A friend at the end

As a nurse, Eileen Ryan is attentive to her patients in many typical ways, such as taking vital signs and providing medication. But in one important way, her role is different from that of most nurses.

She knows her patients will not get better. In fact, they will die, sometimes within weeks, almost always within months.

Ryan is a hospice nurse for VITAS Hospice in South Philly at St. Agnes Hospital. Her patients have an estimated prognosis of six months or less, otherwise they are not eligible for hospice.

"This is end-of-life care," said Ryan, who has been with the facility for four years. "Our goal is pain control and comfort – emotional and spiritual comfort, as well as physical."

VITAS, which is Latin for "life," is a nationwide hospice-care provider. As with all programs, its focus is on comfort and palliative care for patients when medical treatment can no longer help.

St. Agnes’ 28-bed unit is one of only three in-patient hospice facilities in Philadelphia. Although most involve caring for patients in their own homes, the VITAS unit at St. Agnes is for those whose illnesses are difficult to manage at home.

Ryan typically takes care of four to six terminally ill patients each day. The differences lie in their diagnoses and their ages. Her youngest patient was 25; her oldest, 101.

"We have all ages, all cultures and races," says Ryan, 54. "It’s a very diverse mix."

Because of its location, many come from South Philly, but the program does receive patients from all over the area. Being a South Philly native and resident, those are the families that stick out most in Ryan’s mind.

"The South Philly families are often so warm and so appreciative of our care," says Ryan, who lives in the South Park area.

Pain control is a major focus of hospice care, but so is emotional support.

"Part of our role is helping patients and families cope with all the emotion and apprehension that comes with end-of-life care," says Ryan. "The doctors have told them, ‘This is it. All we can do now is make you comfortable.’

"So there’s a whole process of adjustment to this new reality. Many times it’s very scary at first. You can tell from the body language how apprehensive and emotionally vulnerable they feel."

FROM THE START, Ryan makes an effort to alleviate families’ anxieties. Welcoming the patient and family to the unit, Ryan invites the family to relax in the lounge and encourages questions.

"I want to give them the feeling that we’ll do all we can to make this a comfortable experience," she says.

The physical environment even emphasizes comfort. Located on the fifth floor, the unit has a cozy, almost homelike ambience with wallpaper and matching curtains in the patients’ rooms, several comfortable lounges and a working kitchen for families who want to cook their own meals.

Moreover, there’s a 24-hour visiting policy. "Families sometimes basically live here and we tell them, ‘You can visit for as long as you like,’" Ryan says. "We try to accommodate in every way we can."

She and the other hospice nurses are attentive to patients’ needs and the hospice staff also includes doctors, a social worker and a chaplain.

Quite often, the emotional needs of patients outweigh the medical.

"I’ve sat at bedsides and held their hands," Ryan says. "I’ve prayed with them and I’ve cried with them."

If appropriate, she also tries to address their fears about dying.

"I have patients who are alert and oriented," she says. "They’ll say, ‘I know the diagnosis and I know I’m going to die. What will it be like? Is it going to hurt?’ And I assure them that we’ll do all we can to make the final moments as comfortable as possible."

She often builds close, even intense, bonds with her patients.

For instance, a man in his 50s with advanced lung cancer was a South Philly native. Although he had moved to Center City, the South Philly connection became an important one between the two.

"I sat with him and talked about the old neighborhood," said Ryan. "I tried to bring back pleasant memories of a time when he was healthy."

When she found he enjoyed stage plays and show tunes, she arranged for his brother to bring in his compact disc player and his recordings.

But the patient also was feeling great anxiety. In addition to sitting with him and encouraging him to reminisce about the past, Ryan assured him he would not be in pain at the end.

"It definitely had an effect," she says. "When he relaxed, his breathing difficulties subsided and he calmed down."

He lived only two weeks after being admitted. Ryan knew when his death was imminent and she made sure he had effective pain medication.

"He went to sleep and he died very peacefully," she said.

Trained to recognize the signs of impending death, part of her role is to prepare the family for the final stage.

"We can usually tell in advance when a patient is at the beginning of the end," she said, "and we make the family aware of the physical changes that will take place. It helps them cope so they’re prepared for what happens. And it takes away the fear of the unknown."

She emphasizes the dying patient’s hearing remains so she urges the family to talk to them.

"I say, ‘Tell them you love them.’ I reassure them that their loved one hears everything, even if they can’t speak," she says.

She adds, "I like to tell the family that they’ve been given the gift of time to spend with their loved one. They have the chance to say, ‘I love you’ before the end. When everything’s over, that’s something they can keep the rest of their lives."

Ryan keeps something, too. Even though her work involves loss, she gains satisfaction knowing she has helped people at a crucial time. Often family members will return to thank Ryan or other hospice staff members.

"It’s so gratifying to know that people are so appreciative of everything we do," she said.

Her commitment to hospice nursing evolved during a 34-year career in the field. After graduating as an licensed practical nurse in l971 from Misericordia Hospital School of Nursing, she held various nursing positions, including working in assisted living facilities and nursing homes and as an operating-room nurse at St. Agnes.

Four years ago, she joined the hospice staff of VITAS at St. Agnes. Outsiders – and sometimes her own three adult children – occasionally wonder how she can choose a career that involves dying and loss.

"They say ‘Mom, how can you do this?’" she said, "But I can’t imagine doing anything else. I totally love what I do. I love working with patients and their families and giving them comfort at a very difficult time in their lives.

"And my patients teach me how to live. They’ve been handed a death sentence and they make me realize what’s important in life – health and family above all. And they remind me to set priorities, because you never know when you’ll have to say goodbye." For information about VITAS Hospice at St. Agnes, call 215-339-4320 or 1-800-209-1080.