New hospices may make dying gentler

RALEIGH -- Three centers devoted solely to end-of-life care are in the works for the Triangle, each the first of its kind in Wake, Durham and Johnston counties.

This fall, Hospice of Wake County will break ground in Cary near the RBC Center for The William M. Dunlap Center of Caring. Duke Hospice in Durham and Johnston Memorial Hospital in Smithfield await the state's go-ahead to build on land they've already purchased for similar facilities.

There are only 15 such freestanding hospice centers across the state. Duke Hospice operates one in Hillsborough in Orange County.

Hospice care provides pain management and comfort to terminally ill people who have decided to forgo treatment. Supporters say the new centers will provide much-needed sanctuaries for families who may need more assistance in death's darker hours, but don't want to check into hospitals.

In Wake, it's a long-awaited milestone. Raleigh is the only metropolitan area in the state without a stand-alone hospice center, officials say. Funding challenges deferred the dream for decades.

The relatives of Geraldine Hunter Covington understand the need for more places devoted to a dignified death. The 74-year-old is living her last days in the closest thing Wake County has to a dedicated end-of-life facility -- a six-bed hospice unit in Rex Hospital. She was lucky to get in. The beds are frequently full and with a waiting list.

Last month, Covington was admitted to WakeMed's critical care unit. Doctors diagnosed her with a urinary tract infection that had turned septic. Bacteria had spilled into her kidneys and bloodstream.

Covington's daughters sing praises of the WakeMed doctors and nurses who cared for their mother, but they developed another opinion of the hospital's waiting rooms.

"It was murder," said Linda Hunter-Nash, 56, of three overnight stays.

The hospital gave out blankets and dimmed the lights, but it was still tough to sleep sitting in uncomfortable chairs with the snores of other families in the waiting room.

"You want to be there" for your loved one, Hunter-Nash said. "That's human nature."

After nothing could be done to save their mother, doctors connected the family to Hospice of Wake County.

Most hospice patients die at home, but sometimes families need more help at the end.

"There are some patients in intractable pain -- the cancer has eaten into the bone or the medicine at home just won't do," says Mark Nichols, the Hospice of Wake County physician caring for Covington at Rex. Other symptoms -- such as severe vomiting, difficulty breathing and psychological problems -- can also be hard for families to manage at home even with visits from hospice nurses.

When a bed opened at Rex Hospital's hospice unit, Hunter-Nash and her sisters, Johnette Hunter, 54, of Fuquay-Varina and Katy Hunter, 53, of Atlanta, agreed to transfer her there.

The room has hardwood floors, a private shower and a movable seascape painting, concealing oxygen supply and suction equipment. Family visits are allowed at all times. Children and even pets are welcome. The room can accommodate overnight stays of two to three family members.

Rex Hospital and Hospice of Wake are jointly requesting the state transfer the license for the hospital's six hospice beds to the new Cary center when it opens about December 2008.

Officials say a free-standing center will be more cost-effective. They add that it will offer a homier environment more conducive to family privacy and interaction than hospitals, primarily focused on acute care.

Officials gush about the elements the new Cary center will include -- a kitchen where families can fix meals or bake bread, a sunroom and doors in each patient room wide enough to roll a bed out into the gardens.

"We need to alleviate pain and suffering, but sunshine, wind, smelling flowers and hearing birds means as much as anything else," says Cooper Linton, a vice president of Hospice of Wake County. "It touches the less touchable parts of suffering."

Hunter-Nash is grateful the nurses at Rex's hospice unit have taken care of administering the doses of morphine her mother needs about every two hours to rein in the pain. It allows Hunter-Nash to focus more on being a daughter, tending to other things she thinks matter to her mother -- being bathed, having her mouth cleaned and her short gray curls brushed.

"She was a really sharp dresser," with stockings every color in the rainbow, Hunter-Nash says. "My mother was a neat freak."

In the 1960s, at a time when a lot of North Carolina black women went to New York for jobs, Covington left Fuquay-Varina to be a live-in housekeeper and raise children for a family that ran a blouse factory. She lived with them for 35 years, acquiring culinary skills in making manicotti and stuffed bluefish. She moved back to North Carolina in the late 1980s.

The last few days have been hard on the family. They see signs heralding the end. Covington's eyes have gone glassy. And even a light touch or kiss can cause her to grit her teeth or writhe in pain.

Yet having this time with her has brought the family closer. On Thursday, they stood around her, hands joined, heads bowed -- thankful for the life she lived and the place she found to die.

(Staff photojournalist Corey Lowenstein contributed to this report.)