Fred Holliday, age 39, had kidney cancer that had spread to his lungs, spine, hips, pelvis, and femur, turning bones so brittle they could snap like twigs. From the time he’d been diagnosed, just two and half months earlier, he had been moved from one facility to another — forty-five transports in all. His wife, Regina, kept count.
She thought the transport to Washington Home and Hospice, on the night of May 20, 2009, would be his last. So did the emergency medical technicians in the ambulance. They had transported Fred before, and they liked him. They had gotten to know Regina, too. She always rode along, and though she sat up front, next to the driver, Fred felt her calming presence and relaxed.
In a strange way, he had come to look forward to ambulance rides. The jostling of a gurney hurt like hell and could be dangerous — during a bed-to-gurney transfer when he first entered the hospital, an orderly had carelessly shoved his hip, cracking it. But these rides got Fred outdoors for a few minutes, the only time that happened anymore. It usually lifted his spirits to smell air washed clean by rain, feel the breeze on his face, or look up and see sky instead of the pallid acoustical tile of a hospital.
On the way to the hospice, the techs tried talking with Fred but he was lethargic and fading. Regina, usually a rock, started crying. One of the techs quietly cried, too. As Fred was whisked inside, the techs wondered if he would make it through the night.
But the next morning, there he was, sitting up in bed and spooning down applesauce, the first food he had eaten in days. His cheeks had color, and he asked Regina to bring their young sons to see him. The reversal seemed miraculous to Regina, but it was just good palliative medicine. It is not unusual for a patient to come into hospice seemingly on the brink of death and once their pain, nausea, or delirium is controlled, they rally. It happens so often it that has a name: the hospice spurt. The phenomenon seems counterintuitive, especially if you think of hospice as “giving up.” Until that morning, Regina did.
She and Fred did not exactly “choose” hospice. If any of the doctors Fred had seen during his ordeal had proposed a treatment to extend his life, they would have grabbed it, no matter how brutal the side effects. Then again, in hindsight Regina would say that if a doctor had told them honestly that his cancer was too far advanced for any treatment to change its course, that to try simply for the sake of trying would probably do nothing but compound his suffering, the couple might have opted for hospice sooner. But neither conversation took place.
Instead, Fred was transferred from one hospital to another, from the second hospital to a rehabilitation center, from rehab to a third hospital, while a succession of doctors tried to pull him out of the latest crisis, sometimes caused not by his illness but by the care he received. In hospital number two, he underwent surgery to pin the hip broken but never diagnosed in hospital number one. After the operation, he was sent to rehab to relearn to walk before undergoing any cancer surgery, even though Regina told the doctors that Fred had stopped walking before the fracture because he was so weak. The medical team at the rehab center switched his painkillers, leaving him in constant agony on top of incontinence, exhaustion, and anemia. Regina demanded a blood transfusion — he had received them in the first two hospitals, and they fortified him. So one night Fred was wheeled into an ambulance and driven to the nearest hospital, across the parking lot. Insurance rules required a vehicle transport.
The transfusion perked him up. The doctor on duty reviewed his history with more attention and kindness than any other physician had shown, and wondered why on earth she would send a man with stage 4 renal-cell carcinoma back to rehab for physical therapy. She asked Regina if they had considered hospice.
By morning the doctor was off duty, leaving Regina alone to enter Fred’s room, sit down on his bed, and bring up the topic.
“Hospice?” he said. “I’m gong to die?”
She cried and said she was so sorry. She told him he would be able to spend time with the kids.
“OK, Reggie, if that’s what you think is best.”
She did not know what to think. It felt like life in freefall, as if she and Fred had tumbled down a hole, rolling and shouting futilely for help until they now hit bottom hard. But once Fred got settled in Washington Home and Hospice, it did seem best — near paradise compared with every other stop along this awful journey. The night he came in, the hospice physician put him back on his original painkiller, Dilaudid, and a steroid, and his pain ebbed. The staff looked Fred in the eye, which made a big impression on him and Regina both, after months in hospitals where everyone avoided his gaze, as if his illness were shameful.
Relatives from around the country came to see Fred in the hospice, and friends from every chapter in his life. Fred did not particularly like the food. “Other than that, he loved it, Regina said.
“He had a better quality of life in those last fours weeks than at any other time because of the way he was treated. He was treated with dignity and respect and given the correct palliative care.”
“The only problems arose when insurance people butted their heads in.” Now that Fred’s condition stabilized, insurance rules required that he leave the very place where he thrived.
Read Changing The Way We Die to find out how Fred, Regina, and their young sons handled his homecoming.