Hospices and Hurricanes
Brobson Lutz, M.D.
John Fuchs, a hospice patient, left New Orleans in the back of his sister’s SUV during that mandatory evacuation before Hurricane Gustav. His remains returned to New Orleans in an urn.
Fuchs was diagnosed with colon cancer just before his 52nd birthday in November 2004, four years after his wife had died from a pulmonary embolus. Before Hurricane Katrina, surgeons removed a cancerous portion of his colon, but the tumor had already spread into his abdomen.
When diagnosed with cancer, Fuchs was a popular English teacher at De La Salle High School. He had bachelor’s and master’s degrees in English from the University of New Orleans. He taught at De La Salle for most of his career.
His surgery and chemotherapy chipped into his sick leave, but Fuchs continued teaching. During Katrina, he and his mother had sheltered in a place Uptown and waded through floodwaters to escape the anarchy that descended on New Orleans.
As soon as De La Salle reopened, he was back teaching. Except for scheduled doctors’ visits and chemotherapy sessions, he rarely used sick days. Then more darkness – in May 2006, De La Salle terminated his employment.
“He was laid off along with two other teachers with cancer. John was terribly upset.” says Constance Fuchs, his mother, a widow who came to New Orleans with her psychiatrist husband when John was a youngster.
(Asked for a response, De La Salle president Ken Tedesco said, “We cannot comment on personnel matters.”)
“He looked for a new job as he needed to have health insurance. He heard about a vacancy at Chalmette High School in October 2006,” Mrs. Fuchs continues.
“The public school in Chalmette treated John wonderfully. They let him schedule his chemotherapy sessions on Fridays to help him recover over the weekend. The other teachers pitched in to work around his absences.”
In the beginning of his two years at Chalmette High School, he drove himself to work. Later he became less secure about driving so his mother turned chauffeur. She made two round trips a day between her Uptown home and Chalmette so that he could continue teaching. Even so, he lived independently until January 2008, when he moved to his mother’s house.
In the summer of 2008, his cancer returned with vengeance and a bevy of complications. His oncologist Dr. Salvador Caputto transferred his care to the Marrero-based Heart of Hospice of New Orleans in early August 2008.
“It seemed that he was on too many medicines that just were not helping him. Mother and I sat down and decided that we just wanted to keep him comfortable,” says Connie Simonson, his sister. “The hospice medical director Dr. Charles Simonson, no relation to me, thinned out his medicines. He had Fentanyl patches for pain. John moved around on his own until the week before he died.”
His last meal was a little steak and a piece of lemon pie on August 17. After that, he lived on Gatorade and popsicles made by his mother. The hospice social worker called and asked Mrs. Fuchs if she wanted to join her son and other hospice patients in a Crowley nursing home. She did as the social worker instructed – she called 3-1-1 to make sure the city had John’s pickup information and was told all was in order.
“We didn’t hear anything from them early on Saturday so I called 3-1-1 twice. Somebody in San Antonio answered. They couldn’t find any record of John’s case and told me a supervisor would call back. Never did. I called the hospice. The social worker called back about 5 p.m. She told me she had spoken to a person in New Orleans, they found the record, and John and my mother would be picked up soon,” says Simonson.
“My husband and I live on the West Bank. I had been over here all day. I went back to the West Bank and Mother called about 6:30 p.m. [saying] ‘They called from the city and they will be here within an hour.’”
“I had our bags packed and was sitting in the living room with John and all his medicines,” Mrs. Fuchs recalls. “I called again about 1:30 a.m. Sunday, and an ambulance marked Providence Hospital in Mobile arrived about 30 minutes later.”
“The paramedics came in and started writing John’s name on his leg. ‘Where are you taking us?’ I asked. They said they could only take us to the Union Passenger Terminal, but that out-of-town evacuations had already been suspended for the night.”
The steadfast Mrs. Fuchs didn’t see the logic of sitting out the night at the train terminal, especially since it seemed that the plans to go to Crowley had fallen apart. At about 2:30 a.m. the ambulance left with the crew saying “if you don’t go now, we won’t come back.”
Since it was now obvious that the hospice plan wasn’t working and that an ambulance transport for brother and mother to Crowley was unlikely, Simonson and her husband took charge posthaste. They loaded their SUV with a feather bed for John and crossed the river from the West Bank.
“My husband Scott carried him to the SUV. John was heavy and Scott was struggling, but we got him in the van and left early Sunday morning via back roads, missing all that contraflow mess coming out of New Orleans to reach our camp in Mississippi.
“We set up a bed downstairs, and John seemed to be doing well at first. He ate two popsicles and was alert and joking with us. He could only lie comfortably on one side. You could see a bulge where the tumor was on his other side.”
“By Monday he wasn’t alert anymore. He had a blank stare like he was blind and felt clammy. I put ice on his face. He would nod at me,” says John’s mother sadly, remembering how hurricane force winds blew and they lost power. Her son-in-law later hooked up a generator to run a fan and refrigerator.
John Fuchs died about 2 a.m. on Tuesday, Sept. 2, with his heroic mother by his side. (For remembrances from his students, see www.legacy.com) Of course, the death of patients in hospice care isn’t unexpected. But evacuation stresses accelerate these deaths and cause intense problems for caregivers and family.
Different places have different approaches: Canon Hospice, which provides both home and in-patient care had more definitive plans.
Canon had their own pre-arranged contract with an ambulance service. Even though the EMS units they expected were diverted by the state for other transports, they scrambled to secure a bus as well as backup ambulances for patients on oxygen and those who had to lie down. In all, they transported about 30 patients.
“I was on that bus with my husband. We left Elmwood about 2 a.m. Sunday morning and made good time on clear roads, said Aline Hill, 61. “Airline Highway didn’t have a lot of traffic at that time so we made it to Baton Rouge in about one and a half hours.”
“My husband Raymond Hill Sr., was diagnosed with pancreatic cancer last March. He had five CyberKnife treatments at West Jeff [West Jefferson General Hospital] but I don’t think it did him any good. They sent him for chemo over the summer, but his cancer was too advanced.”
“They settled us in this big Baptist church in Baton Rouge early that Sunday morning. The storm hit Monday. Lights went out and it was hot. I washed him off, swabbed his mouth and fanned him. He died 10 a.m. on Sunday,” recalls his widow.
What lessons can we learn from hospice evacuations and Gustav? Hospices have the same problems as everyone else yet magnified, according to Susan Henning, a health care attorney with the New Orleans law firm of Curry and Friend. She offers these observations:
nIt is a difficult situation because family members are often unable to manage evacuation on their own and may have to rely on the Hospice.
nTransporting of terminally ill patients is going to be traumatic and can hasten death.
nIt is important for hospices to advise families that evacuation destinations and arrangements might not be ideal.
nFamily members need to ask hospices the same questions they would ask a nursing home: What are you going to do in the event of a mandatory evacuation? Where will you go? What is my role in all of this? What if I cannot take the patient with me?