By Ruth Hill R.N.
The Hospice of Beaune in Beaune in Burgundy, France, admitted its first patient on January 1st, 1452. Erected in 1443, the poor and rich came from all over Europe, devastated by the 100-year war. The Duke of Burgundy, Philip the Good, delegated the job of building this refuge for end-of-life care to his conscientious and capable chancellor, Nicolas Rolin. Marauding bands pillaged and destroyed villages. The country people abandoned their fields and sought refuge in the walled cities. Crops failed. People starved. Disease was rampant. Daily survival trumped care for the dying.
The hospice was an oasis of comfort. Patients ate with pewter dishes rather than wooden bowls at the time. They had a comfortable dormitory with a chest for clothes. The Chapel was integrated into the hall, allowing patients to participate in services without leaving their beds. Imagine the therapies given: opiates, laudanum (the widely used tincture of opium and alcohol), wine from the donated vineyards, and hemp plants grown by the farmers. Today, the Hospice de Beaune is a museum that, in 1971, transferred its patients to a modern hospital.
In 1893, Lillian Wald, RN, the founder of home health in America, made her very first home visit to a young mother living in the Lower East Side of Manhattan who was hemorrhaging after giving birth. By 1895, the demand for her services was so great that she moved her operation to Henry Street. In addition to caring for the sick, the Henry Street Settlement provided financial assistance and incentives such as scholarships to the community and established social programs.
In 1910, the Henry Street Settlement had a staff of 54 nurses and operated a convalescent home, three country homes, and first-aid stations. The Visiting Nurses Association of America branched off from the Henry Street Settlement in 1944 and continues to flourish to this day, providing advanced nursing services in the home, ranging from simple wound care to infusion of blood products to children with genetic disorders.
Dame Cicely Saunders, a dynamic woman who was unable to promote holistic caring as a nurse or social worker, became a physician who could forever alter the way we think about end-of-life care. Her vision was of an atmosphere like the Hospice of Beaune, truly patient-centered, with specific mental, physical, and emotional needs cared for. To her, this meant removing terminally ill people from the sterile hospital environments of the 1950s into their homes surrounded by loved ones. Efforts to mimic natural childbirth using midwives at home coincided with the shift in palliative care treatments that avoid sedating patients unnecessarily.
In 1967, Dame Sanders’s dream materialized in a suburb of London when she established the first modern hospice: St. Christopher’s. She then came to Yale and influenced Florence Wald, the mother of the American hospice movement, who in 1974 started the first modern hospice in the US, Connecticut Hospice in Branford, Connecticut.
Today, there are over 5,899 Medicare-certified hospices across the US that practice the principles of Florence Wald and Dame Cicely Saunders. As modern hospices and home health agencies evolve, they will include a holistic approach that focuses on comfort, spirituality, relationships, and personal development right up until the final moments. The mantra of “dying with eyes wide open” is encouraging medical cannabis for pain, agitation, hallucinations, nausea, vomiting, dementia, and shortness of breath. With medical cannabis, patients leave their stupor behind and enter a peaceful life transition with loved ones by their side. If your nurse is helping you obtain cannabis for symptom relief, thank them profusely. Management erects barriers preventing nurses from just talking about cannabis.
This month of November, as we celebrate Hospice and Home Health Month, remember where we were 58 years ago. Thank your nurses, home health aides, social workers, and chaplains for their dedication and bravery in helping patients access safe use of palliative care with cannabis. The DEA’s rescheduling plan for marijuana, stuck in the bureaucratic morass of quicksand, needs Trump’s influence.
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