A beautiful death

March 11, 2005 -- Today the Philadelphia Inquirer ran a significant profile of Fox Chase hospice nurse Bunny Dugan as part of the ongoing series "Cancer Chronicles" by staff writer Fawn Vrazo, who herself has metastatic breast cancer. The piece is very good in explaining the nature and merits of hospice care, and placing it in the larger context of the United States' "skittishness about death." It also does a good job of showing the importance of the emotional support hospice nurses like Dugan provide and how difficult their work can be, though it could have done more to bring out the significant clinical skills the work requires. That would have helped readers better understand that hospice nurses are highly trained professionals.

The piece reports that Dugan has been a hospice nurse with the city's prominent Fox Chase Cancer Center for 13 years. Dugan was originally an ED nurse, but she shifted to hospice after her father was able to die from his terminal kidney cancer at home under hospice care, surrounded by his family--a "beautiful experience," according to Dugan. Vrazo reports that hospice nurses like Dugan "help the dying live as well as possible in the time they have left." The piece includes some important information about hospice generally. It reports that there are more than 3,000 hospice programs and about 20,000 hospice professionals nationwide, but that hospice remains underutilized, despite evidence that hospice patients live longer and the fact that Medicare and private insurance cover it, due to a national "unease" about death.

The piece focuses on Dugan's care for a patient with advanced ovarian cancer. It follows her to a home visit at which she assesses, counsels and comforts the patient, as well as checking on her pain medications and blood pressure and listening to her lungs. The piece emphasizes the psychosocial aspects of the nursing role; we do not hear anything specific about what medications the patient is on, or other technical information. This focus in discussing Dugan's role continues in the report's account of the Fox Chase hospice team's weekly meeting about its current patients. Of course, things like how well the patient is getting around, her appetite and weight, and how supportive her family is are key factors in a nursing assessment and in the patient's health. We just wish the piece would have included a little more detail as to more obviously technical aspects of the nurses' work, such as discussions of pain medication, trends in vital signs, psychological care, or other clinical aspects of dying. By contrast, the meeting's "leader" is Michael Levy, an "oncologist and pain expert" who founded the hospice in 1982 and is "[a]ctive in the national hospice movement." We're guessing Dugan could also be described as a "pain expert." In general, though, the piece does a pretty good job of avoiding the "physician is king" theme, stressing the team nature of the group and the importance of Dugan's work. It also generally avoids angel stereotyping, though it does arguably convey Dugan's courage and resilience somewhat more than her clinical expertise. The piece reports that most of Dugan's patients die within weeks, and that she estimates she has attended nearly 650 funerals. Dugan "cries a lot" and attends Mass every day.

In a final irony, a note after the end of the piece's online version explains that the "Cancer Chronicles" series is about Vrazo's experience and those of "others she is meeting along her journey -- doctors, patients, researchers, volunteers and others." Well, here's to the "others."

See the "Cancer Chronicles" article by Fawn Vrazo in the March 11, 2004 edition of the Philadelphia Inquirer.

Contact Fawn Vrazo at 1-215-854-4199 or fvrazo@phillynews.com.