Sacred encounters, far from the medical miracles

‘What will it be like when I wake up there?” asked my 92-year-old patient, who is at the end of her life.

“I don’t know, that’s one of life’s great mysteries,” was my reply. She paused, and then quietly said, “It will be better than now.” I agreed and continued to hold her hand.

This is what we call a sacred encounter in my workplace. I have been blessed to have many. I am a gerontological nurse practitioner and I make house calls. I visit my patients in the home and provide their health care. This is no office practice with its limited time and exhausting waits; instead, each patient has their living space with its history and stories.

It’s different what I do in this world of modern medical marvels. Yet, it gets to the heart and soul of providing health care to a vulnerable and often-invisible population. I go to elders’ homes and give them my time and respect. My care is patient centered, meaning I see my patients at their convenience and give them the time they need to build trust and get through their 70, 80, 90, or 100-plus years of life history.

Impossible, you say! Impractical to replicate because of the time needed and limited financial payoff.

Absolutely necessary is my argument.

Our current health care delivery system is not designed to appropriately care for this population. For example, I have several patients who have had strokes and are bed-bound with feeding tubes and require total care, 24 hours a day. They are cared for by family members and need at-home medical and nursing support. I have patients who are oxygen-dependent and unable to drive or even physically tolerate the effect of a trip to a health care provider’s office. I could go on.

It is cost effective, what I do. Being cost effective does not translate into less or inferior care. I am bound to the same standards as my physician colleagues. What benefits my patients, for example, is that I can treat a bladder infection or asthma flare-up at home, preventing an emergency room visit and possible hospital stay. Being able to respond to the first sign of illness is paramount in this patient population.

For those not familiar, a nurse practitioner is an advanced-practice nurse with a graduate-level education who can assess, diagnose and treat patients. We can order medications, labs and X-rays. We work in various specialties, including family practice, pediatrics, women’s health and my field — geriatrics.

So, I advocate. I write and meet with my representatives. I work within my professional organization to help advance my profession to help meet the needs of this growing patient population. I give thanks daily for the existence of my program and the compassion and expertise of my colleagues on the House Calls team that allows for this care.

What really matters most to me as a human being and health care provider is the sacred encounter. The shared laugh, the celebration of a 60-year marriage, the stories of the young lives that are now old, and those final conversations before we say goodbye. Those things, to me, put any concern into its proper perspective.