Caledonia Argus

Lapham devoted to helping those in final stages of life

Posted: 11/18/03

By David Heiller
Argus News Editor

Palliative care is not a household phrase, but itís one that Carrie Lapham believes in with all her heart.

The Eitzen woman is in a small group-of nurses nationwide to earn certification last May from the American Nurses Credentialing Center in palliative care management.

Lapham, who works at Gundersen Lutheran Medical Center in La Crosse, was among the first 49 men and women in the nation ever to receive the certification. She had previously been certified as medical surgery nurse, so it was exciting to get certified in what she was doing on a daily basis.

Palliative care focuses on patients who have incurable diseases and enhancing their quality of life. Lapham and a team of co-workers reach people earlier in their disease process, and their care often lasts up to death and bereavement.

She has devoted most of her 19 years as a nurse to this kind of work. The Caledonia native started her profession as a public health nurse for Houston County in 1984. Thatís where she developed a passion and interest for patients and their family in the end-of-life process. She saw many patients who wanted to be able to stay at home. ìPublic health care and nursing can help people stay at home for as long as possible,î she said.

In 1989 she began working at Gundersen on the medical oncology unit and then in the hospice program. At the same time, she entered graduate school at Winona State University, where she received her masterís degree in nursing in 1995 as a clinical nurse specialist.

During that time she heard more about palliative care programs that worked with patients that werenít yet in hospice. She saw the need to bring people into care that werenít eligible for hospice, yet had some of the same symptoms and concerns.

ìWe tried to broaden out that care continuum to meet the needs of people who were dealing with those things earlier on in their disease process,î she said.

Patients in hospice receive palliative care, but people who are non-hospice can receive palliative care too. Lapham works with patients who do not yet qualify for requesting hospice services.

Palliative care, both hospice and pre-hospice, focuses on comfort. People in hospice want to stay at home as long as they can, be comfortable, and keep their quality of life as high as possible.

When reaching the point of hospice, the burdens of chemotherapy or surgery would likely outweigh the benefits, Lapham explained. When patients, families, and their physician decide to participate in hospice, she helps with the transition.

Care goes beyond physical

Laphamís work is not the traditional job of nursing, if there even is such a thing. People who are facing terminal illnesses can have many symptoms that go beyond physical things like pain or shortness of breath.

There are many emotional aspects, Lapham explained on November 7. ìThe disease affects them in so many ways,î she said. ìThey may have pain so they may not be able to go out and socialize like they used to. So they feel isolation.î

That can lead to depression. ìPeople who suffer from chronic pain are more likely to be depressed,î she said. Physical, emotion, spiritual aspects are all entertwined in palliative care.

Itís hard for Lapham to describe a typical day. If a patient is struggling with symptoms that are hard to control, she focuses on that, does a symptom management assessment, adjusts medicine, sees how itís working, follows up on them, and perhaps does a house call too. Plus she works closely with home care and helps with referrals. Assisting with advance care planning is another role for a palliative care nurse.

Palliative care is a complex, group effort, Lapham said. Many workers get involved, like chaplain, social worker, nutritionist, physician, family counselor, and physical therapist. ìThat whole team of people really need to be pulled into that plan of care,î Lapham said. ìWithout the interdiscipline team, weíre not really providing good palliative care.î

She meets with several different teams during the week and consults with them regularly.

Difficult but special work

The work is draining yet rewarding. ìSome days can be really tough days, but most of the days, the people that you meet, the patients and their families, you develop real close relations with them that can last for a long time,î Lapham said. ìItís really a very important time in their lives, a stressful time but an important time.

It means a lot to Lapham to be included in that. ìSo itís difficult but itís special. If thereís a way that we can make a difficult time a bit easier, that gives me satisfaction in my role.î

The interdisciplinary teams offer support for each other, she said. ìAnd you have to consciously take time to do be able to do things that help you relax, some respite for yourself. So outside activities are really important as well.î

Family and friends play a key role in that. ìCertainly with four kids, you do get away,î she said. ìYou need to get away.î

Lapham, whose maiden name is Hartley, was born and raised in Caledonia. She moved to Cannon Falls when she was in high school, then went to college at Mankato State and Viterbo, where she received a nursing degree. She and her husband, Wes, have four children: Leslee, 19; Travis, 17; Ethan, 11; and Kevin, nine.

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