Angels Among Us

Nurses dedicated to those at end of life

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The living room of the Bartletts' home is a record of the care Tom Bartlett has received since March, when RTA Hospice first came to care for him.

After getting the go-ahead from Tom's primary care provider, hospice brought in a lift chair to help him get in and out of bed and made a plan for the services they would provide. As his chronic obstructive pulmonary disease progressed, Tom weakened and he could no longer use the lift, and a hospital bed was brought in.

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Field nurse Marilyn Benzel, LPN, right, asks Geraldine Bartlett about her health.

The lift chair sits in the Bartletts' living room, along with a hospital tray table where his medications are kept.

There is other equipment as well. He is on oxygen. And his wife, Geraldine, at 94, is becoming frail, too, and so her walker sits at the head of the bed, near the door.

The room is dimly lit and cool. Tom's bed faces a wall covered with old black-and-white photos -- his family is around him.

"It was gradual with Tom," Geraldine said. "He had had strokes before we married."

He significantly recovered from the strokes when the couple married in 2001.

In their wedding picture, Tom is a big man.

Now, he is frail -- half the size he was when he and Geraldine married.

When his condition started to deteriorate, Geraldine tried to provide for him on her own, but when he lost the use of his legs, she was unable to give him the help he needed.

She was familiar with hospice from the time when her first husband became ill with Parkinson's disease. She called for their assistance once again.

The admission team for Payson's RTA Hospice -- Phyllis Elstrom, RN, and Jo Sanders, lead social worker -- went to the Bartletts' home and assessed the needs.

Geraldine is never far from Tom's side. There is still a sofa in the room. She sits there while the hospice workers and others care for her husband.

They bathe him -- he is still too big for Geraldine to lift -- and take his vital signs, check the oxygen and gently massage his paper-thin skin with moisturizer.

Each touch, each soft word is a sign of the love and respect the workers have for their patient and his wife.

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Geraldine Bartlett sits with a cat adopted for her husband, Tom, by hospice volunteer Bruce James and Norma Gilchrist, a paid caregiver. "Tom is quite taken with (the cat) and I am, too. And she's become the hospice cat," Geraldine said.

To see these women and men provide for their patients is proof that there are angels on earth.

The Bartletts' primary team from hospice are RN Linda Thurman and social worker Kathy Vance. They also have a certified nursing assistant on the team and one of two ministers who work with hospice.

Thurman has been working with hospice for more than six years. Vance will soon have her fifth anniversary with the service.

Before coming to hospice, Thurman worked as an oncology nurse for more than a decade.

"I felt I've done well with patients at the end of life," Thurman said of her decision to join hospice.

"They welcome you and treat you like family. It's so rewarding."

She said she want to make sure patients are comfortable when they die.

"It takes a lot out of you, but we have bereavement counseling available to the staff," she said. Thurman said she has never taken advantage of it.

She said she has not used the counseling service because, when you realize your patient has no quality of life left and they are ready to go, you know you have given them and their family what they have needed.

"If we could get there before the very end, we could make them much more comfortable," Thurman said. Often hospice is not called in until the very last days of a patient's life. Other times, the staff and volunteers go in when there is as much as six months remaining for the patient.

"Sometimes our work extends their life," Thurman said, as is the case with Tom Bartlett.

Because Thurman finds the work so rewarding, she said, "I can't foresee doing anything else."

Vance was recruited by hospice director Vicki Dietz.

"I wasn't sure it was for me. It's a very different experience than I've had," Vance said. "But I loved the connection with the families. There is very positive bonding that happens. There is a lot of positive energy here.

"I love the idea of quality of life and helping them enjoy their last days. I'm able to help make them not be afraid. I help the family."

RTA Hospice gives family members a booklet to read, "Gone from my Sight: The Dying Experience," by Barbara Karnes.

Their state of mind determines when the book is shared. Sometimes it is given to people at the beginning of the hospice service, other times not until later, and in some cases, not until the end.

While no one can predict when Tom Bartlett will die, and he has been with hospice more than a year, it was only a couple of weeks ago that Vance gave the "blue book" to Geraldine.

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The Bartletts' primary team from hospice are Linda Thurman, RN, and social worker Kathy Vance. They also have a hospice volunteer, Bruce James, who visits regularly, certified nursing assistant Teresa Fender (pictured) and a minister, Pastor Lynn Richie.

And it was only last week that she felt ready to start reading it.

The book describes the stages of death -- the symptoms, the experience -- and helps family members understand what their loved one is going through.

Another part of hospice service is helping patients and their families make decisions about the arrangements for death.

Again, the subject is sometimes brought up early if they are ready, or the discussion comes later when they are prepared to deal with it.

"It's surprising to realize how many people don't make the arrangements for when they die," Thurman said.

Part of Vance's job is to present them with the options, including the costs involved.

Once the patient dies, the hospice team waits 48 hours, then they call the survivors to see how they are doing. Vance and the other social workers will then refer them to bereavement counseling.

More than caregivers

Volunteer Bruce James was matched with the Bartletts by Patti Kaufman, hospice volunteer coordinator.

James was in World War II as a flyer, just like Tom, Geraldine said. He visits every week, visiting with Tom about their shared memories.

Tom can no longer speak, but he likes hearing the stories, his wife said. James also has provided Geraldine with help around the house.

Currently, he is clearing out the garage for her.

Working with the volunteers in their two weeks of training, Kaufman said she gets a good idea of the kind of people they are and the kind of needs they can meet.

Most hospice volunteers stepped up to help because they experienced the kind of service it provides through its work with a family member. Others choose to volunteer because they want to give back to the community.

"All of them go above and beyond," Kaufman said. The training prepares them with solutions to common scenarios, from getting the patient to open up to knowing how to lift him in the event of a fall."

When the couple were first married, Tom had a sweet, little dog, Geraldine said.

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Norma Gilchrist, a paid caregiver, stays with Tom Bartlett during the day.

It died, and then, last Christmas, James and Norma Gilchrist, a paid caregiver, who stays with the Bartletts most days, went to the Payson Humane Society shelter and adopted a cat for Tom.

"Tom is quite taken with (the cat) and I am, too. And she's become the hospice cat," Geraldine said.

Gilchrist stays with the Bartletts during the day and Geraldine has the night shift.

"They told me to call if I ever needed any help, no matter what time it was," she said. "It was hard for me to (ask for help) at first, but I was told to do it and so, I do it."

Geraldine said she has never seen such good care.

"They say they like to come here. They are always ready to smile and give you a big hug," she said.

Another part of the team helping the Bartletts is Pastor Lynn Richie. He comes to see them frequently.

"The last time he was here he read us Psalm 91. It's his favorite Psalm and it's my favorite, too," Geraldine said.

Psalm 91:5 reads, "Thou shalt not be afraid for the terror by night; nor for the arrow that flieth by day."

"It's hard. He's on the way out," Geraldine said. "We talked about the Lord a lot. He's not afraid. He will see his family and I will be there soon."





Understanding hospiceJune 1. We introduced you to Tom and Geraldine Bartlett, who have allowed us to make the journey through hospice with them.Today. We look at hospice staff, who dedicate themselves to helping others cope with the end of life.June 15. We will see how hospice care continues for the survivors, after a patient dies.

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