SAN DIEGO — Emma Martin is dying of multiple myeloma, a form of bone cancer. The 67-year-old woman is at home, and her husband, Norman, is by her side, 24 hours a day.
San Diego Hospice is there, too, for scheduled visits during the week, and for emergencies, in the form of a team--a nurse, a social worker, a home health aide, a volunteer or a chaplain.
Norman Martin, 67, was a prisoner of war during World War II, and he needed a lot of help after that, he said, just as he needs and appreciates the help he is receiving now.
"Without (the hospice team), I would be dead," he said. "You give them a call and they are always there--even Gail, the girl who answers the phone, is worth her weight in gold.
"If my wife has a problem at night, they page the nurses--get hold of the doctors. It's the greatest thing. So good. There's love in their hearts."
Supported primarily by insurance funds, Medicare, Medi-Cal and donations, San Diego County's hospices have served thousands of dying people and their families, helping the family to care for the dying patient at home with a team of medical and counseling professionals and volunteers.
Daniel Bressler, medical director of San Ysidro Health Center, said, "Hospices in England are residential. People go and stay until they die. Here they are home services which allow people to go home, and drugs are given for comfort. But the patient has to be appropriate for it--has to want it. It's not for everyone. There has to be a lot of family willingness and acceptance. . . .
"Some people don't want to be told they are going to die in six months. These people would rather go home and hire a non-hospice nurse rather than have hospice people in their home constantly reminding them they are terminal."
The idea was begun in London by Dr. Cicely Saunders in 1967, and the first hospice in the United States was opened in New Haven, Conn., in 1974. Now there are 1,300 in the United States, five of them in San Diego. The oldest, San Diego Hospice, was started in 1977.
According to Dody Eiler, executive director of Elizabeth Hospice in Escondido, "The hospice concept is growing like mushrooms."
The number of terminally ill patients requiring hospice care is increasing, due in part to rising costs of medical care, increased longevity and AIDS.
San Diego Hospice is nonprofit and serves 100 to 130 people daily. Hospice of the North Coast, in Encinitas, started in 1978, has a caseload of 30, is also nonprofit and is affiliated with Scripps Memorial Hospital-Encinitas and Tri-City Hospital in Oceanside. Elizabeth Hospice in Escondido, also nonprofit, was started in 1978 and serves 20 to 30 patients each week in the Palomar-Pomerado Hospital District. Horizon Hospice in Poway, started in 1984, serves an average caseload of 20, and is a for-profit, proprietary hospice.
Kaiser Permanente, San Diego's largest health maintenance organization, started a hospice program in August and serves 15 patients at its El Cajon facility.
The not-for-profit hospices are financed mainly by insurance, donations and fund-raising. San Diego Hospice is also Medicare-certified, as is Horizon Hospice.
True Ryndes, director of clinical programs at San Diego Hospice, said there is a difference between pain and suffering--and that hospices understand both.
"Pain has to do with the physical burning or crowding of a tumor," he said, "but suffering has to do with the anguish people experience when they separate from loved ones. We try to help people get rid of not just the physical pain, but the anguish, anxiety, depression, insomnia, anger and fear."
The hospice, too, he said, has to do with healing, not curing. "The ability to cure the disease does go away, but symptoms can be controlled, and the patient can be made comfortable, and relationships can be healed," Ryndes said. "We help the patient determine if he or she is in right relation to themselves, to others, and in right relation to a higher power, however they see that.
"When there is nothing to be done to cure the disease, there are significant things which can effect healing.
"We . . . act as a team. This is one way in which we differ from (traditional) home health care. It is an integrated approach. My staff is trained specifically to deal with terminal illness. I think together we've created Marcus Welby.
"A nurse may be a spiritual guide, as well as a counselor, as well as a nurse."
Linda Cunningham has been a hospice nurse for five years. "I wouldn't change this job for any other in the world," she said. "Our role is to go in and allow the family to make their own choices. These people aren't just dying patients, they are the same people they always were. I feel it is important to let them know their day counts, and is valued by me as well.
"Years ago, our aunts and relatives lived down the street. Now, with our nuclear families, this isn't so. It seems to me that the hospice team becomes almost an extended family."