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Leading with Dignity

Kristine Kowalski would likely win the prize for the Torrance Memorial Medical Center employee with the longest drive to work. The hospital’s director of hospice services drives 100 miles from her home in San Diego. The three-hour-plus round-trip drive is daunting—but worth it for Kowalski, who shares the hospital’s philosophy of attending to terminally ill patients’ pain, suffering and emotional needs in the final weeks and months of life.

“I interviewed with several agencies in San Diego and all the communities in between,” reports Kowalski, who celebrates her one-year anniversary at Torrance Memorial at the end of August. “A lot of them were very financially-driven, not patient-oriented; it was just productivity and meeting quotas. But Torrance Memorial is focused on the patients, not the numbers. Hospice can be very unstable. You can have a very high census and within literally a weekend lose a good percentage of the patients. But that’s the nature of the job, and Torrance Memorial understands that.”

While Torrance Memorial Medical Center has had a hospice program since 1983, Kowalski is the first full-time, permanent manager dedicated solely to the division. She oversees a staff of 22 people, including eight nurses, five home-health aids, three social workers, a bereavement coordinator and a volunteer coordinator. The service has expanded significantly under her leadership

“Kris brings a lot of support to our patients and families, is the liaison to the hospital and physicians, and does a really good job of supporting her staff,” says Terri Ferry, Torrance Memorial’s administrator of the Home Health and Hospice departments. “Hospice is a tough business to be in, and the staff goes through a lot of emotional and ethical kinds of dilemmas. And she’s really there for them. I think she’s been a great addition to our team.”

Born and raised in Chicago, Kowalski is the daughter of two military officers—her father was in the British Royal Air Force, and her mother was in the Polish Air Force. With flying in her blood, she joined the Air Force Reserve in 1988. It was on the flight deck of a C-130 that she met her husband of 20 years, Dan.

She was activated for military duty during the Gulf Wars—Desert Shield and Desert Storm—serving as a flight nurse. In 2009 she was activated for Iraqi Freedom and was a mass casualty/trauma nurse specializing in pediatrics.

Shortly after Hurricane Katrina hit in 2005, the Federal Emergency Management Agency tapped her to set up a mobile surgical hospital in Houston. In two days time, she found two remote locations, set up two hospital facilities and began treating patients in outlying areas, only to have to evacuate two weeks later when Hurricane Rita hit.

“It was challenging, but I thrive on challenges,” says Kowalski, who is still a Lieutenant Colonel in the Air Force Reserve. “I have enough confidence in my abilities; I knew I could do it. It was never a question of, ‘Can we do this?’ The nursing part of me said there were people that needed help. We found a way, and we did it.”

When not helping FEMA or the Air Force, Kowalski’s civilian job was as an ER trauma nurse. She adored the work but eventually came to question whether aggressively treating patients was always the right course—whether less aggressive treatment might sometimes be more appropriate.

“I saw what we were doing just to satisfy patients’ family, resuscitating people, compressing the chest, sticking a tube in their mouth, cracking every rib to keep them alive. We started approaching the family, bringing them in during the code and asked if this was truly what they wanted,” recalls Kowalski, who in 2008 switched gears and became a hospice nurse. “Hospice is about easing their suffering but also maintaining their dignity. We can monitor pain and keep them at home where they have a better quality of life.”

Kowalski hopes patients and their families will learn to take advantage of hospice’s services, emphasizing that hospice is not a service that helps people to die sooner.

“I understand it’s a hard decision to use hospice,” she says. “A lot of people feel like if they come to hospice, nothing is going to be done for them—that when they come on [to hospice care], they will pass within hours or days. It’s really just the opposite. It definitely has to be someone who has been diagnosed with a terminal illness and a physician says they have six months or less to live. That’s also the state definition of hospice. We often become like part of the family. Our care often helps extend their life and gives them extra time with their loved ones.”

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