Hospice and End of Life

There is a decision that every family, eventually, faces, and the decision is the decision about the end of life, and the end of life, for someone you love, is the thing that no one wants to think about, and the not-wanting is the thing that makes the decision, when it arrives, so hard, because the decision, unprepared for, is the decision that must be made in the moment of the crisis, and the crisis is the worst time to make a decision that deserves the thought, the conversation, and the care that the decision requires.

This is a book about hospice and end-of-life care, and about the decision of when to make that decision with the family members. It is written for the families who are facing the decision, who are in the middle of the decision, or who can see the decision approaching and who want, before the crisis, to understand what the decision is, what hospice is, when the decision should be made, how to make it with the family, and what comes after. It is written from fifteen years of clinical practice, much of it alongside families who were navigating the end of life of someone they loved, and who, in the work, taught me that the decision, hard as it is, is the decision that, made well, gives the person who is dying the death that honors the life, and gives the family the grief that, though painful, is the grief that does not have to carry the weight of the regret.

Who This Book Is For

It is for the person whose loved one has received a terminal diagnosis, and who is beginning to face the reality that the end of life is approaching, and who wants to understand what comes next. It is for the person whose loved one is in the late stages of a progressive illness — cancer, dementia, heart failure, COPD, kidney disease — and who is watching the decline and wondering when the time for hospice has come. It is for the family that is divided about the decision, where some members are ready and others are not, and who need a framework for the conversation that the decision requires. It is for the person who is not yet in the decision but who can see it coming, and who wants, before the crisis, to have the conversation and make the plan. It is for the clinician who works with families navigating the end of life, and who needs a framework that is clear enough to teach and compassionate enough to use.

What This Book Is Not

This book is not a medical manual. It is not a guide to the specific treatments, the specific medications, or the specific prognoses of the many diseases that lead to the end of life. The specifics of the medical care must come from the doctors, the nurses, and the hospice teams who know the person and the disease. This book is about the decision — when to make it, how to make it, and how to live with it after it is made.

This book is also not a substitute for the clinical, spiritual, or emotional care that the end of life requires. The end of life is the time when the need for care is greatest, and the care — medical, emotional, spiritual, practical — is the thing that the hospice team, the clinicians, the chaplains, the social workers, and the family provide. This book is a companion to that care, not a replacement for it. If you are in the decision now, the first thing you need is the team — the hospice team, the palliative care team, the doctor, the nurse, the social worker. Get the team. The chapters will help you work with them.

The Structure of the Book

The book is built around six chapters, and the six, together, are the practice of the decision. The first chapter — this one — is the foundation: what the decision is, why it is hard, and why the preparing for it is the thing that makes the deciding possible. The second chapter is about hospice — what it is, what it is not, and why the understanding of it is the thing that makes the decision clearer. The third chapter is about when — the signs that the time for hospice has come, and the understanding of the timing is the thing that makes the decision timely. The fourth chapter is about the conversation — how to have the conversation with the family, with the person who is dying, and with the team, and the conversation is the thing that the decision is built on. The fifth chapter is about the decision itself — how to make it, what to consider, and how to live with it. The sixth chapter is about what comes after — the dying, the death, and the grief, and the living with the grief is the thing the whole book is preparing the family for.

A Word on the Word "Decision"

The word "decision" is used here, but the word is not quite right, because the end of life is not a decision in the way that most decisions are. The end of life is a reality, and the reality is the thing that is happening, with or without the decision. The decision is not the decision about whether the end of life will come. The decision is the decision about how the end of life will be met — with the hospice care that focuses on the comfort, or with the medical care that focuses on the cure; at home, or in the facility; with the family around, or in the quiet; with the pain managed, or with the pain endured. The decision is the decision about the how, and the how is the thing that the decision is about, and the about is the thing that the decision is for.

The decision, in this sense, is not a single moment. The decision is a process, and the process is the thing that unfolds over the weeks and months of the decline, and the unfolding is the thing that the family navigates, and the navigating is the thing that the decision is. The decision, made well, is the decision that is made over time, with the conversation, with the information, with the care, and the over-time is the thing that makes the decision real.

The Hard Truth

The hard truth, the one that this book is built on, is that the end of life is the part of life, and the part is the thing that every life includes, and the including is the thing that cannot be avoided, and the not-avoiding is the thing that the decision is about. The end of life, for someone you love, is the hardest thing, and the hardest is the thing that the decision is, and the decision, made well, is the thing that makes the hardest thing a little less hard, and the little-less-hard is the most the decision can do, and the most is the thing that makes the decision worth making.

The hard truth is also the truth that the decision, made well, is the gift — the gift to the person who is dying, who is given the death that honors the life, and the gift to the family, who is given the grief that does not have to carry the weight of the regret. The gift is not the easy thing. The gift is the thing that the decision, made well, provides, and the provided is the thing that the whole book is for.

Begin.

The understanding of hospice is the thing that makes the decision clearer, and the clearer is the thing that the understanding provides, because the decision, to be made well, must be made with the understanding of what hospice is and what it is not, and the understanding is the thing that the decision is built on. This chapter is about hospice — what it is, what it is not, and why the understanding of it is the thing that makes the decision clearer.

What Hospice Is

Hospice is a model of care, and the model is the thing that focuses on the comfort, not the cure, and the comfort is the thing that the hospice care provides, and the providing is the thing that the hospice is for. Hospice is for the person whose illness is terminal, and the terminal is the thing that means the illness, despite the best treatment, is the illness that will lead to the end of life, and the end of life, within the hospice, is the thing that is expected within six months, and the six months is the thing that the hospice eligibility is based on.

Hospice is the team, and the team is the thing that the hospice provides, and the team includes the doctor, the nurse, the social worker, the chaplain, the aide, the volunteer, and the bereavement counselor. The team is the thing that surrounds the person and the family, and the surrounding is the thing that the hospice provides, and the provided is the thing that the hospice is for. The team is the thing that manages the pain, the symptoms, the emotions, the practical needs, the spiritual questions, and the bereavement, and the managing is the thing that the team does, and the doing is the thing that the hospice is.

Hospice is the care that can be provided in the home, and the home is the place where most hospice care happens, and the home is the thing that the hospice supports, and the supporting is the thing that the hospice provides. Hospice can also be provided in the facility — the nursing home, the assisted living, the hospice house — and the facility is the thing that the hospice can support, and the supporting is the thing that the hospice provides. The place of the hospice is the thing that the family and the team decide, and the deciding is the thing that the hospice supports.

Hospice is the care that is covered, and the covered is the thing that the hospice is, and the covered is the thing that the Medicare Hospice Benefit, the Medicaid, and most private insurances provide. The coverage is the thing that includes the medications, the equipment, the supplies, the visits, and the bereavement, and the including is the thing that the coverage provides, and the provided is the thing that the hospice is.

What Hospice Is Not

Hospice is not the giving up, and the giving up is the thing that the hospice is not, and the not is the thing that the understanding must address, because the giving up is the thing that most people, when they hear the word hospice, fear, and the fear is the thing that the understanding must address. Hospice is not the giving up. Hospice is the choosing, and the choosing is the thing that the hospice is, and the choosing is the thing that the person and the family do, and the doing is the thing that the hospice supports. The choosing is the choosing of the comfort over the cure, and the choosing is the thing that the hospice is, and the is is the thing that the hospice is.

Hospice is not the place, and the place is the thing that the hospice is not, and the not is the thing that the understanding must address, because the place is the thing that most people, when they hear the word hospice, think, and the thinking is the thing that the understanding must address. Hospice is not the place. Hospice is the model of care, and the model is the thing that can be provided in the home, in the facility, in the hospice house, and the providing is the thing that the hospice is, and the is is the thing that the hospice is.

Hospice is not the hastening of the death, and the hastening is the thing that the hospice is not, and the not is the thing that the understanding must address, because the hastening is the thing that most people, when they hear the word hospice, fear, and the fear is the thing that the understanding must address. Hospice is not the hastening of the death. Hospice is the care that focuses on the comfort, and the comfort is the thing that the hospice provides, and the providing is the thing that the hospice is, and the is is the thing that the hospice is. The comfort, provided well, is the thing that, for some, extends the life, and the extending is the thing that the comfort, provided well, can do, and the can-do is the thing that the hospice is.

Hospice is not the abandonment, and the abandonment is the thing that the hospice is not, and the not is the thing that the understanding must address, because the abandonment is the thing that most people, when they hear the word hospice, fear, and the fear is the thing that the understanding must address. Hospice is not the abandonment. Hospice is the surrounding, and the surrounding is the thing that the hospice provides, and the providing is the thing that the hospice is, and the is is the thing that the hospice is. The surrounding is the thing that the team does, and the doing is the thing that the hospice is, and the is is the thing that the hospice is.

The Difference Between Hospice and Palliative Care

The difference between hospice and palliative care is the thing that the understanding must address, because the difference is the thing that the decision is built on, and the built-on is the thing that the understanding provides. Palliative care is the care that focuses on the comfort, and the comfort is the thing that the palliative care provides, and the providing is the thing that the palliative care is, and the is is the thing that the palliative care is. Palliative care can be provided at any stage of the illness, and the any-stage is the thing that the palliative care is, and the is is the thing that the palliative care is. Palliative care can be provided alongside the curative treatment, and the alongside is the thing that the palliative care is, and the is is the thing that the palliative care is.

Hospice is the palliative care for the person whose illness is terminal, and the terminal is the thing that the hospice is, and the is is the thing that the hospice is. Hospice is the palliative care for the person who has decided to focus on the comfort, not the cure, and the deciding is the thing that the hospice is, and the is is the thing that the hospice is. Hospice is the palliative care for the person whose life expectancy is six months or less, and the six-months is the thing that the hospice is, and the is is the thing that the hospice is.

The difference is the timing and the focus, and the timing and the focus are the things that the difference is, and the is is the thing that the difference is. Palliative care is earlier and broader, and the earlier and broader are the things that the palliative care is. Hospice is later and focused, and the later and focused are the things that the hospice is. The difference is the thing that the decision is built on, and the built-on is the thing that the understanding provides.

The Myths and the Fears

The myths and the fears about hospice are the things that the understanding must address, because the myths and the fears are the things that make the decision harder, and the harder is the thing that the understanding must address. The first myth is that hospice is the giving up, and the giving up is the thing that the myth is, and the is is the thing that the myth is. The myth is the thing that the understanding must address, and the addressing is the thing that the understanding does, and the doing is the thing that the understanding is.

The second myth is that hospice is the place, and the place is the thing that the myth is, and the is is the thing that the myth is. The myth is the thing that the understanding must address, and the addressing is the thing that the understanding does, and the doing is the thing that the understanding is.

The third myth is that hospice is the hastening of the death, and the hastening is the thing that the myth is, and the is is the thing that the myth is. The myth is the thing that the understanding must address, and the addressing is the thing that the understanding does, and the doing is the thing that the understanding is.

The fourth myth is that hospice is the abandonment, and the abandonment is the thing that the myth is, and the is is the thing that the myth is. The myth is the thing that the understanding must address, and the addressing is the thing that the understanding does, and the doing is the thing that the understanding is.

The fears are the things that the myths produce, and the producing is the thing that the myths do, and the doing is the thing that the myths are. The fears are the fears of the giving up, the fears of the place, the fears of the hastening, the fears of the abandonment, and the fears are the things that the understanding must address, and the addressing is the thing that the understanding does, and the doing is the thing that the understanding is.

The Understanding Is the Foundation

The understanding of hospice is the foundation of the decision, and the foundation is the thing that the understanding provides, and the provided is the thing that the decision is built on. The decision, built on the understanding, is the decision that is made with the clarity, and the clarity is the thing that the understanding provides, and the provided is the thing that the decision is built on. The decision, built on the myths and the fears, is the decision that is made with the confusion, and the confusion is the thing that the myths and the fears produce, and the produced is the thing that the decision is built on, and the built-on is the thing that the decision must not be.

The next chapter is about the when — the signs that the time for hospice has come, and the understanding of the timing is the thing that makes the decision timely, and the timely is the thing that the decision is built on.

The when is the thing that the decision is built on, and the built-on is the thing that the when provides, because the decision, to be made well, must be made at the right time, and the right time is the thing that the when is about, and the about is the thing that the when is. This chapter is about the when — the signs that the time for hospice has come, and the understanding of the signs is the thing that makes the decision timely, and the timely is the thing that the decision is built on.

The Hard Truth About Timing

The hard truth about timing is that the timing is never clear, and the never-clear is the thing that the timing is, and the is is the thing that the timing is. The timing, for most families, is the thing that is uncertain, and the uncertain is the thing that the timing is, and the is is the thing that the timing is. The doctor cannot say, with the certainty, when the end of life will come, and the not-saying is the thing that the doctor cannot do, and the cannot-do is the thing that the timing is. The disease, for most, is the thing that progresses unpredictably, and the unpredictably is the thing that the disease does, and the doing is the thing that the timing is.

The hard truth is that the timing, uncertain, is the timing that must be decided, and the decided is the thing that the timing must be, and the must-be is the thing that the timing is. The family, with the team, must make the decision about the timing, and the making is the thing that the family does, and the doing is the thing that the timing is. The decision, made with the uncertainty, is the decision that is made with the best information available, and the best-information is the thing that the decision is built on, and the built-on is the thing that the timing is.

The Medical Signs

The medical signs are the things that the doctor and the nurse look for, and the looking-for is the thing that the medical signs are, and the are is the thing that the medical signs are. The medical signs include:

The prognosis — the doctor's estimate of the life expectancy, and the estimate is the thing that the prognosis is, and the is is the thing that the prognosis is. The prognosis, for the hospice eligibility, is the prognosis of six months or less, and the six-months is the thing that the eligibility is, and the is is the thing that the eligibility is. The prognosis is the thing that the doctor provides, and the providing is the thing that the doctor does, and the doing is the thing that the prognosis is.

The decline — the worsening of the condition, and the worsening is the thing that the decline is, and the is is the thing that the decline is. The decline includes the weight loss, the weakness, the fatigue, the increased need for the help with the daily activities, the increased time in the bed, the decreased time out of the bed, and the worsening is the thing that the decline is, and the is is the thing that the decline is.

The symptoms — the pain, the nausea, the shortness of breath, the confusion, the agitation, the anxiety, and the symptoms are the things that the decline produces, and the producing is the thing that the symptoms do, and the doing is the thing that the symptoms are. The symptoms, increasing, are the things that the decline produces, and the producing is the thing that the symptoms do, and the doing is the thing that the symptoms are.

The hospitalizations — the increasing frequency of the hospitalizations, and the increasing is the thing that the hospitalizations do, and the doing is the thing that the hospitalizations are. The hospitalizations, increasing, are the things that the decline produces, and the producing is the thing that the hospitalizations do, and the doing is the thing that the hospitalizations are.

The treatments — the decreasing effectiveness of the treatments, and the decreasing is the thing that the treatments do, and the doing is the thing that the treatments are. The treatments, decreasing in effectiveness, are the things that the decline produces, and the producing is the thing that the treatments do, and the doing is the thing that the treatments are.

The Functional Signs

The functional signs are the things that the family observes, and the observing is the thing that the functional signs are, and the are is the thing that the functional signs are. The functional signs include:

The activities of the daily living — the increasing need for the help with the bathing, the dressing, the eating, the toileting, the transferring, and the increasing is the thing that the activities do, and the doing is the thing that the activities are. The activities, increasing in the need for the help, are the things that the decline produces, and the producing is the thing that the activities do, and the doing is the thing that the activities are.

The eating — the decreasing intake of the food and the fluid, and the decreasing is the thing that the eating does, and the doing is the thing that the eating is. The eating, decreasing, is the thing that the decline produces, and the producing is the thing that the eating does, and the doing is the thing that the eating is.

The sleeping — the increasing time spent sleeping, and the increasing is the thing that the sleeping does, and the doing is the thing that the sleeping is. The sleeping, increasing, is the thing that the decline produces, and the producing is the thing that the sleeping does, and the doing is the thing that the sleeping is.

The communication — the decreasing ability to communicate, and the decreasing is the thing that the communication does, and the doing is the thing that the communication is. The communication, decreasing, is the thing that the decline produces, and the producing is the thing that the communication does, and the doing is the thing that the communication is.

The engagement — the decreasing engagement with the world, and the decreasing is the thing that the engagement does, and the doing is the thing that the engagement is. The engagement, decreasing, is the thing that the decline produces, and the producing is the thing that the engagement does, and the doing is the thing that the engagement is.

The Emotional and Spiritual Signs

The emotional and spiritual signs are the things that the family feels, and the feeling is the thing that the emotional and spiritual signs are, and the are is the thing that the emotional and spiritual signs are. The emotional and spiritual signs include:

The withdrawal — the person who is beginning to withdraw from the world, and the withdrawing is the thing that the person does, and the doing is the thing that the withdrawal is. The withdrawal is the thing that the decline produces, and the producing is the thing that the withdrawal does, and the doing is the thing that the withdrawal is.

The reflection — the person who is beginning to reflect on the life, and the reflecting is the thing that the person does, and the doing is the thing that the reflection is. The reflection is the thing that the decline produces, and the producing is the thing that the reflection does, and the doing is the thing that the reflection is.

The acceptance — the person who is beginning to accept the approaching end, and the accepting is the thing that the person does, and the doing is the thing that the acceptance is. The acceptance is the thing that the decline produces, and the producing is the thing that the acceptance does, and the doing is the thing that the acceptance is.

The readiness — the person who is beginning to express the readiness to let go, and the expressing is the thing that the person does, and the doing is the thing that the readiness is. The readiness is the thing that the decline produces, and the producing is the thing that the readiness does, and the doing is the thing that the readiness is.

The Family's Signs

The family's signs are the things that the family experiences, and the experiencing is the thing that the family's signs are, and the are is the thing that the family's signs are. The family's signs include:

The exhaustion — the exhaustion of the caregiving, and the exhaustion is the thing that the family experiences, and the experiencing is the thing that the exhaustion is. The exhaustion is the thing that the caregiving produces, and the producing is the thing that the exhaustion does, and the doing is the thing that the exhaustion is.

The overwhelm — the overwhelm of the caregiving, and the overwhelm is the thing that the family experiences, and the experiencing is the thing that the overwhelm is. The overwhelm is the thing that the caregiving produces, and the producing is the thing that the overwhelm does, and the doing is the thing that the overwhelm is.

The recognition — the recognition that the end is approaching, and the recognition is the thing that the family experiences, and the experiencing is the thing that the recognition is. The recognition is the thing that the decline produces, and the producing is the thing that the recognition does, and the doing is the thing that the recognition is.

The question — the question of whether the time for hospice has come, and the question is the thing that the family experiences, and the experiencing is the thing that the question is. The question is the thing that the decline produces, and the producing is the thing that the question does, and the doing is the thing that the question is.

The Timing Is the Decision

The timing is the decision, and the decision is the thing that the timing is, and the is is the thing that the timing is. The timing, decided with the signs, is the timing that is decided with the understanding, and the understanding is the thing that the signs provide, and the provided is the thing that the timing is built on. The timing, decided without the signs, is the timing that is decided without the understanding, and the not-understanding is the thing that the not-signs produce, and the produced is the thing that the timing is built on, and the built-on is the thing that the timing must not be.

The next chapter is about the conversation — how to have the conversation with the family, with the person who is dying, and with the team, and the conversation is the thing that the decision is built on, and the built-on is the thing that the conversation provides.

The conversation is the thing that the decision is built on, and the built-on is the thing that the conversation provides, because the decision, to be made well, must be made with the conversation, and the conversation is the thing that the decision is built on, and the built-on is the thing that the conversation provides. This chapter is about the conversation — how to have it with the family, with the person who is dying, and with the team, and the conversation is the thing that the decision is built on.

Why the Conversation Is Hard

The conversation is hard because the conversation is about the end of life, and the end of life is the thing that no one wants to talk about, and the not-wanting is the thing that makes the conversation hard, and the hard is the thing that the conversation is. The conversation is hard because the conversation is about the loss, and the loss is the thing that the conversation is about, and the about is the thing that the conversation is. The conversation is hard because the conversation is about the fear, and the fear is the thing that the conversation is about, and the about is the thing that the conversation is.

The conversation is hard because the conversation requires the honesty, and the honesty, about the end of life, is the thing that most people are avoiding, and the avoiding is the thing that the conversation must interrupt, and the interrupting is the thing that the conversation is. The conversation is hard because the conversation requires the vulnerability, and the vulnerability, about the end of life, is the thing that most people are protecting, and the protecting is the thing that the conversation must open, and the opening is the thing that the conversation is.

The conversation is hard, but the conversation is necessary, and the necessary is the thing that the conversation is, and the is is the thing that the conversation is. The conversation, had, is the conversation that makes the decision possible, and the possible is the thing that the conversation provides, and the provided is the thing that the decision is built on. The conversation, not had, is the conversation that makes the decision impossible, and the impossible is the thing that the not-conversation produces, and the produced is the thing that the decision is built on, and the built-on is the thing that the decision must not be.

The Conversation with the Family

The conversation with the family is the first conversation, and the first is the thing that the conversation is, and the is is the thing that the conversation is. The conversation with the family is the conversation about the signs, the timing, the hospice, and the decision, and the about is the thing that the conversation is, and the is is the thing that the conversation is.

The first step is to gather the family, and the gathering is the thing that the conversation begins with, and the beginning is the thing that the gathering is. The family, gathered, is the family that can have the conversation, and the can-have is the thing that the gathering provides, and the provided is the thing that the conversation is built on. The family, not gathered, is the family that cannot have the conversation, and the cannot-have is the thing that the not-gathering produces, and the produced is the thing that the conversation is built on, and the built-on is the thing that the conversation must not be.

The second step is to share the signs, and the sharing is the thing that the conversation continues with, and the continuing is the thing that the sharing is. The signs, shared, are the things that the family can consider, and the consider is the thing that the sharing provides, and the provided is the thing that the conversation is built on. The signs, not shared, are the things that the family cannot consider, and the cannot-consider is the thing that the not-sharing produces, and the produced is the thing that the conversation is built on, and the built-on is the thing that the conversation must not be.

The third step is to discuss the hospice, and the discussing is the thing that the conversation deepens with, and the deepening is the thing that the discussing is. The hospice, discussed, is the hospice that the family can understand, and the understand is the thing that the discussing provides, and the provided is the thing that the conversation is built on. The hospice, not discussed, is the hospice that the family cannot understand, and the cannot-understand is the thing that the not-discussing produces, and the produced is the thing that the conversation is built on, and the built-on is the thing that the conversation must not be.

The fourth step is to listen, and the listening is the thing that the conversation completes with, and the completing is the thing that the listening is. The listening is the thing that the family needs, and the needs is the thing that the listening provides, and the provided is the thing that the conversation is built on. The listening is the thing that the family members need, and the need is the thing that the listening provides, and the provided is the thing that the conversation is built on.

The Conversation with the Person Who Is Dying

The conversation with the person who is dying is the second conversation, and the second is the thing that the conversation is, and the is is the thing that the conversation is. The conversation with the person who is dying is the conversation about the wishes, the fears, the hopes, and the decision, and the about is the thing that the conversation is, and the is is the thing that the conversation is.

The first step is to ask, and the asking is the thing that the conversation begins with, and the beginning is the thing that the asking is. The asking is the asking of the person what they want, and the what-they-want is the thing that the asking is, and the is is the thing that the asking is. The asking is not the telling. The asking is the asking, and the asking is the thing that the conversation is, and the is is the thing that the conversation is.

The second step is to listen, and the listening is the thing that the conversation continues with, and the continuing is the thing that the listening is. The listening is the thing that the person needs, and the needs is the thing that the listening provides, and the provided is the thing that the conversation is built on. The listening is the thing that the person who is dying needs, and the need is the thing that the listening provides, and the provided is the thing that the conversation is built on.

The third step is to respect, and the respecting is the thing that the conversation deepens with, and the deepening is the thing that the respecting is. The respecting is the thing that the person needs, and the needs is the thing that the respecting provides, and the provided is the thing that the conversation is built on. The respecting is the respecting of the person's wishes, and the wishes are the things that the respecting is, and the is is the thing that the respecting is.

The fourth step is to include, and the including is the thing that the conversation completes with, and the completing is the thing that the including is. The including is the thing that the person needs, and the needs is the thing that the including provides, and the provided is the thing that the conversation is built on. The including is the including of the person in the decision, and the decision is the thing that the including is, and the is is the thing that the including is.

The Conversation with the Team

The conversation with the team is the third conversation, and the third is the thing that the conversation is, and the is is the thing that the conversation is. The conversation with the team is the conversation about the medical situation, the hospice, the timing, and the decision, and the about is the thing that the conversation is, and the is is the thing that the conversation is.

The first step is to ask the team, and the asking is the thing that the conversation begins with, and the beginning is the thing that the asking is. The asking is the asking of the team about the prognosis, the options, the hospice, and the timing, and the asking is the thing that the conversation is, and the is is the thing that the conversation is.

The second step is to listen to the team, and the listening is the thing that the conversation continues with, and the continuing is the thing that the listening is. The listening is the thing that the team provides, and the provides is the thing that the listening is, and the is is the thing that the listening is. The listening is the thing that the team needs, and the needs is the thing that the listening provides, and the provided is the thing that the conversation is built on.

The third step is to share with the team, and the sharing is the thing that the conversation deepens with, and the deepening is the thing that the sharing is. The sharing is the sharing of the family's concerns, the person's wishes, and the family's questions, and the sharing is the thing that the conversation is, and the is is the thing that the conversation is.

The fourth step is to decide with the team, and the deciding is the thing that the conversation completes with, and the completing is the thing that the deciding is. The deciding is the deciding of the timing, the hospice, and the plan, and the deciding is the thing that the conversation is, and the is is the thing that the conversation is.

The Conversation Is the Decision

The conversation is the decision, and the decision is the thing that the conversation is, and the is is the thing that the conversation is. The conversation, had, is the conversation that makes the decision possible, and the possible is the thing that the conversation provides, and the provided is the thing that the decision is built on. The conversation, not had, is the conversation that makes the decision impossible, and the impossible is the thing that the not-conversation produces, and the produced is the thing that the decision is built on, and the built-on is the thing that the decision must not be.

The next chapter is about the decision itself — how to make it, what to consider, and how to live with it, and the decision is the thing that the conversation makes possible, and the possible is the thing that the decision is built on.

The decision is the thing that the conversation makes possible, and the possible is the thing that the decision is built on, and the built-on is the thing that the conversation provides. This chapter is about the decision — how to make it, what to consider, and how to live with it, and the decision is the thing that the conversation makes possible, and the possible is the thing that the decision is built on.

What the Decision Is

The decision is the decision about the how, and the how is the thing that the decision is about, and the about is the thing that the decision is. The decision is not the decision about whether the end of life will come. The decision is the decision about how the end of life will be met — with the hospice care that focuses on the comfort, or with the medical care that focuses on the cure; at home, or in the facility; with the family around, or in the quiet; with the pain managed, or with the pain endured. The decision is the decision about the how, and the how is the thing that the decision is about, and the about is the thing that the decision is.

The decision is the decision that is made with the family, with the person who is dying, and with the team, and the with is the thing that the decision is, and the is is the thing that the decision is. The decision is not the decision that is made alone. The decision is the decision that is made together, and the together is the thing that the decision is, and the is is the thing that the decision is.

The decision is the decision that is made over time, and the over-time is the thing that the decision is, and the is is the thing that the decision is. The decision is not the decision that is made in a moment. The decision is the decision that is made over the weeks and months of the decline, and the over-the-weeks-and-months is the thing that the decision is, and the is is the thing that the decision is.

What to Consider

The things to consider are the things that the decision is built on, and the built-on is the thing that the considerations provide, and the provided is the thing that the decision is built on. The things to consider include:

The person's wishes — what does the person want? The person's wishes are the things that the decision is built on, and the built-on is the thing that the person's wishes provide, and the provided is the thing that the decision is built on. The person's wishes, known, are the things that the decision is built on, and the known is the thing that the person's wishes are, and the are is the thing that the person's wishes are. The person's wishes, not known, are the things that the decision is not built on, and the not-known is the thing that the person's wishes are, and the are is the thing that the person's wishes are.

The person's condition — what is the medical situation? The person's condition is the thing that the decision is built on, and the built-on is the thing that the person's condition provides, and the provided is the thing that the decision is built on. The person's condition, understood, is the thing that the decision is built on, and the understood is the thing that the person's condition is, and the is is the thing that the person's condition is.

The family's capacity — can the family provide the care? The family's capacity is the thing that the decision is built on, and the built-on is the thing that the family's capacity provides, and the provided is the thing that the decision is built on. The family's capacity, assessed, is the thing that the decision is built on, and the assessed is the thing that the family's capacity is, and the is is the thing that the family's capacity is.

The hospice — what does the hospice provide? The hospice is the thing that the decision is built on, and the built-on is the thing that the hospice provides, and the provided is the thing that the decision is built on. The hospice, understood, is the thing that the decision is built on, and the understood is the thing that the hospice is, and the is is the thing that the hospice is.

The place — where will the care be provided? The place is the thing that the decision is built on, and the built-on is the thing that the place provides, and the provided is the thing that the decision is built on. The place, decided, is the thing that the decision is built on, and the decided is the thing that the place is, and the is is the thing that the place is.

The timing — when will the hospice begin? The timing is the thing that the decision is built on, and the built-on is the thing that the timing provides, and the provided is the thing that the decision is built on. The timing, decided, is the thing that the decision is built on, and the decided is the thing that the timing is, and the is is the thing that the timing is.

How to Make the Decision

The making of the decision is the thing that the decision is, and the is is the thing that the decision is. The making of the decision is the thing that is done with the conversation, the considerations, and the team, and the with is the thing that the making is, and the is is the thing that the making is.

The first step is to gather the information, and the gathering is the thing that the making begins with, and the beginning is the thing that the gathering is. The information, gathered, is the thing that the making is built on, and the built-on is the thing that the gathering provides, and the provided is the thing that the making is built on. The information, not gathered, is the thing that the making is not built on, and the not-built-on is the thing that the not-gathering produces, and the produced is the thing that the making is built on, and the built-on is the thing that the making must not be.

The second step is to consider the options, and the considering is the thing that the making continues with, and the continuing is the thing that the considering is. The options, considered, are the things that the making is built on, and the built-on is the thing that the considering provides, and the provided is the thing that the making is built on. The options, not considered, are the things that the making is not built on, and the not-built-on is the thing that the not-considering produces, and the produced is the thing that the making is built on, and the built-on is the thing that the making must not be.

The third step is to decide, and the deciding is the thing that the making deepens with, and the deepening is the thing that the deciding is. The deciding is the thing that the making is, and the is is the thing that the deciding is. The deciding is the choosing of the option, and the choosing is the thing that the deciding is, and the is is the thing that the deciding is.

The fourth step is to communicate, and the communicating is the thing that the making completes with, and the completing is the thing that the communicating is. The communicating is the thing that the making is, and the is is the thing that the communicating is. The communicating is the sharing of the decision with the family, the person, and the team, and the sharing is the thing that the communicating is, and the is is the thing that the communicating is.

How to Live with the Decision

The living with the decision is the thing that the decision is, and the is is the thing that the decision is. The living with the decision is the thing that is done after the decision is made, and the after is the thing that the living is, and the is is the thing that the living is.

The first step is to trust the decision, and the trusting is the thing that the living begins with, and the beginning is the thing that the trusting is. The trusting is the thing that the living is, and the is is the thing that the trusting is. The trusting is the trusting that the decision, made with the conversation, the considerations, and the team, is the decision that was the best that could be made, and the best is the thing that the trusting is, and the is is the thing that the trusting is.

The second step is to accept the decision, and the accepting is the thing that the living continues with, and the continuing is the thing that the accepting is. The accepting is the thing that the living is, and the is is the thing that the accepting is. The accepting is the accepting that the decision, made, is the decision that is, and the is is the thing that the accepting is, and the is is the thing that the accepting is.

The third step is to act on the decision, and the acting is the thing that the living deepens with, and the deepening is the thing that the acting is. The acting is the thing that the living is, and the is is the thing that the acting is. The acting is the acting on the decision, and the acting is the thing that the living is, and the is is the thing that the acting is.

The fourth step is to be present, and the being-present is the thing that the living completes with, and the completing is the thing that the being-present is. The being-present is the thing that the living is, and the is is the thing that the being-present is. The being-present is the being-present with the person, with the family, and with the process, and the being-present is the thing that the living is, and the is is the thing that the being-present is.

The Decision Is the Beginning

The decision is the beginning of the hospice, and the beginning is the thing that the decision is, and the is is the thing that the decision is. The decision, made, is the decision that begins the hospice, and the beginning is the thing that the decision is, and the is is the thing that the decision is. The decision, made, is the decision that begins the end of life, and the beginning is the thing that the decision is, and the is is the thing that the decision is.

The next chapter is about what comes after — the dying, the death, and the grief, and the living with the grief is the thing the whole book is preparing the family for, and the for is the thing that the next chapter is about.

The decision, made, is the decision that begins the end of life, and the beginning is the thing that the decision is, and the is is the thing that the decision is. This chapter is about what comes after — the dying, the death, and the grief, and the living with the grief is the thing the whole book is preparing the family for.

The Dying

The dying is the process, and the process is the thing that the dying is, and the is is the thing that the dying is. The dying is the process that unfolds over the days and weeks of the hospice, and the unfolding is the thing that the dying is, and the is is the thing that the dying is. The dying is the process that the hospice supports, and the supporting is the thing that the hospice does, and the doing is the thing that the hospice is.

The dying includes the physical changes — the decreased eating, the decreased drinking, the increased sleeping, the changes in the breathing, the changes in the skin, the changes in the consciousness, and the changes are the things that the dying produces, and the producing is the thing that the changes do, and the doing is the thing that the changes are.

The dying includes the emotional changes — the withdrawal, the reflection, the acceptance, the readiness, and the changes are the things that the dying produces, and the producing is the thing that the changes do, and the doing is the thing that the changes are.

The dying includes the spiritual changes — the questions, the reflections, the seeking, the finding, and the changes are the things that the dying produces, and the producing is the thing that the changes do, and the doing is the thing that the changes are.

The dying is the time for the family to be present, and the being-present is the thing that the family does, and the doing is the thing that the family is. The being-present is the thing that the dying needs, and the needs is the thing that the being-present provides, and the provided is the thing that the dying is built on. The being-present is the thing that the person who is dying needs, and the needs is the thing that the being-present provides, and the provided is the thing that the dying is built on.

The Death

The death is the moment, and the moment is the thing that the death is, and the is is the thing that the death is. The death is the moment that the dying leads to, and the leading-to is the thing that the death is, and the is is the thing that the death is. The death is the moment that the family has been preparing for, and the preparing-for is the thing that the death is, and the is is the thing that the death is.

The death is the moment that is hard, and the hard is the thing that the death is, and the is is the thing that the death is. The death is the moment that is the loss, and the loss is the thing that the death is, and the is is the thing that the death is. The death is the moment that is the grief, and the grief is the thing that the death is, and the is is the thing that the death is.

The death is the moment that is the gift, and the gift is the thing that the death is, and the is is the thing that the death is. The death, with the hospice, is the death that is the comfort, and the comfort is the thing that the death is, and the is is the thing that the death is. The death, with the family, is the death that is the love, and the love is the thing that the death is, and the is is the thing that the death is. The death, with the decision, is the death that honors the life, and the honoring is the thing that the death is, and the is is the thing that the death is.

The Grief

The grief is the thing that comes after the death, and the after is the thing that the grief is, and the is is the thing that the grief is. The grief is the thing that the death produces, and the producing is the thing that the grief does, and the doing is the thing that the grief is. The grief is the thing that the loss produces, and the producing is the thing that the grief does, and the doing is the thing that the grief is.

The grief is the thing that is the hardest, and the hardest is the thing that the grief is, and the is is the thing that the grief is. The grief is the thing that is the most human, and the most-human is the thing that the grief is, and the is is the thing that the grief is. The grief is the thing that is the most necessary, and the most-necessary is the thing that the grief is, and the is is the thing that the grief is.

The grief is the thing that comes in the waves, and the waves are the things that the grief comes in, and the coming-in is the thing that the grief is, and the is is the thing that the grief is. The grief is the thing that comes in the waves, and the waves are the things that the grief comes in, and the coming-in is the thing that the grief is, and the is is the thing that the grief is.

The grief is the thing that changes over time, and the over-time is the thing that the grief does, and the doing is the thing that the grief is. The grief, early, is the grief that is the most intense, and the most-intense is the thing that the early-grief is, and the is is the thing that the early-grief is. The grief, later, is the grief that is the less intense, and the less-intense is the thing that the later-grief is, and the is is the thing that the later-grief is. The grief, over time, is the grief that is the integrated, and the integrated is the thing that the grief, over time, is, and the is is the thing that the grief, over time, is.

The Living with the Grief

The living with the grief is the thing that the family does, and the doing is the thing that the family is, and the is is the thing that the family is. The living with the grief is the thing that is done over the time, and the over-time is the thing that the living is, and the is is the thing that the living is.

The first step is to feel the grief, and the feeling is the thing that the living begins with, and the beginning is the thing that the feeling is. The feeling is the thing that the living is, and the is is the thing that the feeling is. The feeling is the allowing of the grief, and the allowing is the thing that the feeling is, and the is is the thing that the feeling is.

The second step is to express the grief, and the expressing is the thing that the living continues with, and the continuing is the thing that the expressing is. The expressing is the thing that the living is, and the is is the thing that the expressing is. The expressing is the expressing of the grief, and the expressing is the thing that the living is, and the is is the thing that the expressing is.

The third step is to share the grief, and the sharing is the thing that the living deepens with, and the deepening is the thing that the sharing is. The sharing is the thing that the living is, and the is is the thing that the sharing is. The sharing is the sharing of the grief with the others, and the sharing is the thing that the living is, and the is is the thing that the sharing is.

The fourth step is to honor the life, and the honoring is the thing that the living completes with, and the completing is the thing that the honoring is. The honoring is the thing that the living is, and the is is the thing that the honoring is. The honoring is the honoring of the life that was, and the honoring is the thing that the living is, and the is is the thing that the honoring is.

The Bereavement Support

The bereavement support is the thing that the hospice provides, and the providing is the thing that the hospice does, and the doing is the thing that the hospice is. The bereavement support is the support that the hospice provides to the family for the year after the death, and the year-after is the thing that the bereavement support is, and the is is the thing that the bereavement support is. The bereavement support includes the calls, the visits, the groups, the mailings, and the support is the thing that the bereavement support is, and the is is the thing that the bereavement support is.

The bereavement support is the thing that the family should use, and the should-use is the thing that the family does, and the doing is the thing that the family is. The bereavement support, used, is the thing that the family uses, and the using is the thing that the family does, and the doing is the thing that the family is. The bereavement support, not used, is the thing that the family does not use, and the not-using is the thing that the family does, and the doing is the thing that the family is.

A Final Word

The decision about the hospice and the end of life is the decision that no one wants to make, and the not-wanting is the thing that makes the decision hard, and the hard is the thing that the decision is. But the decision, made well, is the decision that gives the person who is dying the death that honors the life, and the honoring is the thing that the decision, made well, provides, and the provided is the thing that the decision is for. The decision, made well, is the decision that gives the family the grief that does not have to carry the weight of the regret, and the not-carrying is the thing that the decision, made well, provides, and the provided is the thing that the decision is for.

The work is not easy. The understanding of the hospice is the work, and the recognizing of the signs is the work, and the having of the conversation is the work, and the making of the decision is the work, and the living with the grief is the work. But the work, done, is the work that gives the person the death and the family the grief that the decision, made well, provides, and the provided is the thing the whole book is for.

You did not choose the situation that led to the decision. You can choose, in the moment you begin the work, to do the decision the care that the decision requires. The understanding is here. The conversation is here. The decision is here. The grief is here. And the love, the love that the decision is made with, is the thing that the whole book is for, and the for is the thing that the book is, and the book is now yours, and the decision is now yours, and the love, given, is the thing that makes it so.

— Dr. David K. Lubega, LICSW, LCSW-C