To the editor:
About a year ago, I was fortunate to have a conversation with Dr. David Merkel about a concern that we shared. Because this issue was very important to him, and because public understanding of this issue can contribute to greater quality of life and peace in so many lives, I offer this discussion as a tribute to him, a most beloved and respected doctor and civic leader who died Saturday, Sept. 15.
As a hospice volunteer, I have sat with the dying, sometimes alone and sometimes with family. I have also participated in the bereavement process, phoning the families of those who have passed away to offer understanding and supportive listening.
One thing I have learned is something Dr. Merkel also felt strongly about: People can benefit from hospice in their last months, not just their last days. Patients with a terminal illness should be offered options for their care, with an explanation of the likely benefits and physical and psychological discomforts of various treatments. All too often, hospice is mentioned only when the doctor says, "There is nothing more I can do." Very often, much earlier, it would be reasonable to consider whether available "curative" treatment is preferable to "palliativecomfort" treatment. That is a consideration for the patient, his/her family and the doctor to make together.
In hospice experience, there are many stories of people with terminal illnesses who decided to get the most out of their last months: spending time with grandchildren, renewing old friendships, traveling or doing whatever remains on the "bucket list." Research shows that folks who choose comfort care tend to live longer than those who stay with more aggressive treatment. And hospice is expert at keeping them free from pain, allowing a better quality of life and a peaceful passing.
In my bereavement work, I have spoken with folks whose families have benefitted from hospice services: nursing, personal care, end-of-life planning, pastoral care, volunteers to provide respite to the caregiver, and other comfort care. Those who have had hospice for months prior to the death are typically far more at peace with their loss. Those who called in hospice in the last few days often are having much more difficulty because they have not been able to benefit from the preparation for death hospice offers.
Choosing comfort care at the appropriate time is a blessing to the patient and the family. Health regulations allow one to begin hospice care when the doctor says there is probably only six months remaining. David Merkel believed that a patient should be allowed to make a choice that will provide the best quality of life for that time, long before "there is nothing more to do."
Our community is blessed by the availability of palliative care through the agency he founded with his wife, Ann: High Peaks Hospice and Palliative Care. You can reach them at 518-891-0606.