Last month, when Bill Gallagher passed away from a lung ailment at his home in Saranac Lake, he was surrounded by his wife, Tomi, and two of his daughters. But also on hand through that long, last night of his life was Barbara Touby, a nurse with High Peaks Hospice and Palliative Care.
It was Touby's job to help make Bill as comfortable as possible, to help the family manage his final hours, and to clean and care for his body after he passed.
"We didn't think he would pass away that night," Touby recalled. "It was a really awesome experience to see how the family dealt with that."
High Peaks Hospice nurse Barbara Touby is often at her patients’ sides when they pass away.
(Enterprise photo — Mike Lynch)
If it weren't for Touby, it's unlikely that Bill would have been able to spend his final hours at home.
"Hospice made it much easier," Tomi Gallagher recalled. "None of this is easy - but easier."
Since 1986, High Peaks Hospice has offered support and alternative care for thousands of patients and their families, providing nursing care and support, as well as counseling and bereavement programs. Important and powerful as this work can be, the experience of death is often painful and emotionally complicated, for families and for the more than 200 nurses, social workers and volunteers who run the program.
This is the second of a two-part series on hospice care in the Adirondacks. The first part appeared last week and can be found here: http://www.adirondackdailyenterprise.com/page/content.detail/id/522282/-You-re-not-alone-.html
High Peaks Hospice cares for between 300 and 400 clients a year from its offices in Saranac Lake, Port Henry and Glens Falls. They are in intimate contact every day with people who are often sick, suffering, lonely and sometimes angry.
"For every amazing and peaceful passage we witness, there are equally difficult deaths," said hospice nurse Sarah Wardner.
"Sometimes they are unpleasant because of wounds and pain. When the family is a very challenged family, we have to realize that those things have been going on for years."
The stress and emotion of this work is heightened by the fact that hospice workers sometimes spend as long as half a year with their clients, developing close relationships and navigating with them some of life's most important transitions.
"It's difficult to not get attached to patients," said Ryan Mellon, a former social worker with hospice who has since moved on to another career.
"I have to admit, the hardest cases I've had to work with are those people who are closest to my age. We've had a number of young people (die)," he added.
Shawn Galbreath is the new executive director of High Peaks Hospice. She says a big part of her job is helping front-line hospice teams avoid what she calls compassion fatigue.
"People just care and care and care to the point where you're empty," Galbreath said.
"That's what I don't want to happen to people here," she added. "I've seen it happen, where people are just so dedicated to what they do that they don't take a deep breath. And they become numb, they become empty."
It's important to note that hospice workers regularly describe their work as a passion and a calling; they insist that it is the most rewarding type of nursing or social work that they've ever done.
"I started as a volunteer in 1994, and now I'm a case manager," said Peggy Wiltberger. "It's a job I want to do forever."
"I have the privilege of meeting all the families first and explaining hospice services to them, so I get to know just about everybody and it's wonderful," agreed Kathy Lamb, who handles intake for hospice. "I've done a lot of different kinds of nursing, and this is a privilege."
But hospice workers also acknowledge that this kind of job can also be draining and isolating.
"I find that outside of work, it's really hard to talk to people about this stuff," Mellon said. "Like if you're at a party or whatever and you say, 'I work for hospice,' the conversation stops. There's no going past this point."
Death is something most people don't like to talk about, but it is a daily occurrence for the hospice team. To help manage those pressures, there are regular group sessions for staff and volunteers. Just before Christmas, 20 people gathered around a big table at High Peaks Hospice's office in Saranac Lake to acknowledge and say good-bye to patients. At the center of the table was a bowl of water and scattered carnations.
"As we remember each person, let's float a flower and say a few words," counselor and bereavement coordinator Barbara Hofrichter said as she passed a list of patients who had died over the last few months.
"I've been here for two years now, and I find this work emotionally exhausting but very rewarding," said Jeff Gray, hospice's chaplain. "It's healing to come back to the office to talk with everybody as we go through difficult circumstances."
"People ask me, 'How can you deal with it all the time?'" added Wiltberger. "But when there's a really hard time of life that people go through, it brings out the best in people. Really, what you see is all the love. And it's really not about the sadness and the loss, so much as all the love in the families that you witness."
Often, hospice workers like nurse Karen Fraser cite their own life experience for wanting to serve in this field.
"I think it may seem somewhat emotionally exhausting," she said, "but it is so much more healing to be with families and talk about pain and death and loss and remembrances outright, than the way death was hidden and denied and avoided in my family.
"Every day I'm thankful that the grief we share with our families is so much cleaner and more healing than the kind of grief I felt as a child, when it was hidden and ignored," Fraser added.
Despite these strategies - and the obvious love for the work that hospice workers demonstrate - there are times when the sickness and sorrow and death are simply too much. Wardner says that in those moments, she often retreats to her car.
"That can be a very private place," she said. "I can yell and scream and bang the steering wheel. Because yeah, you have to let go. Especially if you're on call and the beeper goes off, and five minutes later you have to deal with another family."