Local Nurse Provides Comfort During The End Of Life Journey

outer banks hospice nursePam Hay’s destiny was determined at the tender age of 6 years old. In the hospital, scheduled to undergo a tonsillectomy, the nurses explained the procedure to her. Pam noticed there were additional children awaiting the same operation, so she took it upon herself to share the details with them. Overhearing Pam’s conversation with the other children, the nurses were impressed and shared the episode with her parents. “Well,” her parents exclaimed, “it looks like Pam is going to be a nurse!”

Pam has spent 37 years fulfilling her destiny. For seventeen of those years she has served as a registered nurse with the Dare Home Health and Dare Hospice programs.

Waking each morning in her Southern Shores home, Pam prepares for work, ever mindful that there is no such thing as a “typical day.” With her patients’ health situations changing constantly, flexibility is a necessity in her job. Working three 10-hour shifts and one 7 1/2-hour shift, she visits two to seven patients each day. In addition, the staff of nurses alternate a 24/7 on-call status. “Regardless of our schedules,” says Pam, “everyone is quick to step in and offer support whenever necessary.”

“Anyone who has chosen the career of a nurse has a certain need to give or to be needed,” says Pam. Indeed, Pam’s patients benefit from her desire to apply her knowledge and devotion to the goal of restoring their good health. However, there are other patients under Pam’s care for whom there is a different goal. These are the patients who are in the final stages of a terminal illness, usually with less than six months left to live. The goal in these cases is not to seek a cure but to make the patients comfortable and free of pain so that they live each remaining day as fully as possible. By order of a physician and the decision of the patient or family, these are the patients who have been placed in hospice care.

Simply stated, hospice is end of life care. The focus is on quality of life. Hospice nurses provide support to family caregivers in a variety of settings, including the patient’s home, assisted-living facilities, nursing homes, and hospitals. The nurses work to achieve symptom management and to help the patient achieve their personal goals.

“Society prepares us for events such as birth, graduation, and marriage but when it comes to the death of a loved one, a family can be woefully unprepared, making the prognosis difficult to accept,” says Pam.

Administering to the needs of the dying is a calling. It requires a special person. Pam’s gentle demeanor and obvious compassion for her patients is a blessing for both patient and family. She is dedicated to doing whatever she can to help the patient celebrate and enjoy the remainder of their life. “Most important,” she says, “is the ability to listen to the patient and family members. Sometimes they just need a shoulder to cry on. A positive attitude is crucial. I am of no help to the patient if I am distressed.”

Addressing the patient’s physical, emotional, and spiritual needs is a team effort. In addition to the hospice nurse, a nurses’ aide is available to assist the family with such duties as bathing the patient and changing bed sheets while the patient remains in the bed. The team has their own social worker who assists with such things as securing a will, funeral arrangements, obituary writing, and financial concerns. “There have been families who could not afford the cost of a funeral or cremation services,” says Pam. The social worker can attempt to find funding. Local churches have assisted with funeral costs and medical equipment not covered by insurance. There are trained respite care volunteers available to give caregivers an opportunity to relax and recharge. Rounding out the team is a chaplain who ministers to the patient’s spiritual needs.

Developing an attachment to a patient and family is often unavoidable. Pam is a Navy veteran, proudly having served as a nurse for five years in the U.S. and Japan, so when she discovered a patient was a Pearl Harbor survivor, they shared their experiences and formed a common bond. She has assisted families who have been here for generations, enjoyed their company and been entertained by their fascinating stories “I’ll admit,” Pam says, “it does get to me. I have cried in my car after leaving a patient. I try to be professional, but I am human.”

Members of the hospice team make every effort to attend the funerals of patients. They often keep in touch with families through cards and phone calls. At times, Pam has crossed paths with family members after the passing of their loved one and they are quick to express their gratitude to her for making a difference.

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The geographic size and distance of Dare County poses some challenges for providing services, especially when time is a factor. Each nurse is assigned a specific territory, rotating assignments every few months. They must prepare for contingencies, think ahead, and get medical supplies and equipment in place well in advance. To provide peace of mind, a “comfort pack” containing nausea and anti-anxiety medication is provided for the caregiver with instructions on how to administer to the patient. In the event of a hurricane forecast, a disaster preparedness plan must be formulated. It is interesting to note that when Hurricane Irene caused a breach on NC12, cutting off access to Hatteras, the National Guard delivered the nurses via helicopters to the island so they could care for their stranded patients.

Another unique feature of Dare County is the large population of retirees. In many cases, their family members are far-flung, leaving them feeling vulnerable, without a support system. The hospice program can be especially helpful to this group, providing somewhat of a “surrogate family.”

On the bright side, not all hospice patients are necessarily homebound – some are able to get out and about. Dare Hospice also accommodates “Hospice Vacationers,” which are patients from outside the area who wish to travel here, perhaps to see the ocean or check something off their “bucket list.” They coordinate with the patient’s home hospice program to make it happen, providing the necessary care.

When not working, Pam makes a concerted effort to not dwell on her patients. “I need to be present for my own family,” she says. Spending time on the beach, gazing at the ocean and breathing in the salt air all help her relax. Her faith and church attendance offer peace. Weekly meetings with team members help ease the stress, providing a time for all to share concerns and encouragement.

Dare County / Outer Banks hospice nurse services are paid for by Medicare, Medicaid, and most private insurances. If ability to pay is an issue, arrangements can be made.

“Families are overwhelmingly receptive of the hospice service provided in Dare County,” says Pam. “Hospice care can be the last ‘gift’ to the patient and to the family. It is a time for reminiscing and sharing memories.”

Pam is grateful for the oppofrtunity to be an integral part of such a caring organization. After all, it was her destiny.♦

Kimberly Armstrong

Kimberly Armstrong’s artistic talents are limited to drawing conclusions. However, she can perform a rollicking rendition of “The Skater’s Waltz” on the piano.

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