Ruthann Truesdell, a registered nurse and case manager with 1st Choice Home Health and Hospice, applies lotion to Willie Mae Bowen's arms during a visit to Bowen's home in Kenai last week. Willie Mae and her husband Jack chose to use hospice care when Willie Mae was diagnosed with cancer.
M. Scott Moon
Willie Mae Bowen sits in an easy chair in the corner of the living room of the cozy log home just off Strawberry Road. She and her husband Jack built the home themselves after they came to the Kenai Peninsula 40 years ago.
Willie looks tired, and she frequently closes her eyes between thoughts. She talks just above a whisper, but her face lights up when she talks about her home.
“When we moved up here from Bakersfield, the company put us in a trailer,” she says. “Our house in Bakersfield was paid for, and I resented the fact that I couldn’t live in a house. I finally conned him into building me a house.”
Fresh snow is falling outside, but inside, the Bowen’s house is comfortable and warm. A cat stretches out on the living room floor, occasionally batting at a toy. Several books rest on the coffee table along with a Bible, next to information Willie has compiled about herself for her obituary.
It is the place Willie has chosen to die.
Willie was diagnosed with cancer last March. She wasn’t feeling well after returning from a trip to Yuma, Ariz., and after several nights of not being able to sleep, she had Jack take her to the doctor. When an MRI was recommended, she declined.
“I said, ‘No, I’m not going to do that, because I know what I’ve got. I know I’ve got cancer, and I don’t want to be operated on,’” she said.
Truesdell and Jack Bowen discuss changes to Willie Mae's medications at the end of one of Truesdell's visits.
M. Scott Moon
“My mother had been operated on for the same thing. She died a miserable, horrible death. I don’t want that, although I’m coming to the conclusion it’s all going to miserable.”
While Willie talks, Ruthann Truesdell, a registered nurse and case manager with 1st Choice Home Health and Hospice, goes over directions for a new pain-management medication with Jack. Ruthann asks Jack if she needs to write it down. Jack says he’s got it, but Willie thinks otherwise.
“Just because I don’t make mistakes is no sign he doesn’t,” she says, smiling.
Jack takes the good-natured barb in stride.
“She’s flown co-pilot with me for a long time, so she knows me pretty well,” he says.
Ruthann has finished a physical examination of Willie, checking her vital signs and making sure she’s comfortable. The tumor is behind Willie’s left shoulder blade, and she’s been having pain in her arm. Ruthann wants her to try a medication delivered by a patch applied to the skin, which wouldn’t make her sleepy like the oral pain medication she’s on. She’s concerned about finding the proper dosage, though. With the other medication, it took several tries to find a dosage that helped Willie manage her pain without knocking her out for the day.
“Her prime goal is to not sleep through all this, but I explained, as you get closer to the end, you’re going to get sleepier,” Ruthann says.
Her medical care and paperwork completed, Truesdell reads Psalms from the Bible before concluding a visit. Helping patients and their families with their spiritual needs is an important componenet of hospice care, according to Truesdell.
M. Scott Moon
When she finishes getting medications organized, Ruthann asks Willie if she’d like her to read from the Bible. Willie’s eyesight has been affected, and she is able to read just some of the time.
Tending to the spirit is part of the hospice mission, and faith is very important to Willie. She and Jack are members of the Soldotna Church of God.
Willie makes a joke about not wanting to hold up the photo shoot, smiling toward the newspaper photographer and reporter sitting on the couch. After assurances that we don’t want to interfere with her routine, Ruthann begins reading from the book of Psalms.
Ruthann’s experience with hospice care goes back to her nursing school days, when she was able to participate in a hospice program. A patient she had been working with died just before she graduated, and she was invited to a family-only service.
“Most people wouldn’t think of being at a death, or being part of the dying process, as something they would want to do, or would feel rewarding or feel like a privilege, but being at a death, to me, is more important than being at a birth,” Ruthann said.
Ruthann Truesdell, registered nurse and case manager, 1st Choice Home Health and Hospice.
“At the end, you can help them work through the process, help the family work through the process. It’s just very rewarding. It’s a privilege to be a part of it. I owe them my thanks for sharing a very intimate part of their life with me.”
Ruthann finished nursing school 20 years ago, and though she’s moved around the country since then, she’s looked for opportunities to be involved in hospice care everywhere she’s lived.
Nationwide, the number of patients served by hospice continues to rise. According to the National Hospice and Palliative Care Organization, 1.2 million patients received hospice services in 2005, and one-third of all deaths in the United States were under the care of a hospice program.
On the peninsula, 1st Home Health and Hospice is a certified hospice provider. The agency provides skilled nurses and physicians and works hand in hand with Hospice of the Central Peninsula, a volunteer hospice organization, to provide end-of-life care.
Care goes beyond simply making sure a patient is comfortable. Hospice services also cover the emotional well-being of both a patient and the patient’s family, with grief counseling and chaplain services.
Hospice of the Central Peninsula maintains a loan closet of medical equipment and can provide information or referrals to other community services.
Volunteers also help with chores and errands, and provide companionship for patients, as well as a time to rest for their caregivers. An interdisciplinary team, which includes care and volunteer coordinators, physicians and a chaplain, meets regularly to discuss patient needs, from medical to spiritual.
Time is the most important thing hospice care offers patients and their families.
“We’ve had lots of time to talk, about what to do with this and what to do about that,” Jack said. “The only thing I regret is that she’s going ahead of me. We’d like to be buried in the same box. We can’t do that, but that’s been the good thing about it, we’ve had time to discuss things and time don’t wait for no man.”
“I’ve got all my things together, my clothes, my notes. I’m just about ready to depart,” Willie said, as though she’s getting ready for another trip in the RV.
Willie said the regular visits from nurses, doctors and volunteers associated with hospice have been a blessing.
“It gives me quality time at home. Your life goes on, but it’s better to be at home than in a hospital bed,” she said.
“I don’t want to go. I’m not ready to leave, but I am ready as far as getting everything in order. I’ve got it done up as well as I’m able to do it. I guess you’re not ever fully ready.”
Jack and Willie have had lots of time together. They met in school in Bakersfield Jack was a cowboy from Oklahoma, Willie was a city girl from Florida. They’ve been married for 68 years, and Willie says there’s no secret to staying together that long.
“If we had something to fight about, we fought about it. We didn’t run. We worked it out, and we were compatible,” she said.
When Jack retired from oil field work in 1990, they decided to stay in Alaska instead of heading south.
“We found out we were too bushy to move Outside, so we stayed here,” Jack said.
This is the first winter in several years they haven’t spent traveling south in their motorhome, though, and when Willie talks about their travels, it sounds as though she’d like to take one more trip.
Willie Mae talks with the Bowens' cat, Lulu, as her husband Jack receives guidance from Truesdell. Hospice takes a team approach to care and works with patients and their families, as well as other medical workers, to make them as comfortable as possible.
M. Scott Moon
“I don’t want to go, I don’t want to leave,” she said again. “We have a motorhome, we’ve been going Outside, it will be awfully hard. We’ve got a boat, and an airplane, so we’re quite active I don’t know what Jack is going to do.”
Jack and Willie’s sons, Johnny and Mickey, have stayed in the area, and Jack and Willie have been able to watch their grandchildren grow up and become parents themselves.
“I made peace with the boys. They said it’s OK to go this way. I’m not young; I’m not leaving behind babies. I feel more at ease about that,” Willie said.
Johnny still lives next door to his parents. He’s grateful for the care his mother has gotten through hospice.
“We don’t want to see her go, but we’re all going to be facing that threshold sometime,” he said. “I’m 55. If I was faced with the same situation, I think I’d go the same way. I think Mom, especially at 79 years old, I think she made the right choice.”
Will Morrow can be reached at firstname.lastname@example.org.
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