Rochester Post Bulletin
11/24/2003

'I don't feel like an angel, but I think the nurses are'
Hospice medical director keeps tabs on patients

By Jeff Hansel
jhansel@postbulletin.com

Outside, the sun shines, cardinals flutter, squirrels scamper up tree trunks, blue jays bully their smaller neighbors, and a group of turkeys ignores it all.

Inside Seasons Hospice, Dr. Tom Miller busily prepares for his rounds. Most of the time, Seasons serves people in their own homes, whether at nursing homes, family houses, hospitals or assisted living. But Seasons also offers a peaceful, eight-bedroom home-away-from-home for those who need or want a place to go with people trained in hospice care.

Miller checks medical records, discusses patient needs with nurses and adds a jest or two, bringing staff-warming smiles.

As medical director, he oversees care in coordination with his patients' primary physicians. He's witness to a range of emotions: overwhelming gratitude, disbelief, engaged compassion, laughter transformed to tears, resistant acceptance, relief and joy.

It's Nov. 14, and he's making his rounds.

Helen Silhasek, he learns, has been playing cards; teaching would be a better word. The game is 500 and, "I won," she says, claiming the staff was letting her, but knowing they lost fair and square. Within 6 feet of her window, a trio of turkeys is blissfully unaware of the coming Thanksgiving holiday.

Miller has a practice outside of Seasons, but does rounds as medical director at Seasons to be familiar with patients, family and staff needs.

"Other than carrying the phone, my life goes on," he says, jiggling the telephone attached to his hip as if it's part of his body. He's available by phone 24 hours a day. But he shifts credit to staff members and volunteers.

"I don't feel like an angel, but I think the nurses are," he said. He pauses to dictate patient notes while staff members admit a new patient. Then, he moves on to the room of Zigmund Glaunert, who rests.

"I pray to him every night and squeeze his hand," says his wife, Janet, who stays by his side. "A couple days ago, he did squeeze my hand."

"I'm convinced that at some level he knows you're here," Miller says.

She says her husband witnessed the atomic bomb tests in Nevada in the 1950s and questions whether that was the source of his cancer.

She tells Miller, "I told him again today, 'It's OK to die.'"

Zigmund Glaunert died the next day.

Miller also speaks with Byron Papenfus, whose mother, Janice, sleeps.

"I'm Dr. Miller, may I listen to you?" Miller asks Janice, who rouses and grasps Byron's hands tightly when the doctor prepares to listen to her heart.

Miller invites Byron to the living room, assuming Janice might be aware of conversation, despite her declining health.

Before he leaves, Byron takes a brown stuffed animal and, with rugged hands, gently places it upon his mother's chest.

"He's substituting his hands for the teddy bear, which is a nice thing to do," Miller says. It is a tender moment, and Miller is touched.

"Our goal here is to keep her as comfortable as possible," he tells Byron once they're in the other room. But the doctor is clear about Janice's condition.

"We're dealing with several things that might be leading to her death fairly soon," Miller says. Byron said Wednesday he'd like a miracle, a common hope. But he also tells Miller, "it didn't take us long to realize that this is the end of her life."

On Friday, Janice died.

A short time later on Wednesday, Miller is with the family of a new patient. Families often struggle with acceptance, questioning whether healing will occur in spite of the less than six-month life expectancy required for hospice placement. Concerns range from the mundane to life and death. Miller explains that hospice workers don't hasten death, but they also do not prolong dying.

"Most of the time, it's a very gradual progression to the beautiful death where the family is around the bedside," he says.

It is now early evening, and the sky outside is dark. The evening nurse, Michelle, is checking to see whether Helen would like a cup of tea. Miller has several more patients to look in on, and Michelle's work is just beginning.

It'll be green tea for Helen. Two cups, please.