Pat Naecker sits in her country-style kitchen, looking out the bay window. A sloping front yard runs up against a large pond and a pasture, where four horses graze in the summer sunshine.
Her dark hair is cropped short. Her skin is pale white beneath her white-and-green striped shirt, on which a large gold cross rests. Her small hands are crossed on the table in front of her. Her large blue eyes are direct as she turns her gaze from the outdoor scene.
"I've spent a lot of time in hospitals the last six years," she says. "I didn't want to go back. I want to be at home with my family. I want to die at home."
Last February, Naecker's doctors told her there was nothing more they could do for her. She has had stomach cancer for six years. Now, after seven operations, chemotherapy and radiation treatments and "all kinds of experimental treatments," Naecker is home to stay, thanks in part to the Hospice Services of Howard County.
Hospice is a private, non-profit organization that has been in business in Howard County since 1978. It is affiliated with the Bon Secours Nursing Order in Baltimore and its extended-care facility in Ellicott City. The nursing care, paid for by the client's insurance, makes it possible for Naecker to stay in her ranch home outside of Clarksville with her family.
"The medical aspect has been significant," says Naecker, 41. "The nurse has helped me dress some open wounds, and I have a colostomy that she helps me with. If she has a question, or I do, she'll contact my doctor. I'm still tied to NIH [the National Institutes of Health in Bethesda]."
The nurse has taken the strain off everyone. No more long trips to Bethesda. No more worry about whom to depend upon when a medical question arises. All of it allows Naecker, a former Howard County physical education schoolteacher, who takes intravenous fluids at night, a chance to relax at home.
At home she is surrounded by her family: husband, Bob, who works for the Department of Education; her children, Jamie, 15, Matt, 13, and Carrie, 8; her mother, Margaret Smith, who has lived with them since last November, and a lively menagerie of three schnauzers, seven puppies, one kitten and the horses out front.
"I've talked about it with my kids; I knew I wanted to be home when I died, even when I wasn't aware of Hospice and that it could do all these things for me," says Naecker.
The hospice program originated in England through the efforts of Dame Cecile Saunders, who came up with the idea of providing care and comfort to people who were terminally ill. She established St. Christopher's Hospice in 1967.
The name, hospice, is taken from that of the medieval way station. Run by monks, the shelters were places where weary and ill travelers were welcome to stop for care and comfort. Saunders felt people who are dying are also on a journey.
In Howard County, Hospice is a member of the national hospice organization and is licensed by the state of Maryland.
Hospice offers nursing aid and assistance to the terminally ill, like Naecker, but it offers more. It provides emotional support to the client and family through a volunteer program. Hospice also offers a bereavement program and holds weekly support meetings for adults and children.
Its services, aside from the nursing care, which is generally covered by insurance or Medicare, are free of charge. The economy, however, is forcing the organization to consider a nominal $5 fee for its support meetings to offset costs. But Weber says the fee would be completely voluntary.
Hospice is housed in a new condominium office building on Twin Knolls Road, which it now owns thanks to three major donations from Glen and Hugh Cole, Kathleen and John Liparini, and Eva and Ernst Winkler.
The program operated last year on approximately $180,000. It receives funding primarily through private contributions, but did receive $48,000 in grants from the Howard County government and the Columbia Foundation.
"We've found there are people who are willing to come to events and support us, but they don't want to hear the 'D' [death] word," says Hospice director Nancy Weber.
That's why Hospice began a series of events that serve to anesthetize contributors against the reality of death.
They can attend "A Taste of Howard County," a sampling of the best gastronomic delights from area restaurants, Hospice Night at Toby's dinner theater and "Decorators' Show House" without once thinking about Hospice Services.
There are only three full-time employees, Weber, volunteer coordinator Elaine Patico and an office manager. Seven others work part time from five to 30 hours a week. There are 55 volunteers, each of whom has been through a 30-hour preliminary training program and has attended educational seminars.
When volunteers are asked what it is that they do, they almost always answer, "We listen." And much of what they listen to
are hard questions: Why did this happen to me? Where is God? What's the point? What will my family do? How can I get through this?