Kokomo Tribune; Kokomo, Indiana

December 11, 2013

RAY MOSCOWITZ: Hospice is not about giving up, but letting go

Cynthia Price spent 19 years caring for the dying.


MC Weekly

---- — She has cried after leaving a patient.

She has been called “Mom’s angel.”

She has been honored by simply being asked to ring a dinner bell.

Through it all, Cynthia E. Price of Peru has done her job — and to me, there can be no higher compliment for people in her profession.

Now 65, Price has retired after 40 years as a nurse, the last 19 as one who cared for hospice patients.

When she’s asked to define a hospice, Price responds in a clear-cut, direct way:

“All of us are going to die. All of us have the right to determine how, where and the circumstances under which that occurs. Hospice is not about ‘giving up’ but about ‘letting go.’ Hospice is about self determination at the end of life.”

Just as her husband, Jeff Price, an attorney, advocates for clients, Cynthia Price advocates for hospice.

Price believes hospice is “just now coming into its own. It is now seen as a viable alternative for end-of-life care.” She believes there will be a trend toward more government oversight.

There are essentially two kinds of hospice care. Basic elements apply, but the delivery systems are different, Price said.

She elaborated:

“At home, the patient and/or primary caregiver are given the tools to keep the patient functioning at the optimal level as long as possible. This is done through education regarding the disease, dying process, provision of medical equipment, medicines and emotional support to the patient, caregiver and family.

“In a health facility, the staff is already educated as to the disease process.

“Hospice education regarding the dying process may be necessary. In Indiana, the rules for medication use in a facility are different for hospice patients. For instance, anti-anxiety meds are strictly controlled and documentation is stringently required. But for a hospice patient, generally, anxiety is part of the dying process. So anti-anxiety meds are used to alleviate the distress. The state does not look upon the use of these medications as a 'chemical restraint.’”

Education is a primary duty of a hospice nurse, Price said, along with emotional support, medical care and coordination of overall concern for the patient.

All of it is critically needed to deal with all kinds of patients and all kinds of families. Patients are not alike. Attitudes can range from accepting inevitable death to “fighting all the way,” Price said.

She admits it was often very difficult to deal with a family, adding, “The behaviors varied.”

And yes, she says, some patients and family members berated her for simply doing her job.

“This is a very difficult, frightening and intimate time for the patient and family,” she points out. “They are very vulnerable.”

And while it was very difficult to keep her emotions in check, she says, it was a must. “I was no good to a patient or family if I couldn’t maintain some professionalism.”

The most important asset or ability a hospice nurse must possess, she says, is empathy. Knowledge or the ability to find an answer is second.

Still, there were occasions when the human condition caught up with her. She admits, when asked, she cried at times, particularly when a patient died — but never in the presence of the family, only in private.

“Part of my responsibility was appearing at the funeral or viewing,” she notes. “This was to provide closure for the family and myself.”

On one occasion, she was in the visitation line to the casket when the daughter of the deceased recognized her. Price recalled that occurrence:

“‘I know you,’ the daughter said. ‘You’re Mom’s angel. We couldn’t have got through this without you.’ She introduced me to her sibs like I was a rock star.

“It just happened that right behind me was Jeff. ‘Who are you?’ the daughter asked.

“He first said he was my designated driver, trying to make a joke. When she didn’t laugh, he said he was sorry for her loss. Then, suddenly, she said, ‘Wait, you’re Mom’s lawyer.' 'Yes, that’s right,’ he said. ‘Well, thanks for coming,’ she said, almost as an afterthought. The excitement in her voice was gone.”

After another patient died, the family invited her to their home for a remembrance service and dinner. A family member always rang the dinner bell, but on this occasion, Price related, they asked her to do the honors, in essence telling her that she was part of the clan.

And then there was the patient who called her "Cynthiane.” Price tried to correct her but it was no use. “She spoke as though she were in a Shakesperean play. ‘I had lettuce today, I did.’ You know, she talked like Yoda!”

Some patients couldn’t or wouldn’t die until someone arrived or left, Price said. “Medically, the patient should be gone, but the mind is very powerful! They couldn't until this person left the room or that person came in.”

Asked if Jeff’s legal background helped her, she responded: “Yes. I was able to explain legal documents related to health care in ways that patients and families could understand.”

Price used that knowledge in dealing with a caseload of 20 to 30 patients scattered over White, Fulton, Cass, Miami and Kosciusko counties. And when she was on call, she cared for patients in 23 counties.

Her job required flexibility in both her professional and private lives. Some days started at 7 a.m., others at 11 a.m. Some days ended at 1 p.m., others at 10 p.m. It all depended on her caseload and the distance she traveled, as well as emergency-symptom management, she said.

During the week, she was on call 16 hours, from 5 p.m. to 9 a.m. the next day. On weekends, she was on call from 5 p.m. Friday to 9 a.m. Monday.

Three nurses, three social workers, three chaplains, a doctor and a nurse practitioner were on call daily, Price said.

Price has had just two employers since 1992, when she started working for Wabash County Hospital. In 2005, she joined Guardian Angel Hospice Inc.

But nursing has been a 40-year career, during which she worked at several hospitals.

One of six children, Price was born and raised in Indianapolis. Her parents were Milton E. DeVoe, a CPA, and Nancy W. DeVoe, a homemaker. When she was 13, her father accepted a job transfer to Evansville. Shortly after the family moved there, her mother died after a long, difficult battle with cancer.

Price is reticent when asked about herself, but in an email, she wrote: “Jeff believes my work in hospice is related to [my mother’s] illness. I don’t know.”

After she was graduated from William Henry Harrison High School, Price enrolled at DePauw University in Greencastle. During her college years, she worked as a camp counselor and a governess, which involved taking care of three children on a farm.

She earned a BSN at DePauw, and it was there she met Jeffry G. Price, who was attending rival Wabash College in nearby Crawfordsville. It was at a local restaurant through friends of hers in February of her freshman year, she recalled.

Why nursing?

“Forty years ago, choices for women were generally either nursing or teaching. I hated teaching,” Price said.

She got into hospice nursing while working for Wabash-Miami Home Health Care. She was part of a team that started the hospice program for that agency in 1994.

Dedicated to the hospice process, she says: “I would strongly urge everyone to make sure that they carefully consider how they want their end-of-life care to go. And then have that discussion with their doctor, family and lawyer.”

Now, after four decades of faithfully taking care of others, Cynthia Price will concentrate on herself. She will have more time for her leisure activities — reading, cooking, gardening, travel.

And now, without her hectic schedule, she and Jeff will be able to spend more time with their children and four grandchildren. Their daughter, Elizabeth Price Childs, 40, is an attorney who practices with Jeff. Their son, James A. Price, 38, is an attorney with the Simon Property Group in Indianapolis.

So what’s next? she’s asked.

“Take a year off to determine direction,” she responds succinctly.

At the very least, Cynthia Price has earned that.

But undoubtedly she will continue to be a powerful advocate for hospice, no matter what the future holds.

“Only 10 percent of deaths use hospice,” she points out. “That’s just wrong!!”

No argument here.

Ray Moscowitz of Bloomington is a retired newspaper executive and former publisher of the Peru Tribune. Contact him at r.mosco@comcast.net.