April 16, 2008
Nurse helps patients, families consider hospice
Sandra Ruland is the Partners Hospice liaison for DFCI and BWH
Dancing was Dorothy Hershkowitz's passion. Whether she was healthy or undergoing treatment for ovarian cancer, she was determined to continue teaching ballet and modern dance in the Boston area. When her cancer returned and then progressed, Dorothy opted to sign on with Partners Hospice so she could remain active dancing, gardening, traveling, and spending time with family and friends while preparing for her inevitable final weeks.
During that time, she met weekly with hospice nurse Sandra Ruland, RN.
"Our goal was to help assure Dorothy that we would do everything possible to manage any pain or distress so she could enjoy life and, when the time came, to die peacefully at home," Ruland recalls. "We met every Wednesday for about 10 months. She was an extraordinary person, and I carry her memory with me."
Ruland is now the program's full-time liaison to Dana-Farber and Brigham and Women's Hospital, helping patients with life-limiting illnesses and their families consider and transition to hospice, which provides medical, emotional, and spiritual care at the last stage of life.
"We're here to help people have the best quality of life possible," says Ruland. "When people choose hospice, we want to provide them with the kind and compassionate care they deserve. This is a big responsibility, and I take it very seriously."
This role comes naturally to Ruland, who began working in nursing homes as a teenager and spent 10 years as a nurse on one of the Dana-Farber/Brigham and Women's Cancer Center oncology units. In addition, her husband, Fred, is a long-time cancer survivor who has been treated here. Although he is doing well, she says, "I know what it's like to be the worried caregiver at home."
Ruland joined the hospice two years ago, when it was owned by Dana-Farber and called HealthCare Dimensions Hospice. In November 2006, DFCI transferred ownership to Partners Home Care, a nonprofit provider of home-based medical care in eastern Massachusetts.
Although Partners Hospice serves adults and children with many terminal conditions (such as heart disease, kidney disease, and alzheimer's), about 60 percent are facing cancer. Of its current census of 115 patients, most are at home, about one-third are at skilled nursing facilities, and a small number are hospitalized, according to Partners Hospice Executive Director Keith Kertland.
How it works
As hospice liaison, Ruland receives referrals from caregivers and then meets with the patients to discuss their options. If the individual signs on, Ruland arranges services such as visits from a nurse, home health aide, and physician, if needed. She'll provide progress reports to the patient's primary caregivers at DFCI or BWH and make sure patients have the necessary medicine and equipment, such as a hospital bed, oxygen, or shower chair.
Although adult patients can continue with palliative treatment to reduce symptoms, she says, once they sign on with hospice they can no longer receive aggressive therapy for their illness and should have a prognosis of six months or less. It is different with children, who can continue receiving treatment once on hospice. Many patients use the service for longer than six months, as long as they meet the criteria.
Ruland believes hospice is an important choice, and she has seen its benefits personally.
When a friend was facing metastatic breast cancer and struggling with whether to activate hospice, Partners Hospice Medical Director JoAnne Nowak, MD, made a home visit during a snowstorm. "She leaned over, looked my friend in the eyes, and made it all OK," Ruland remembers. "JoAnne took away the drama and fear of signing onto hospice. And she does that for patients all the time."
Ruland has witnessed beauty as families come together around a dying person, neighbors and friends deliver food and support, and providers go above and beyond their normal duties.
"If people are going to die, and I can make a difference, I'd rather be there than not there," she says. "It's so fulfilling to be part of the solution."
To reach Sandra Ruland, call (781) 894-1100.
— Debra Ruder
debra_ruder@dfci.harvard.edu
