Giving back to the community in an unusual way

Jose Garcia became a hospice nurse “by accident.” As the father of a 1-year-old daughter at the time, the hours of the job appealed to him. He could work Monday through Friday from 8 a.m. until 5 p.m., which suited his young family. He trained at a teaching hospice in San Diego that attracted doctors and nurses from all over the world.

“That excellent experience of working there set me up for being pretty well prepared for a career in hospice,” he said. “It was just such a good place and I brought all of that experience with me.”

Garcia has been a registered nurse for 22 years and a hospice nurse for the past 17 years. He currently is a case manager at the Visiting Nurse Association of Cape Cod Hospice & Palliative Care division. His job is to ensure that his patients get medical management for pain, nausea, anxiety and agitation, while receiving care in their homes. He also helps patients to enhance their quality of life doing what they most want in this last stage of their life.

Garcia finds the job rewarding for many reasons. It is very satisfying to get the patient and their families to a point where they are mentally, emotionally and, for some, spiritually to a good place of ease and physical comfort, he said.

A lot of what he does is education – for both the patients and their families, since families are the caregivers when he’s not there.

“Some of our clients have never ever taken any narcotics or any anxiolytics (drugs used for anxiety) and sometimes they are very fearful of the medications,” he said. He’s had some patients fear they would die if they began taking morphine, which is not the case at all, he said.

“Part of care is having people transition from being very, very scared and sometimes even alone, to a point where they feel like they’re supported,” he said. “It’s a process. It doesn’t happen overnight. It doesn’t even happen in a few days.”

Goals of Hospice

The goal of hospice isn’t to prevent a person from dying. It’s to ensure that they can stay home with their loved ones and pets as long as possible, and hopefully until the end of their life. Garcia has been with many patients as they take their last breath, with their loved ones comforting them and telling them they will be missed, that they are loved, and they will see them on the other side. That part of his job “is a gift,” he said.

“The ability to pass comfortably without any distress – that’s a beautiful moment for people,” he said.

Not all patients can actually stay at home, Garcia acknowledged, but they can still get the comfort of hospice care surrounded by family members and pets at Cape Cod Healthcare’s McCarthy Care Center in East Sandwich. The staff at the facility do everything they can to mimic a home setting, rather than a hospital setting. Loved ones are also welcomed and supported by the staff there.

“The McCarthy Care Center was a real game changer because now we are a fully functional team,” he said. “Sometimes we just can’t take care of people in their homes. We would love to, but their disease and their symptoms are just much more than we can handle,” he said.

Enjoying the Job

Garcia said some people can’t imagine enjoying hospice care.

“To be honest, I learn a lot from it,” he said. “Every day is so new to me, so there’s never anything that’s standard. Every case is a unique case and we let it develop and ensure that we meet the goals of the client.”

The primary goal of hospice is comfort care. They aren’t trying to reverse the disease, because doctors have already determined that is not possible. Patients are constantly being evaluated and at the six-month mark, if the patient has had any decline in health, even just a loss of five pounds, hospice care is extended.

Garcia has had clients that have been in his care in hospice for a little over five years and others who pass before he even has a chance to meet them. It’s better to start care earlier, rather than later because hospice care also has another benefit that most people don’t know about – more time. Studies show that people in hospice care live longer “but the biggest part of it is that it also enhances the quality of life and that’s probably a bigger key – to get to go to the beach one last time or to go to see the Red Sox play one more time,” he said.

Garcia works mostly in Falmouth and Woods Hole, but he has had clients in Mashpee and even a few in Bourne. He’s been working in the region long enough that he has had multiple members from the same family in his care. They are always happy to see him, he said.

“Sometimes families say we couldn’t have done this without you and that’s not just on me,” Garcia said. “That’s also the team – the social workers and the chaplain and even the family members are private caregivers. It becomes a team approach. It’s so great to watch people transition to feeling comfortable so that they can enjoy things like having visitors. I’m giving back to the community and I definitely feel very appreciated.”