Juneau physician describes benefits of hospice

Posted: Wednesday, September 03, 2008

If you've ever wondered what Hospice and Home Care in Juneau can offer you or a member of your family, you could learn a lot talking with Dr. Bob Urata at Valley Medical Care. As medical director of HHCJ, Urata oversees the services that nurses and other staff provide through Juneau's Hospice program.

"At Hospice and Home Care we look at the total patient," Urata said when I visited his office last week. "Most patients face not only physical pain, but psychological, spiritual, and sometimes financial pain as well. That's why we use a team approach, combining the efforts of nurses, physicians, a chaplain, a social worker, therapists with special skills, nursing aides, and trained volunteers.

"Some people have great difficulty facing death, but we have more tools than ever before to treat patients at home. If we have time to work with them, we can discover things that can be done. When they die, the majority of the time they die in peace."

Urata was born and grew up in Wrangell. He attended University of Washington Medical School and did a three-year Family Medicine Residency at the University of Washington Hospital as well. He began serving as medical director of Hospice in the late-1980s, when Mary Tonsmeire was the single Hospice nurse. Since then Juneau's Hospice agency has grown to include home care services and has earned certification from Medicare.

Urata said he meets with nurses and other Hospice team members twice a week to discuss individual cases and assure that all patients are receiving high quality care. "We often deal with complicated cases in which pain is difficult to control," he said. "I make suggestions to the nurses, who also communicate with each patient's primary doctor.

"The nurses are very dedicated and passionate about their work," Urata said. "It's not easy. They often get very close to their patients, so there is a lot of grieving and sadness. The reward is that you've helped a person you've gotten to know pass on to the next life in a very peaceful, comfortable, and dignified way - and many times on their own terms."

One of the most difficult and important things, Urata said, is educating doctors, patients, and families, about the role Hospice can play. He said people often get referred to Hospice very late because they do not realize how close they are to dying, and doctors sometimes find it difficult to communicate that information to them in a timely fashion. "How do you give bad news to a patient in a timely way?" he said. "It's a very hard thing. You don't want to give up on a patient. ... In the U.S. health care system, we're trained to save lives - and rightly so - but we're not trained so well in helping prepare people for the process of dying."

Urata encouraged people to learn about the benefits of Hospice early. "If you or a loved one are suffering from severe illness-heart disease, cancer, or emphysema, for example, and are slowing down, you should consult your physician, or a family member can call Hospice to learn about what the program has to offer.

"We should all probably talk about death and dying," he said. "When your turn comes up, what do you want when you're dying? If your illness is terminal and there's nothing left to do, do you want to be at home? Do you want to be comfortable? Do you want to have control till your last day? If you do, the best way to deal with that is through Hospice."

Urata also suggested that people consider completing three types of advance directives: a living will, a "do not resuscitate" directive (such as through Alaska's Comfort One program), and durable power of attorney, appointing someone to make health care decisions should you not be able to.

• Marge Osborn is a Hospice and Home Care of Juneau volunteer.

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