In 1974, Connecticut Hospice, the first hospice in the United States, opened in New Haven. Founded by a team under the leadership of Florence Wald, its establishment was a significant milestone in the American hospice movement. Dianne E. Puzycki was there to help the fledgling organization get off its feet—and she never left. At age 82, she continues to work the night shift at Connecticut Hospice once a week. “I want to be part of it as long as I can,” she says. “It's become part of my life, my philosophy.”
THE EARLY DAYS
Puzycki wasn't always a hospice nurse, but she felt a calling toward the specialty before it even existed in the United States. After graduating from nursing school in 1955, she started her career at Memorial Hospital (now part of Memorial Sloan Kettering Cancer Center) in New York City. There she cared for patients with cancer, many of them young women. “At that time, we didn't talk about death and dying,” she says. “We weren't allowed to talk about that. It really haunted me for years.”
In the early 1970s, Puzycki's interest in hospice was piqued by two influential women. One was the English physician Dame Cicely Saunders, who founded the first modern hospice, St. Christopher's in London, and whose ideas heavily influenced Florence Wald; the other was psychiatrist Elisabeth Kübler-Ross, whose 1969 book On Death and Dying introduced the concept of the five stages of grief. Puzycki credits both women, whom she saw speak, for motivating her to get involved in hospice care. She remembers the impact of one meeting with Kübler-Ross in a restaurant in Branford, Connecticut: “I couldn't get over how wonderful she was. As a younger nurse, I was very impressed with this new movement.”
Puzycki joined Connecticut Hospice as a volunteer, and since the organization didn't yet have its own facility and employed just a few paid staff, she spent six years in that role doing home care visits. (She also raised five children during that time.) She was eventually hired for a full-time position.
Unlike her previous job, being a hospice nurse meant learning how to openly address the process of death and dying with patients. Working with a mentor, Puzycki says, “I learned to be very comfortable talking about this stuff. I had to learn to know what to say, when to say it, and how to say it.” And owing to the newness of the hospice concept, educating others was also a part of Puzycki's early role. “People didn't know who we were or what we were. They expected us to have ‘the shot’ [to perform euthanasia]. It took a lot of teaching for people to become knowledgeable.”
Early on, Puzycki witnessed the power of the hospice services she helped provide via home visits. She recalls caring for one of Connecticut Hospice's very first patients, “Annie,” at a time when the organization had very little money and was fundraising. Annie had a prized Kennedy half-dollar she insisted on donating in gratitude for the services she received. “She gave what she had, from her heart,” says Puzycki.
THROUGH THE DECADES
In 1980, Connecticut Hospice opened its first full-fledged facility in Branford, where it would operate until moving to a newer space in 2001. Puzycki looks back with reverence on her decades of work for the organization—“I've been privileged to be a part of it,” she says.
She remembers the names and faces of countless patients she cared for, many whose last moments struck her as profound. One of her most vivid memories was of one Easter morning, around sunrise. “We had a woman dying. The patient across from her was an ALS patient whom we had never heard speak. The woman who was dying kept saying ‘I'm so afraid, I'm so afraid,’” Puzycki recalls. “All of a sudden this voice comes up and it's the ALS patient—she said, ‘Don't be afraid.’ I said, ‘Is that you?’ and she said yes. I don't think I ever heard her speak after that. She was able to help that woman.”
She also remembers a man who accurately predicted his time of death, a Holocaust survivor who insisted on keeping his shoes and coat next to him at all times, and a woman whose contorted face dramatically changed into a peaceful expression whenever she listened to a religious tape. “You don't forget when you experience those moments,” Puzycki says.
Puzycki views hospice care as a constantly changing and improving specialty. “We can [now] get patients into a comfort zone better and easier than we did in the past,” she says, noting the effectiveness of drugs like lorazepam (Ativan) and haloperidol (Haldol), which weren't available when hospices first started. She recalls that early on more patients stayed up at night, afraid, passing the time in a big family room by the nurses’ station. “Now, most people sleep at night.”
She has also noticed that patients’ hospice stays are shorter today than in the past, owing to better treatment options. “Most patients are here maybe a couple of weeks,” she says. “Patients have had incredible medical care before they become part of hospice. There's so much out there with chemo, treatment, and surgeries that we didn't have all those years ago.”
REFLECTIONS ON THE PROFESSION
Puzycki says that what she values most about being a hospice nurse is the opportunity to be present with patients. “Sometimes [comforting them] is not always about medicine—sometimes it's just being there, meeting their needs.” She adds, “You have to spend time with patients. You can't just be abrupt, go in, do what you have to do. Take the time if you think they need you to be there. And sit—even if you just hold their hand until they're calm.”
Being present for patients and “picking up on the little things” is to Puzycki the key to hospice nursing. And she says that seeing the compassionate actions taken by her colleagues, especially the younger ones, makes her feel hopeful about the future of the profession. She recently saw, for example, a fellow nurse lean down and kiss an elderly patient on the head. “I said, ‘That's a good hospice nurse.’”
Puzycki believes that her job and the patients she cares for continuously enrich her and teach her to appreciate life. The value of that experience, she says, keeps her from fully retiring. “People say, ‘How can you do this work?’ I think that I'm on the other side of it—you get great benefits from it as a person,” she explains. “I don't know anything else I would want to be doing.”—Diane Szulecki, editor