ORIGINALLY WRITTEN JANET HAMOUS
Cyndi Pohlman of Peabody missed last Friday’s high school homecoming game, but she’s not complaining. A patient’s family needed her, and that was more important.
Pohlman is a home health aide and 24-year employee with Central Homecare & Hospice, and she helps care for patients and families during the final months of a patient’s life.
It is with her help that patients are able to remain at home in the final stages of their illnesses, in familiar surroundings in the company of the family, friends and pets they love.
Pohlman’s job description says she provides assistance with personal hygiene, but the families she has served probably remember her better for her secondary roles as teacher, listener, empathizer, confidante, sounding board, shoulder to cry on and expert on the process of dying at home.
Pohlman works on both the home care and hospice sides of Central Homecare & Hospice and makes house calls throughout Harvey, McPherson and Marion counties.
“On the home-care side, the focus is on rehabilitation,” she said. “On the hospice side, it’s more comfort care and teaching family members how to take care of people. Most of the family members aren’t used to doing it-it’s all new to them.”
She finds family members eager to learn, and is always touched by the tenderness they show in caring for their loved one.
“They’re willing-we couldn’t do it without the families being willing to help out and keep a loved one at home,” Pohlman said.
Because of the sometimes rapid change in a patient’s condition, Pohlman said she might be teaching the family something new every time she visits.
“The patient might be walking one time and in a wheelchair the next and in the bed the next time,” she said.
Pohlman has found that too much information at one time can overwhelm family members, who already have plenty on their minds.
“I teach them what they need to know right then. Then the next time, I teach them what they need that day,” she said.
Figuring out the best way to accomplish something in another person’s home is a challenge Pohlman faces every day, and it requires her creativity.
“In the home, what’s different than in a nursing home is that you are adapting to everybody’s house,” she said. “You may not do something the conventional way you’re trained to do it, but according to what works in the home.
“You just have to continually adapt. You work with what you have, and if one way doesn’t work, you come up with another way.”
Pohlman said she has come to “expect the unexpected.”
“Every case is different-there are no two alike,” she said. “And every case is a learning experience.”
Pohlman never knows what may await her at a particular home visit.
Although most visits take between one and two hours, circumstances may demand she stay longer, even if it’s already 6:30 p.m. and she has two more stops to go.
“You might be done with your work, but the family is asking questions,” she said. “They’re dealing with the patient day in and day out, and they do have a lot of questions because it is new territory. If you haven’t been through a death before, it’s all new ground and you don’t know what to expect.”
Pohlman described a recent situation where a patient who had been talkative several days earlier had become nonverbal.
“I was done with my patient’s care, but the patient had taken a turn for the worse,” she said. “At that point you’ve got a spouse pretty distraught and tearful.
“When the tears are welling in their eyes, and they’re saying, ‘I’m losing my buddy,’ or, ‘It’s going to be our 25th anniversary coming up and I don’t think we’re going to make it now,’ you’re right there with them.”
While many people would find it exhausting to provide such constant emotional support, it is what Pohlman loves most about her job.
“For me it’s rewarding to be there with people when they really need you the most,” she said.
“There are different stages of death, and people go through them in different orders and lengths of time,” she said. “If you see angry family members or somebody who is in total denial, you are just patient with them and work with them because you know it’s tough. It’s hard for them to watch their loved ones die.”
Although Pohlman tries to answer all the questions posed to her, sometimes she just doesn’t have the answers.
“People want you to give them a time,” she said. “I don’t do that, because I don’t know. A lot of times you’ll see the downhill, but then you’ll see them rally a little bit. It’s an up-and-down thing, so you really don’t know.”
She said both patients and families ask her what they should expect to happen as the end of life approaches.
“You can’t tell them exactly, but you can give examples,” she said. “Or, if they’re wanting to know some of the signs of death, you can give them that.”
When she’s alone with patients, Pohlman finds they often open up more than they will in front of family members.
“They guard their families,” she said. “They don’t want their families to be worried or upset. I see the patients come into acceptance before some of the family members.”
Pohlman said she often finds humor helpful in breaking the tension, and she tells jokes and stories when she feels the patients are open to them. She has found that even in the grimmest of circumstances, people don’t lose their sense of humor.
“There’s humorous stuff that happens even in bad situations,” she said.
One of her favorite stories is one she tells about a time she made a home visit on a road between two apartment complexes.
“I knocked on the right-numbered apartment and said, ‘I’m here to give you your bath,'” she recounted, “and he said, ‘You’re not giving me a bath.’
“I said, ‘Is there anybody here by such-and-such a name?’ and he said, ‘No.’ It was the wrong place!”
The apartment complex where the patient lived was across the street.
“I’d have really felt bad if he’d have let me give him a bath,” she said, laughing.
Pohlman said humor can be the wedge that gets people to open up and helps build the bond between caregivers, patients and family members that is so much a part of the hospice experience.
It is that unique bond that Pohlman loves about her job.
But she admits the longer she has known a patient, the harder it is to see them go.
“The end gets hard, the end’s tough,” she said. “You know it’s coming, but you don’t know when.”
When Pohlman has become close to a patient, his or her death hits her particularly hard, she said.
Tears glisten in her eyes as she recounts the story of a patient who actually died during her visit.
“My first thought was, ‘No,
don’t go,’ and that’s what I said to him,” she said. “Then I said, ‘Oh, what am I saying? It’s OK, you can go.’
“We do give them permission to go. If you don’t let go-people hang on,” she said.
“Then his son said, ‘Dad, we love you, we’re going to miss you, but it’s OK.’ When he said that, that heart stopped beating and he was gone,” she said. “That was tough. I probably cried every day for three weeks after that one.”
Pohlman said she is normally able to deal with the grief, but there are times when her hospice work has taken an emotional toll.
“Usually I can hold composure pretty good,” she said. “But there have been a couple times when I’ve had death after death after death after death, and they switched me over to the homecare side.”
She said at one point when her own father was ill, a lot of her patients were dying and it became too much for her to handle.
“I was having about 10 people a month die for about three months in a row, and I told them to switch me out, this is too much for me-I can’t handle everybody dying.”
But even as hard as it is to lose a patient, Pohlman still wants to be able to finish her job with each one.
“I am there for them, and I want to be there until the end,” she said. “It’s a privilege to get to be there when somebody’s in those end stages.”
Pohlman recalls a time when her patient load was changed and she was no longer assigned to care for certain patients who had previously been in her care. That was a low point in her career because she was not able to see some of her patients through to the end.
“I did go and see one patient, because they said he wasn’t doing too good,” she said. “I had a day off and I went up there and visited him. He wasn’t really responding to anyone else at that time.
“But when I said, ‘I’m going to miss you,’ he said, ‘I know,'” she said, her eyes filling with tears. “You know it’s worth it then.”