Making the transition

Hospital program eases end-of-life concerns

At 46, he was vital and active, enjoying life with his wife and two young sons. And then he was diagnosed with cancer and given a 10-to-12-month prognosis. Determined to make the most of his limited time and to help his family adjust, he asked his doctor for a referral to Transitions, a Community Hospital program designed to provide volunteer and case management services to individuals (and their families) facing a lifethreatening illness with approximately one year of life or less.

After being admitted to the program, a Transitions coordinator referred him to a children’s support group for his sons. He and his wife met on a regular basis with a Transitions volunteer who offered emotional support and care throughout their journey. Ultimately, he and his family chose hospice for his end-of-life care.

“In the short, two-year life of the Transitions program, we’ve had fantastic feedback from patients about the service and from those patients who have moved on to the hospice program,” says Michael Benedetti, program manager for Hospice Resource Centers. “The patients who do go on to the hospice program get to maintain the relationships they had with the volunteers in the Transitions program. They’ve all been grateful for the free service and have been happy this program was brought to their community.”

Transitions services are free and available to clients in their homes, skilled-nursing facilities, or assisted-living facilities. Focused on meeting needs ranging from financial resources to counseling to assistance in moving to the hospice program at the optimum time, Transitions provides case management by a coordinator and respite care by trained volunteers, as well as connecting patients with community resources intended to provide assistance, comfort, and compassion.

The Transitions coordinator will assist the patient and family in obtaining information, counseling services, and care-giving resources; understanding healthcare options; and filling out an advance directive to set the parameters for end-of-life care.

Volunteers, trained in basic hospice instruction by Resource Center staff, provide companionship, respite, food preparation, and light housekeeping, and will also run errands.

John Francis Brown

She was just a little bit of a thing, 5 pounds soaking wet, at most. But she had a big presence, and she stayed with him all day. Cats are like that. During the last three days of his life, she remained curled up under his arm until the nurse came to call. At that point, his wife had to resort to oven mitts to drag her off the bed. She’d howl and screech as only a Siamese can, and the moment the nurse departed, she’d run silently up the length of his body, then kiss his face and curl up back under his arm. She was there, in fact, when he died.

John Francis Brown, a talented athlete who played football for West Point and was an expert skier and skin diver, projected the same discipline into an illustrious career. Awarded a master’s degree from Princeton and a doctorate of Arabic history and philosophy from the American University of Beirut, the meticulous scholar spent the last 11 years of his career chairing the Arabic department at the Defense Language Institute (DLI) in Monterey.

To be relegated to his bed — trapped, really — for the final months of his life was a sentence he never anticipated. But the laryngeal cancer discovered in 1998, followed by lung cancer nearly four years later, had robbed him of more than his energy. Reading was exhausting. Thinking about the inevitable could be overwhelming.

That’s when Community Hospital’s Transitions program stepped in, sending Magnus Toren to spend quality time with Brown.

“The librarian for the Henry Miller Library in Big Sur, Magnus spoke French and German and shared John’s intellectual being,” says John’s wife, Beth Brown. “A great big, tall, slender man, Magnus quietly came in every Wednesday morning and spent two hours with John while I went to play tennis. They’d visit and talk about books, and he’d ask me if I needed anything done around the house.”

Toren brought books on tape and shared a common knowledge of computers with John. Mostly, he was a good listener.

“As a volunteer,” says Beth,“Magnus was so well trained. I knew he could take care of anything. He had such a sweet, loving personality; it was as if some wonderful force had come into the house. John said the one nice thing he could say about his illness was that it had been a privilege to know Magnus. For a man not terribly magnanimous about people, it was quite a telling statement.”

During the last two weeks of his life, Brown received full hospice care. The phlebotomist spoke French with him and brought him packages of freshly caught fish. The nurse, who came in at midnight to help Beth administer medication, became like a daughter to him. The night he died, she stayed until 1:30 in the morning.

“John had just had his 80th birthday,”says Beth, “and we’d just celebrated our 12th wedding anniversary when he passed away. It was a terrible time, but I have to tell you, I can’t speak highly enough about the people who helped us. Everything was done with such tact and grace; you really can’t ask for more than that.”