Eight people were standing around Betty Doebel's bed, trying to figure out how to move her to a stretcher without breaking any bones.
The hospice team had been anxiously rehearsing this moment for weeks, ever since Doebel had decided that she wanted to go back home to the Pennsylvania hills to die.
Inoperable cancer had spread throughout her body, including her skeleton. Her bones were so brittle with cancer that one day last August, as the nurses were turning her in bed, her left thigh bone crumbled. The leg was now in traction, a 10-pound sandbag dangling from the foot of her bed to hold the bone fragments more or less in place and keep them from rubbing against each other. The slightest pressure on her leg was excruciating.
Near Childhood Home
And now the hospice team was about to try to transfer her to a stretcher and into an ambulance for a 127-mile drive to a Bedford, Pa., hospital near her childhood home.
No one knew exactly how much time Doebel had left, but it wasn't likely more than a few months. At 54, after nearly 30 years in the Washington area, what she wanted most was to move back home.
"She said she wanted to go back to the farm and look out the window at the mountains," said her husband, Leo. "OK, lady, whatever you want."
Doebel knew the risk. She had been warned that she might not survive the journey. The motion and stress could dislodge a potentially fatal blood clot or throw her blood calcium out of whack. Sheer pain could send her into shock.
"I'm facing the unknown," she said. "I don't know what's going to happen."
"We'll just get a whole bunch of people and all pull together, and pray," said Leo Doebel, pacing outside her room.
While Betty Doebel closed her eyes and tried to forget what was happening, the team of eight fashioned her bed sheet into a kind of hammock and slide-lifted her ever so gingerly onto the blue foam "egg-carton" mattress on the stretcher alongside her bed.
It worked. A cheer--more relief than exultation--rose from around the room. Doebel opened her eyes, smiled, closed them again.
They wheeled her down the hall, interrupted by farewells from the hospice staff and other patients, and out into the sunshine. Two ambulance attendants lifted the stretcher into the back of the van.
Eyes shut against the glare and pain and fear of pain, Doebel lay motionless on a kind of nest, her stretcher and foam mattress buttressed by sandbags. Her stuffed white rabbit, Snuggles, rested by her left shoulder, and an automatic pump the size of a cigarette pack fed continuous morphine directly into her bloodstream through a tube in her chest.
Doebel's hospice nurse, Norah David, climbed into the back of the ambulance. It was her day off, but missing this trip was unthinkable. She made sure that they had everything: X-rays, medicines, six extra pillows, apple juice, crackers, lollipops, a trash bag. The ambulance pulled out, Leo following in the family Ford.
On a beautiful bittersweet fall day, Betty Doebel was going home.
The term "hospice" derives from a medieval word for a wayside shelter for travelers on difficult journeys. The Oxford English Dictionary defines it as "a house of rest" for pilgrims, travelers, the destitute or the sick.
The word has come to mean a place or way of caring for the terminally ill and their families. Modern-day hospices are modeled on St. Christopher's in London, founded in 1967.
Hospices do not use extraordinary medical means--such as blood transfusions or an artificial respirator--to treat a dying patient when prolonging life would merely prolong the patient's death. When death occurs, there is no attempt to revive the patient.
The first hospice in the United States, Connecticut Hospice Inc. in New Haven, was founded in 1974. Now there are an estimated 1,500 hospice programs around the country in various stages of development, including about 1,000 already open. More than 100,000 Americans received hospice care last year, according to the National Consumers League.
Hospice of Northern Virginia, Betty Doebel's way station on her journey home, was founded in 1977 and is the largest of nearly a dozen hospices in the Washington area.
Some Provide Home Care
Some hospices are based within hospitals; others exclusively offer home care through a visiting-nurse service. Still others, like Hospice of Northern Virginia, are free-standing programs that provide both home care and inpatient care.
What they share is a commitment to viewing death as an integral part of life and to improving care of dying patients for whom medical cure is no longer a realistic possibility.
Hospices are not for everyone, and they have no monopoly on compassionate care of the gravely ill. They are intended to supplement conventional hospital care, not to supplant it.