.  She didn’t want to be around when Bill’s body left the home.  This is a common request from family members.  When the funeral home pulled up, she chatted with her friend from the service then scurried to her bedroom and closed the door before Bill’s body rolled by.  The funeral service quietly took Bill’s body outside to the waiting black Suburban.

I told Diane I wouldn’t leave until  her friends from Connecticut arrived.  They were already on their way and it would be a matter of perhaps thirty minutes.  She talked about Bill and how unreal everything seemed.  I hadn’t known that they had been together for thirty five years.  Diane wrote down the places she wanted to invite people to send memorial contributions.  Just before Diane’s friends arrived, she apologized again for calling 911.

“I am so sorry that I didn’t call hospice first,”she began.  “I could only reach that one phone in the bedroom at the time, and the number 8 key doesn’t work.”