Pic: Keith ~ 2000 (less receding line/grey and no beard), Baton Rouge General Medical Center, Skilled Nursing Facility (SNF) - probably sweet talking a nurse into taking one of my problem d/c's! We used to wear those lab coats, so I was sometimes called "Dr. Discharge!"

"Let Go, Let God" YouTube: https://www.youtube.com/watch?v=nWuSzZKIifA

BACKGROUND: So many great memories working on SNF with wonderful colleagues like the Hospitalists (HMG - Drs. Banda, Gummadi, Raju, et al and Ochsner - Drs. Slataper, Kantrow, Hirsch, etc. before they went to OLOL), SNF MD Director - Wonderful Dr. Donnie Batie, Rochelle Howard, RN, Michael Boulingney, CNA, Paula, PT, Cathy, RD, Donna, OT, Jane, ST, Bill, RT, Lynnn Pennington, RN and Dot McCoy, RN and so many others.

As Mary Uter, LCSW, my former BRG Social Worker Director used to tell me when we had a chance to move around when another LCSW quit, "You don't have worry about job security - nobody wants SNF! All the hardest placement patients gravitated to me on SNF ("Don't know what to do with Mr. Smith - yeah, let's send him to SNF," which was a "Loss Leader" (lost least per insurance), as DRGs realy became known as "Da Revenue's Gone" and not Diagnostic Related Groups!

At our Tuesday Utilization Review (UR) luncheon meetings, when a patient no longer met inpatient criteria, Dr. Batie would usually have to give me the directive with his thumb up and told me to tell Mr. A or Ms. B "U R being discharged on Friday!" There were many challenging cases but I learned so much from them - thank You, Lord!

One memorable crazy d/c Friday entailed about 13 discharges, including some new and returning nursing home placements, rehab, home health and this one hospice pt. I'll call "Ms. Jones." Since there were many city emergencies going on that day, we kept on getting delays from Acadian Ambulance as to when Ms. Jones would be picked up to be taken home. I had to keep going back to her to update her when I finally had the good news that Acadian was on the way but said the following to her: "Well, Ms. Jones, you've been very patient with all of these ambulance delays but they are finally on their way! I know you've been "dying to get out of here!" OUCH! - not exactly the best thing to tell a hospice patient! When I turned red, Ms. Jones asked if I was okay, so I was glad to know that she didn't catch that Freudian slip! Remember: Laughter's the best medicine!

Life / Death / Hospice / Breath

“Keith, can you take me out on a stroll for a smoke?” asked the hospice client who was diagnosed with end stage lung cancer.

“Well,” I replied, “I won't walk a mile for a camel, but I'll surely take my friend out for some fresh air! Let's see if we can find your lighter.”

“Yeah,” she said. “With you, there's always a lot of hot air around, so let's get out of here for awhile and just sit outside – try to keep quiet! Won't you take a smoke to help keep your mouth shut!”

How can I forget that encounter with a patient when I worked in the past as a Social Worker for an inpatient hospice?

The simple, lively and even professionally tailored bantering that can go on in the client-provider relationship can open the doors wide for clients to some deeper inner needs for sharing as one is face to face with approaching mortality.

As a professional, I learned much more from encounters like above than any book knowledge had taught me.

Sure, the “Little Blue Book” (“Gone From My Sight”) by Barbara Karnes, RN can be a great helpful tool for enhancing the relationship between both clients and professionals in grappling with death and dying concerns, but there's a “priceless and immeasurable blue book value” to one-on-one communication!

And having a “Floyd Nightengale, RN” (Trygve Olson) to mentor from in that setting was incredible – he showed me so many dynamic ways on how to integrate a holistic approach to engaging clients, especially terminally diagnosed ones, and their loved ones.

Earlier in my career as a Medical Social Worker,I was inspired by colleague, Carlo Cuneo, LCSW, who had a wonderful way of providing informational visits to clients and families considering hospice alternatives. This led to me to write a song, “Let Go, Let God;” here are some of the lyrics.

“You bring comfort to us in need
Death and dying can test our creed
You touch our very hearts
And help us to start
To share our true feelings in-deed

Let Go, Let God ….” https://www.youtube.com/watch?v=nWuSzZKIifA

And how can I forget during those hospital work days my first encounter with Dr. Susan Nelson in a family conference with a terminally diagnosed patient? “When the angels come to naturally take your mother at the appointed time, do you want us to stop them?” she noted.

Earlier in my career, when I had to face hospice concerns for my own family, I had to be reminded and prodded that while I may have a Social Work degree, I firstly have a degree in humanity! As we say in our health related fields, doctors, nurses, social workers, etc. make the worst patients!

So in life, we take each breath
Not knowing the one before death
As Jacob, we're constantly wrestling with the Lord
Who longs to bring us peace, make us restored
"To be or not to be?" Hamlet remindeth.

Keith John Paul Horcasitas, LCSW, MHA, 1133 Knollhaven Drive, BRLA 70810, khorcasitas.yahoo.com, August 10, 2014.