Suspended Between Life And Death -- Kirkland Hospice Center Opens To Care For The Dying, And Those Who Must Live On After Them

Ralph Maddux doesn't like to admit it, but he finally became stooped from lifting his wife so much.

That was last fall, after surgeons treating his wife, Jean, had made their second attempt to remove a tumor from her brain. For a month Ralph, who is 77, cared for her by himself in their Kirkland home. Each day, he turned her, fed her, bathed her.

Doctors discovered Jean's tumor 20 years ago. They operated twice, but the tumor still dragged her steadily down, like an undertow pulling silently on an ocean swimmer. Eventually, she became partially paralyzed. Since her operation last September, Jean, 74, could barely communicate.

"I'd say, `Is your head hurting? And if it is, just blink your eyes,' and she'd let me know if she was in pain," Ralph remembered.

He turned for help to home nurses and aides. Eventually, even that wasn't enough.

"It got to the point where I just couldn't do it," said Ralph, shaking his head. "I just couldn't do it it anymore."

Finally, in February, as Jean's condition worsened, he took the advice of one of the nurses and had his wife admitted to a new center on the Eastside, the Evergreen Hospice.

Home hospice care - where doctors and nurses care for the terminally ill in their homes - is a growing trend in the nation's medical industry. But free-standing, in-patient hospices, while popular in Britain, remain unusual in the United States.

Besides the 15-bed Evergreen Hospice Center, which opened in Kirkland in February, the only other freestanding hospice in the state is a facility in Longview.

In-patient hospice care serves people who don't want to die at home and helps lift the burden from people such as Ralph Maddux, who attend to dying loved ones. The hospice also accepts terminally ill patients who need a few days of professional care, then go home.

Most people, however, come to the hospice to die.

With carefully balanced prescriptions of drugs, hospice staff members help many patients remain lucid and pain-free during their final days.

It's the period hospice workers call "pre-death."

"Pre-death" can be an agonizing experience for the terminally ill. It is a time suspended between life and death, when many patients are so busy avoiding death that they are unable to enjoy the last days of their life. The hospice tries to take the pressure off.

The hospice treats what its administrator, Gerri Haynes, calls the "whole family patient unit."

That distinction recognizes that a person's death is only the figurative pebble dropped into a pond; the ripples of grief that affect family members and friends also must be addressed.

Bereavement classes, where survivors gather to work through their feelings, are offered to those who knew the deceased.

Ultimately, those who work at the hospice hope to comfort their patients not by curing, but by caring.

"In our society, there's not much emphasis placed on dying," says Dr. Claude DeShazo, a surgeon who is medical director at the hospice. "But the dying process is just as universal and rewarding as birth."

Ralph Maddux virtually camped out at the hospice from the day Jean was admitted.

He sometimes slept on the hide-a-bed in the room with his wife of 53 years. Volunteers spent time with Ralph when he needed a break from his vigil. He took his meals at the hospice, too.

He got to know two nurses who always seemed to be on duty, Celia Harper and Kay Hovland.

During Jean's last two days, the hospice's pet dog - a scruffy Airedale mix named Ignatius - followed the old man wherever he went.

Ralph came to realize that the hospice was not only attending to his dying wife's needs, but to his as well.

That's by design.

"It is not a sad place," he says. "If I had not felt the warmth of the people who were supporting me, it would have been even rougher.

"The whole atmosphere is one of compassion and caring, not just for the one who is ill, but for the one who's left."

Jean Maddux died March 7 in the hospice. Hovland was in the room at the time, along with Ralph, other members of the family and their minister.

In the end, Jean's passing appeared to qualify as what the hospice staff calls a "good death."

"Hospitals can offer high-tech care," said Kay Kukowski, bereavement coordinator of Evergreen Hospital. "Hospice offers high touch.

"Hospice treats not just the physical part of dying, but also the emotional part of dying, the spiritual part of dying, even the financial part of dying."

To make good death possible, the hospice has nurses, counselors, a social worker, who advises on financial matters, a chaplain, who has a chapel.

It has windows that open (Haynes rejected original architects' plans that called for permanently shut windows), glowing hardwood floors and handsome wainscotting. Sitting rooms for families are full of comfortable furniture. The hospice is also open to visitors 24 hours.

When the landscaping is finished, a soothing brook will curl through a garden in the back.

The center also has trained volunteers who sit and talk with survivors when the sad hours grow long or when memories need their release. Family members are offered grief counseling that can last months.

"It doesn't seem like a hospital at all," said Arthur Smith Sr., whose 46-year-old son, Arthur Jr., died of colon cancer in the hospice on April 14. "It's more of a homey atmosphere."

Homey, right down to the litter box in one of the sitting rooms.

The litter box is for Reggie, a peanut-colored Persian cat of frosty bearing. Reggie perches patiently on the laps of grieving family members, such as Billy, the son of the late Arthur Smith Jr., so they may comb their fingers through his cotton-candy coat.

The idea of the Evergreen hospice has been around for at least a decade, says DeShazo, who has worked as a surgeon for 17 years.

A Mississippi native, he also served as a combat surgeon with the U.S. Marine Corps during the Vietnam War.

For DeShazo, the important statistic is 50 percent. That's the proportion of cancer patients who die today, even with all the developments in medicine.

"I just began to become aware that no matter how good I was as a surgeon or how excellent the care was at our hospital, that not everyone was cured," he said. "People die."

Like DeShazo, many of the nurses at the hospice are veterans of the cancer ward at Evergreen Hospital Medical Center, the hospice's parent institution. They are trained in the care of the terminally ill. Yet they grew frustrated with the traditional definition of such care.

"The main expectation of the hospital is that you're very professional and that your clinical skills are honed, not that you're really caring or feeling for that person," said Harper, a hospice nurse. "You're there to help solve a very specific problem.

"You can't go into the next room with tears running down your face and tell them the patient next door has just died."

Because death is a frequent caller at the hospice, and it is accepted and never denied.

A rose is placed on the pillow of each patient who dies, including Jean Maddux.

"In this day and age, a person does not have to die in pain," said Ralph Maddux. "And that hospice helps you through the ups and downs.

"I lost Jean, and I miss Jean, but I feel like I made a bunch of new friends."

Since the hospice opened two months ago, 34 people have been admitted to the hospice and 19 have died there. The constant loss at the hospice - even with all the earnest talk of spirituality - can prove stressful for the people who work there.

"None of us imagined it would have as much impact as it is having," said Hovland.

She adds that the stress seems to be compounded by the personal relationships that commonly develop between staff members and families of those who die. Nurses even routinely attend funerals.

The hospice has started a staff-support group. And the first staff meeting in February turned into a memorial service.

"We stood in a circle," recalls Hovland. "There was a dish full of sand that had candles in the middle.

"We discussed one by one each patient who had died here, and how we felt about it. Then each candle was lit, a candle for each patient who had died."

But while the business of the hospice is death, no one talks of "losing patients." Success has a different definition here.

"We succeed if people are free of pain, free of anxiety and accepting of death," DeShazo explained.

"In the cacophony of the acute-care hospital amid all the action going on there, sometimes a person dealing with the personal issues of their life is simply eclipsed.

"We try to give those issues room to breathe here." ------------------------------------------------------------ Evergreen Hospice

-- Publicly owned: In November 1988, voters in King County Hospital District No. 2 approved a $4.4 million bond issue to build the 15-bed hospice. It opened in February on the hill directly east of Evergreen Hospital Medical Center.

-- Service area: The hospice and its affiliated hospital, Evergreen, serve northeast King County, including the communities of Bothell, Kenmore, Kirkland, Redmond and Woodinville. People from any community can be admitted to the hospice, however.

-- Learning about grief: The Evergreen Hospital Medical Center offers a six-week bereavement class for people who recently have lost a loved one. The next series begins April 30 and continues on successive Tuesdays. Afternoon or evening classes are available. It's free. Call 881-1668.