Nurse Rita Grossman has cropped blonde hair and a broad smile.

She’s worked for 9 years at Continuum Hospice Care, associated with Beth Israel Hospital in Manhattan –

and has been a nurse since the 1970s.

 Almost every day of the week Grossman treks around the upper west side–

visiting the homes of her patients on a regular schedule.  Her caseload varies from week to week.

 TAPE:  (:05) “ I think that being a hospice nurse feels like being a family doctor of the old days.” 

Grossman began working with the elderly when she was quite young.

Her mother was a nurse, and Grossman often volunteered at her local nursing home.

She says that’s where she developed a profound respect for the idea of letting go at the end of life… and she is now also devoted to helping people understand what hospice can offer.

TAPE:  :07  Many people who do know something about it are frightened of that idea of it – because of that idea of giving up.”

Grossman says hospice is more about maintaining the quality of someone’s natural life.  For example, inserting a feeding tube may technically keep a body going... but in some cases, it can cause pain and discomfort.

For Grossman her job is less about intervention and more about listening to someone’s needs.

TAPE:  :07  “Hello, Mrs. F – how are you my dear? You feel any better since the other day.  Yeah. ”  TAPE FADES UNDER, STAYS COOL

Today Grossman is visiting her oldest patient, Eleanor, at Eleanor’s apartment on 91st street.   (We promised to use her first name only, to protect her privacy.)

           TAPE:  :02 “Of course I’m going to check you out..”

Eleanor is 101 years old.  She’s been getting hospice care from Grossman since August of last year.  Her mind and sense of humor are still sharp.

Grossman says many people think hospice is only for cancer patients.  But she says Eleanor's main ailment is a fading heart.

The valves flutter, rather than pump, and she’s extremely weak.

TAPE:  :01  “Is it the same?”

Eleanor lies in bed in a tidy apartment she’s lived in since the 1940s.    Outside her bedroom hangs a portrait of her only daughter, who died when she was just 19.  Eleanor also outlived her husband -- he passed away in the late 1970s.

TAPE:  :06 “Let me just wash my hands, then I’m going to take a peek at your feet.”

The room is sparsely furnished… there’s a sink in the corner and the shades are drawn, letting in diffuse pale blue light.

Eleanore herself is small and thin.  Her white hair is brushed back from her forehead and she breathes quickly between sentences.  She can't move much, but her eyes brighten and her face is animated when she talks to Grossman and other visitors.  She leans her head forward to speak, softly, when she says how she's feeling.

TAPE:  :12 “I have a lot of pain.  A lot of pain where. Here.  In your chest? Is that new? Yeah."

Grossman prescribes nitroglycerin, a medicine that increases blood flow to the heart, and reduces chest pain. It also lowers blood pressure.

           TAPE:  :03 “Yeah, sounds like she needs a dose.”

She's speaking with two other women involved in Eleanor's care: her health care proxy (a close friend)--and her home health aide, who comes daily to help her bathe and eat.

Grossman reminds them that addressing Eleanor’s pain is of the utmost importance.  Eleanor's aid was worried that the medicine will drop Eleanor’s blood pressure too much and might hurt her in the long run.

           TAPE:  :02 “Let me check her pressure right now.”

Fade out to black.

Scene I pt. ii

Rita Grossman's days are made up of troubleshooting episodes like this.

 TAPE:   :07 The priority is comfort.  The side effect is the reality we have to deal with.

She means that providing relief may sometimes – though not in Eleanor's case – put a patient at a higher risk of dying.

TAPE:  :40 “When it comes to adequate amounts of pain medication…many physicians up to the very end, the patient's in pain, we want to increase the pain medicine.  The physician is saying if you give more morphine, it might depress her respirations.  That's true.  It is a side effect of morphine.  It can depress respirations.  But if a patient who gets extra morphine dies in a short period of time.  And depressed respirations perhaps contributed to an earlier death.  We don’t say to ourselves, the morphine killed, we say the cancer killed her.”

Pain medication is such an integral part of hospice care that each patient receives a “comfort pack” –a small cardboard box filled with painkillers like morphine.

The comfort packs live in the refrigerator. Often the nurse teaches a family member -- or the patient herself -- how to administer the medication safely and effectively.

This is one of the most dramatic differences between hospice at home and receiving care in a hospital.  The family is near the top of the chain of command and can play a role in helping to relieve pain.

Eleanor has a comfort pack.  But she hasn’t needed it yet.

 Scene II -

TAPE:  :13 “How's that chest pain now?  It's ok now.  I’m going to take your blood pressure again to see if the nitroglycerin made a difference.”

Grossman stays with Eleanor for about an hour.

           TAPE:  :02 “Yes, it did.”

In hospitals, Grossman says nurses are in and out of patients’ rooms and rarely have time to get to know them.   At home, it's a different story.

TAPE:  :25  "I'm going to ask you to put your oxygen on, ok?  Yeah.  Is it ok if I take your hearing aid out when I put this in?  Cause I know it usually gets in the way a little bit.  Yeah.  Good.  I'm usually pretty loud.  Yeah, I hear you.  Are you used to my Boston accent too?  No... Did you notice I had an accent?  No.

Eleanor is originally from Germany.  She says that before deciding on hospice care, she was in and out of the hospital.  She’s happy to be staying in her own apartment.

TAPE:  :30 It’s a place for the dying and I thought I'm in that state already!  And then Rita convinced me that they would take care of me, regardless of how long I live.  And that made me feel much better.

                    CARE – FADE OUT…

                    TAPE:  Sound of tapping on a computer QUICKLY FADE UNDER

The next day, at her apartment, Grossman writes up a summary of her visit with Eleanor and prepares to leave on vacation for two weeks.

           TAPE:  :04 “She’s still having symptoms that need to be managed.”

She doesn’t know if Eleanor will be alive when she gets back.

TAPE:  :16 I feel sad, but I also feel honored. .. I've developed a bond.  I feel honored that she trusts me and that she feels comfortable talking to me with what are intimate, intimate experiences.  I know she looks forward to seeing me."

Grossman says if she ever gets sick herself, she’s arranged to be taken care of the way she cares for Eleanor.  She’s already stipulated when she does and does not want aggressive treatment.

But for now she plans to stay on the job... as a nurse for as long as possible, and then maybe as a volunteer, to help other nurses.

Eleanor has plans too.

Upon her death, she’s donating her brain to the The Neurological Institute at Columbia Presbyterian.  She says, she “figures that science will want the brain of a 101-year-old lady.”

I’m Katie Simon, Columbia Radio News.

BACK ANNOUNCE:  Rita Grossman arrived home from vacation this week.  She reports that Eleanor is weaker than before she left and that she’ll be visiting her soon.