A man lives longer when he is loved

Anna Vasilieva

     «Hospice» in English means place of receipt, a shelter for roamers. The tradition of organising shelters for the old and poor originates from the beginning of the 1st millenium AD. The first of them were founded by Christian Orders in the East Mediterranean region. When Christianity began to spread around the territory of the Roman Empire, hospice prototypes started appearing in Europe. Beginning with the XIX century homes for poor and dying people have been often erected on the initiative of common citizens and not only the Church. For example, Жане Гранье (?), a young French widow who had lost her three children founded the first shelter for the death-sick in France. Then several such institutions followed in other parts of the country.
      In 1935 an American doctor, Alfred Worchester, published his three lectures for medical students titled «Care of the elderly, dying and dead». The most part of information that was the base of this work came from the experience of different religious Orders which were taking care of death-sick patients. In the 50-s the English Marie Curie(?) Fund founded the service of home-care of oncology patients, and in 1952 it published the report concerning physical and social problems of their charges.
      In 1975, after several years of raising money, Doctor Cecil Sanders opened the first hospice in London. In acknowledgement of her special services to the State Doctor Sanders was granted a noble title by Queen Elizabeth. A group of USA medical doctors who visited the London Hospice adopted the experience of their English colleagues. On coming back they created the network of centers for care of terminally ill patients on the base of American hospitals.
      Hospice is a new phenomenon for Russia. In the Soviet times it was not accepted to speak of incurable diseases. First of all this taboo concerned oncology. Today the society makes the first attempts to turn its face to the problems of hopelessly ill and dying people. One of the evidences to this is founding the network of hospices and special services to care of the group of patients who cannot be helped by ordinary medicine anymore. Five years ago the First Moscow Hospice began its work. It was founded on the initiative of an English political writer Victor Zorza.

      Victor Zorza was born in the village of Kolomeya in Western Ukraine. In 1939, after accession of Western Ukraine to the USSR, Victor’s family was transported to Siberia. He was only fourteen then. All his relatives died, only he and his sister managed to survive by some miracle. After his escape from the labor camp Victor was vagabonding about the country for a long time, begging for food and living where he could find a shelter. In Kuibishev the young man met a well-known writer Ilya Erenburg and got to know him by chance. Erenburg helped him to get to England. Once in safety, the former convict decided to find his own explanation to the roots of the Communist terror. He read all works of Stalin, Lenin, Marx and Engels. Studied the history of all major revolutions, beginning with the uprising of Spartak and finishing with modern time. In 1950 The Guardian published his first article on the activities of Nikita Sergeevich Khruschov. Two weeks before the ouster of the legendary General Secretary of the CPSU Central Committee Victor Zorza managed to foresee the events taking place in Kremlin with astonishing perception. Since that time Victor Zorza’s weekly publications in The Guardian and Washington Post have been fascinating the reading public all over the world. In 1975 Victor’s 25-year old daughter, Jane, died of cancer. Shortly before her death when her suffering became unbearable, she was put into a hospice for death-sick patients. Tender hands and empathetic hearts of the hospice staff alleviated her last sorrows. «I am dying and I am happy», said Jane to her parents and willed that they should erect hospices for cancer patients all around the world. After the death of his daughter Victor Zorza set his mind on fulfilling her last will at any cost.
      The democratic changes in our country allowed him to come to Russia. Here he realized that Russia needs such shelters for the suffering more than any other country. He opened his first hospice in Saint-Petersburg in Autumn of 1990. In 1994 the First Moscow hospice started its work.
      Vera Vasilievna Millionschikova became one of the first followers of Victor Zorza’s ideas. Being an oncologist, she kept coming across heartless attitude to incurably ill patients which is so common in our medical practice. Nurses are pointedly fastidious to such patients and even refuse to go in the same elevator, and a doctor is not ashamed to tell an aide: «You can stop attending to that woman with cancer from the third ward. She is hopeless, just wasting our time». Vera Vasilievna could not put up with this attitude to the sick: she took care of her patients not only during the in-patient treatment but after their discharge too, visited them at home, made friends with their families, gave every possible help. All that seemed suspicious to the Physician-in-chief of the institute she was working in. The clouds started pulling up: scandal and dismissal were in the offing. It was at that moment that she heard of a man who founded hospices for cancer patients. Her first meeting with Victor Zorza took place in 1992, and it became clear at once that they were like-minded people.
      Victor Zorza persuaded the Moscow Government to appropriate money and a building for the first hospice in the city. He was granted the vacant building formerly belonging to the Children’s Home not far from «Sportivnaya» metro station. The reconstruction took four years. On September 18th 1997 the opening ceremony of the First Moscow Hospice took its place. The Head of the hospice was Vera Vasilievna Millionschikova.
      Today the First Moscow Hospice takes care of 180 out-patients and 25 in-patients. So far the hospice’s services are available only to the inhabitants of the Central District, but there are the Moscow Mayor’s instructions to build hospices in every prefecture.
      The hospice works under control and in close communication with the district Healthcare Committee. When the district Oncologist-in-chief gets information of a «4th group» (so-called hopeless) oncology patient in one of the district hospitals he transfers these data to the hospice. The first visit to the patient is paid by the hospice doctor who must find out what specific help can be given, as there may be very different cases. There are patients who are tended by their relatives; then the hospice staff provides mainly symptomatic medical aid. Symptomatic treatment means that doctors do not try to cure the illness itself which is impossible to do anymore, but relieve its accompanying symptoms – pain, nausea, vomiting, bed-sores. As for those who need not only medical treatment but also some help around the house, the hospice volunteers deliver food, help with cleaning-up, washing and cooking. When it is necessary the hospice lawyer advises patients on the matters of making a will and handling their property. The hospice is in contact with the representatives of all religious denominations: Orthodox, Catholic, Moslem and Protestant. So if a patient wishes he may be visited by a confessor.
      As most of people endure a severe illness better when they are at home, they are only hospitalized in extreme cases. For example, if a patient is suffering continuous pain that is not relieved by pain-killers. It usually happens when one does not strictly observe the schedule of dosage. In the hospice such a person is provided with his own special plan of treatment, and what is most important – restores his belief in the effectiveness of the therapy. When a patient’s condition improves he comes back home. Some people are hospitalized to give their relatives a rest. Oncology diseases tend to run heavily and for a long time. It often happens that family members have to abandon their work and give all their time and energy to the care of their dying relative. It is not uncommon that a patient’s relatives are themselves on the edge of a nervous breakdown. If the hospice workers see that the situation has reached critical level the patient is hospitalized.
      It happened only three times that patients were hospitalized according to so-called social indications. One of the patients simply did not have a place to live. Another case was a sick woman who lived together with her 86-year old mother who herself was in need of care. The third patient was confined to a communal flat and was sharing a tiny room with her daughter, with an alcoholic neighbor living in the next room. By the time a woman bedridden for 6 years was put to the hospice, her daughter was about to commit suicide.
      In all other cases patients had relatives, friends or neighbors who wished to take care of them. If there are no close relatives at the dying man’s side, the hospice staff do their best to find them and evoke their sympathy. When they do not succeed in it, they turn to neighbors, tell them that a lonely person is dying nearby. Somebody agrees to bring food, others tidy up and cook the meals. There are virtually no refusals.
      The Moscow Hospice has a lot of voluntary helpers. After there was a video shown on TV with the plea for help, the hospice reception phone kept ringing non-stop. Of course, some of the voluntary helpers abandoned their work in time, but the ones who stayed had really deep intentions to help the suffering people. Today there are about three hundred volunteers in the hospice, of whom 30 people are actively working. Their list of duties is very diversified. Some visit the patients at home, others organize concerts for in-patients, do the cleaning up, answer the phone calls, attract sponsors’ attention to the hospice. Most of the hospice helpers are very young (the average age of a volunteer is 22 years). Many of them work in solid firms and get good money, but it does not stop them from dedicating their free time to the hospice. Anton, one of the volunteers, is a computer specialist. When his wife had a daughter last year, Vera Vasilievna thought that he would not have time for the hospice any more. «No, Vera Vasilievna, I can’t do without it now, – replied the young man. – see you next Thursday». After 2 years of work the volunteer service has its well-formed structure that includes coordinators and instructors. Instructors are responsible for the orientation of the novices, while coordinators gather orders from all hospice services before distributing them among other volunteers. Egor, one of the coordinators I had a chance to speak to, dedicates two days a week to visiting patients at home in addition to his coordinating functions. Egor came to the hospice in April of the last year. Shortly before that the young man got into a hospital himself and was astonished at the neglect and unkindness of the medical personnel. On leaving the hospital he made a firm decision to help people who had found themselves in a similar situation. By education Egor is a producer of documentary films. He believes that his work in the hospice helps him in his professional growth: it teaches him to have a sharper feeling of the world around, of simple joys and troubles. He is currently working on a classroom film for the medical staff of the hospice. That was the idea suggested by an instructor from Great Britain.
      Generally speaking, the First Moscow Hospice staff adopts many ways and ideas of their British colleagues who were the first to organize death-care centers. English doctors are working side by side with the Russian personnel, teaching them the right ways to relieve the pain syndrome, heal bed-sores; they hold regular educational seminars on sustaining therapy which is practically unknown in Russia. But there are things that nobody needs to be taught in the hospice. «The main thing we can give to our patients is love, - says Vera Vasilievna. – When a person feels he is loved, he gets rid of pain and lives longer». The first demand of the physician-in-chief to her staff is being responsive to a patient and always ready to listen to him. Can you imagine a nurse deciding to miss her vacation because one of the patients is extremely fond of her and would not hear of anybody else? And in the First Moscow Hospice nobody will be surprised by this fact. Few people are capable of such responsiveness, that is why those who wish to work in the hospice have to go through the test period, on condition of 60 hours of volunteer work.
      There are no «minor points» for those working in the hospice. All rooms are planned and designed with the is a room for relatives next to every ward; each ward has its own exit to the yard where a patient can take his walk at any time. The wards themselves are either one-man or four-man. It was not done by chance: in a room for two people the patients usually get too much attached to each other, and the death of one of them comes as too strong a shock for the remaining person. In a three-man ward one of the patients starts «falling out of the company»; that leads to emotional discomfort which can not be accepted in the First Moscow Hospice.
      Every small detail of the patients’ behavior is also taken into consideration. For example, one of the patients kept eyeing her hands with displeasure. As nobody of the staff could figure out the reason for it, her daughter was contacted. She recalled that her mother took great care of her hands and used never to go out without manicure. When nurses «fixed» the old lady’s hands she simply brightened of pleasure.
      After the visit to the Moscow hospice you start seriously thinking that love can make wonders, especially if you hear of some almost unbelievable stories of recovery. One of the former hospice patients had been bedridden for several years. When she was first seen by doctors, they did not consider her living even a year more. But 5 years have passed, and she has not only lived but learned to walk once more and is now working in the registry department of the hospice.