Carol "Zoe" Klingler, RN, CHPN, with Hospice Atlanta, believes that hospice nursing was the thing she was meant to do. A nurse since 1967, she was living with her husband and three children in Papua New Guinea, when her father was diagnosed with pancreatic cancer in 1976.

"He didn't want to die in a hospital, so I came home to nurse him," Klingler said. "He died at home on a cold, snowy February night and my mother and I didn't know anything to do, but call the doctor." When Klingler heard about hospice care, she knew she had to do it. "I realized that I would be able to give someone else what my mother and I wished that we had had," she said.

She worked briefly for a Medicare pilot hospice program in 1983, but left because the hours were too demanding for a mother of three children in middle school. "I always knew I'd go back to it," she said. Klingler has been a home health hospice nurse in Atlanta for 12 years.

"The goals for hospice nursing are different," she said. "Unlike hospital care, dying is not an emergency. Unrelieved pain or symptoms is an emergency and we move quickly to alleviate them. Our goal is for the patient to die as comfortably and peacefully as possible."

Working in homes brings out all her nursing skills. "You have to assess and propose the best course of action because there's no one to confer with. I don't call a doctor without a proposal, because I know he's going to want to know what I think," she said.

Having the input of a team (social worker, chaplain and home-health aides) helps Klingler view the situation through other perspectives, but she is always aware that she's working on the family's turf. "We don't take over, but we enable and encourage them as they care for their loved one in this very stressful time," she said. "You have to respect their culture, their religion and their wishes."

Even when family members disagree, her job is to bring calm and normalcy to the dying process. "It takes flexibility, as your day can change on a dime, and forming relationships with dying patients can be mentally and physically exhausting," she said.

Klingler likens her role to riding on a train.

"This family has come a long distance before we get on. Our job is to ride with them for several stops before death, to help them get through it the best way they can, but then we get off and the family goes on," she said. "Knowing that I'm going to get off the train helps me to be objective. Still, you can't help giving it your all and you lose a little piece of yourself." Klingler advises new hospice nurses to set boundaries, learn their limitations, and not to make the job their whole life.

"I have a supportive marriage of 38 years, children who have become friends, eight grandkids and a strong faith. In order to give, you have to be filled up," she said.

"You're lucky in life if you find the job that gives you energy, the thing you were made to do. I love this job too much not to do it."