Country Hospice
CR Magazine: Collaberation – Results


End-of-Life Care

Many terminal patients aren't aware of how hospice can help them.


By Danny Wilcox Frazier

Country Hospice

On the rural roads of Iowa, hospice workers offer comfort to those who need it most

By Danny Wilcox Frazier

Penny Beuter’s posture told it all. As she listened to her voicemail that day in July, her shoulders slumped forward. Her free hand rose to cover her eyes. Beuter stood frozen. When her eyes met mine, they seemed to be searching for some faraway horizon, but only for a moment. One of Beuter’s patients, a 34-year-old mother of two, needed her immediately. What ended up being the woman’s final hours would be too hard and painful to endure without her hospice nurse.

Working for Iowa City Hospice in eastern Iowa, Beuter treats many rural patients in places far removed. As an economic shift has devastated small towns across the state, fueling an exodus of young people, an aging population has been left behind in dire need of health care. In communities where doctors once made house calls, now almost no medical services remain. For these people, hospice provides even those who are cut off, geographically and economically, the end-of-life care everyone should be afforded.

When I met Richard Blakey, the 71-year-old reminded me of so many of the men from my hometown of Le Claire, Iowa. A tattoo of a topless woman adorned his right forearm. He was tough, but his heart was huge. And if he liked you, you were family. Beuter and Nichole Davis, a hospice home health aide, had been caring for Blakey at his home in Swisher, a sleepy town surrounded by fields of Iowa corn. Facing advanced renal cell carcinoma, Blakey had checked himself out of an Iowa City hospital nearly three months earlier, letting those charged with his care know that if he was going to die, he would die at home.

While driving to Swisher, Beuter told me that Blakey’s condition had deteriorated rapidly over the previous weekend. Inside Blakey’s home, protected from the late-July heat and humidity, a small window air conditioner worked overtime. Blakey lived with his 93-year-old mother, Irene Wilson, his sister Darlene Miller, 72, and his middle son, Everett. Miller and her mother watched over Blakey day and night; his son, a 40-year-old construction worker, left work when his cell phone alarm indicated it was time to help give his dad his medications.

Blakey always lit up whenever Beuter or Davis arrived. Though a tall blond, it is Beuter’s shy smile that draws the most attention. For the next couple of hours, the two teased each other back and forth, as Beuter organized medicines and checked Blakey’s vital signs. With his health notably worse than the previous week, Beuter contacted Blakey’s oncologist. She knelt by his recliner, feeding him ice while the two talked and smiled. When Beuter and I were leaving the house, it was Wilson who needed support as her son’s worsening state became apparent to her. Beuter hugged her, whispering to her and helping to settle her nerves and weak heart.

The following day, after an appointment at the cancer center during which his doctor stopped treatment, Blakey visited the gravesites his sister and mother bought that morning. The shadow of balloon-like clouds rolled over the plots as Blakey watched Everett identify the graves’ location. Blakey and his son made plans for that night to go fishing, Blakey’s favorite pastime, and invited me along. Though no fish ended up on the end of anyone’s line, the sunset glowed across the water like fire on a prairie. Blakey decided to go fishing again two nights later, inviting me to bring my 6-year-old son. Blakey did not make it, though. A little more than 24 hours later, he died in his sleep, at home.

Family and friends filled the house, all gathering around Blakey’s mother. Tears and laughs filled the room where he died a few hours before. Everyone spoke of Blakey’s compassion for kids in trouble, how he took in those with drug and alcohol problems. A story of turning a pet rabbit into dinner when the refrigerator was empty brought the loudest ovation. The meat, I was told, was tough.

Beuter, Davis and other hospice workers milled in and out, gathering supplies and talking to family, but mostly passing out the hugs that are so needed during times of loss. It was their second death of the week. I watched again as Beuter’s eyes wandered, fixed and motion-free, searching for that horizon.


To view the photographs that accompany this article, please see the print  magazine.