Journal of Sacred Work

I wish that you could see what I see; the radiance of your soul. 

This afternoon a call came in from our hospital liaison nurse, she was asked to coordinate a discharge home for a 50 year old woman with cancer and complex wounds that required a wound-vac, which is very expensive equipment. The hitch, the patient is in the last phase of her life and has significant pain and symptom issues. The family wants and needs hospice care.

The dilemma is that the insurance will not pay for two agencies to care for this patient at the same time. Only one service can bill. The cost of equipment and supplies (thousands per month) is prohibitive for hospice to cover under their reimbursement. The equipment would be covered under  Home Health and we could offer the nursing expertise. We discussed a seemingly viable option for the patient to receive home health palliative care and transition to hospice when the wound-vac was no longer needed.

Our proposal was presented to the oncology case manager. However, she was adamant that the patient needed hospice today! Angrily she said, “We need to think outside the box and make this happen.” I could hear the urgency in her voice.  I asked if I could have 5 minutes and get back to her. There was a lot of pressure to make a decision, NOW. I hurried to consult my boss.

Wheels in motion, we convened a conference with the stakeholders; the hospice director, hospice manager, and home health manager, liaison nurse, my boss and me. Bottom line, we said, “Yes, we will do this!” Next, came the multiple calls and procedural challenges and that are too numerous to mention but they involved a lot of logistics as to who would be the primary service, what doctor would write orders, equipment, billing, authorization, etc. It was complicated with no easy answers and the patient was going home…tonight.

After speaking to the patient’s husband by phone the hospice manager said, “This man was so nice and he said to me, ‘please help us’ ”. It was the defining moment. There was no longer any question in the Hospice Manager’s mind, “This patient needs hospice.” Wheels churning now, schedules were rearranged. The Hospice Manager (a social worker) left the office to relieve a Hospice Nurse on assignment so she could go to the hospital immediately, admit the patient and follow her home.

At 6:30pm, after working a full day, this manager took initiative to venture out to another patient’s home to free up a nurse. I admire this caregiver’s dedication and commitment to Radical Loving Care. Throughout a tense situation she maintained good humor and a loving attitude. Her plans to leave town for the w/e would be delayed.

We all left work with the satisfaction of knowing we came through for this patient and family. We did not let the rules, regulations, barriers or the red tape of healthcare  get in the way. This woman’s wishes to go home would be honored. She will spend her last days at home surrounded by the love of her family and friends. She will have the expertise and support of the hospice team and if problems arise with the wound-vac, a home health nurse will come to the rescue.

 We did not figure out the financial part yet, the insurance verification department was closed for the day. We will figure all that mess out come Monday.

I am grateful to work with  a group of people who will sometimes break the rules and step out of the box in favor of doing the right thing. It makes all the difference in the world, especially to one woman and her family tonight.

Liz Sorensen Wessel