Veterans who served our country deserve to be honored. For this year’s National Hospice Hospice and Palliative Care Month, “Meeting You Where You Are,” we’re sharing how to meet veterans’ unique needs at the end of life.
November is National Hospice and Palliative Care month. The theme for this year is Meeting You Where You Are, because in hospice and palliative care, that is what we do: meet you where you are as you navigate serious illness and death.
November is also the month that we in America honor all veterans who served our country to protect our freedoms. So how do we meet our veterans where they are? How do we meet the unique needs of those who have experienced the horrors of war and lived while their buddies did not?
Corporal Sam’s Story
Corporal Sam was a soldier, husband, father, business owner, and grandfather. Corporal Sam served two tours in Vietnam. He never talked about his experiences there.
I met Corporal Sam after a sudden onset of frequent headaches led to the diagnosis of an aggressive brain tumor. Within a few days, Corporal Sam went from running his own business to needing his children’s help to remain safe and comfortable at home. I visited him after a particularly bad night in which he struggled with pain. I worked with Corporal Sam’s son to adjust his pain regimen and explained that his dad would likely sleep for quite a while as he recovered from the stress of the prolonged pain.
Corporal Sam slept for the next 12 hours. He woke up about 4 am and had a heart-to-heart conversation with his son and daughter. He had one consistent message as they talked that night: “I don’t want any more of that morphine shit! Just let me die with my boots on.”
A simple request. “Meet me where I am.”
What Corporal Sam Needed
As time went on, Corporal Sam talked a little bit about his experiences in Vietnam. He told his son he worried about going to hell “for killing people.” Corporal Sam’s son was shaken by this and shared that his dad had never talked about his time in Vietnam before. “My Dad is a good man. No way he is going to hell for something that happened over there.”
Corporal Sam agreed to have the hospice chaplain visit, stating “a prayer surely couldn’t hurt.”
Our chaplain, John, was skilled in addressing the needs of veterans struggling with things they encountered in combat. He offered a listening ear and an acknowledgment of the pain and shame Corporal Sam expressed. He listened as Corporal Sam talked about his fear of addiction and the stigma associated with morphine after so many veterans came back from Vietnam addicted. Chaplain John reassured Corporal Sam that we would work to manage his pain in other ways. The chaplain also shared his respect for Corporal Sam’s decision to accept some pain as a way to atone for what happened in Vietnam. Atonement was not necessary in the chaplain’s eyes, but it certainly held meaning for Corporal Sam.
The hospice team worked with Corporal Sam and his family to prepare for his final days. Corporal Sam was willing to take small doses of oxycodone at bedtime to help “everyone” sleep, as he knew his children worried when he was in pain. We helped his children understand the role of some pain in his last days and how to be at peace with his decision.
His children took turns sitting with him at night in case he woke up and wanted to talk. They also gave him time alone to work through some of his “war battles,” as he called them. We stopped his insulin and taught them how to provide mouth care to keep him comfortable. We asked about music, and that led to an afternoon of reminiscing about favorite singers and which generation had the better music.
Knowing that war memories can result in agitation and aggression, we taught the family how to approach Corporal Sam slowly and with a calm voice before touching him. We worked together to keep everyone safe.
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Corporal Sam died seven days after he was admitted to hospice. Two weeks after he was diagnosed with the brain tumor. He became unresponsive quickly due to the tumor. He finished his journey just as he requested, “with his boots on.”
Supporting his children was just as important as caring for Corporal Sam. We helped them understand and honor the restlessness and discomfort that were a part of their father’s final journey. We showed them how to provide comfort in ways that were meaningful to them and to their dad. We encouraged them to listen and to be present, to honor their dad with their presence. We honored Corporal Sam’s service to his country and acknowledged the price he, and all veterans, paid for the freedoms we each enjoy.
Providing Skilled Care to Our Nation’s Veterans
Within the next ten years, over 500,000 veterans, many from the Vietnam era, will be dying each year. The need for specialized end-of-life care for these veterans is increasing. How can your agency prepare?
The National Hospice and Palliative Care Organization sponsors the We Honor Veterans Program in partnership with the Department of Veterans Affairs. The program provides resources for organizations caring for veterans at end of life and includes a tiered certification program for hospices committed to providing the specialized care needed to meet veterans where they are.
Deborah Grassman is a nurse practitioner with over twenty years of experience working with dying veterans within the VA system. She shares her experience in her book, Peace at Last: Stories of Hope and Healing for Veterans and Their Families, and through her work at Opus Peace. Her 2020 TED talk entitled SOUL INJURY, Restoring Personal Peace provides a glimpse into the important work she has done with dying veterans.
Corporal Sam and his family had a very short hospice experience. They were fortunate to receive care from a hospice agency that specialized in caring for veterans and their families. Is your agency up to the task? Remember, 500,000 veterans are year will be needing hospice care a decade from now. We owe each and every one of them, and their families, the best possible care.