Montgomery Hospice

Expert medical end-of-life care. Hospice at Home and Casey House care for over 1,500 patients annually, regardless of ability to pay. Grief support provided for family members and the community.

Why do we exist?

In the two decades that hospice has been part of American healthcare, thousands of persons with life-limiting illnesses have turned to hospice programs for comfort, dignity and compassion. When treatment for cure no longer adds to the quality of life, hospice offers the skills and experience that can make each new day a gift. Montgomery Hospice has provided this extraordinary care since 1981.

Most people with life-limiting illnesses prefer to be at home, in familiar surroundings. Montgomery Hospice at Home provides this care. If needs cannot be met at home, Montgomery Hospice at Casey House provides expert hospice care in a beautiful new 14-bed house located at 6001 Muncaster Mill Road in Rockville.

Nonprofit Montgomery Hospice offers a full range of services that bring symptom relief and peace of mind to patients, as well as support for those who love and care for them. Hospice's bereavement care, available to all grieving family members and friends, is an extension of this support.

What have you accomplished?

Saving Life Most of us enjoy and cherish life, and then there are a blessed few for whom life is a passion. David Gratz and Willa Little-Gratz are surely on the passion side of this ledger. Only three months after David's death, Willa generously shared glimpses of a remarkable man and a wonderful partnership. She hopes her story will enable others to make every moment count, with help from hospice.

David and Willa have extracted life from the darkest situations, and hope is a personal and professional creed. David Gratz is responsible for saving thousands of lives. He was chief of Silver Spring's fire department, then director of Montgomery County Fire and Rescue Services. His expertise benefited fire departments throughout the country, and he became president of the International Association of Fire Chiefs.

Well-educated, raised in politics and practiced in its skills, he played an important role in advancing legislation that keeps us all safer. Representing the National Fire Protection Association in his consulting role, he was director of NFPA's international operations and traveled the world teaching fire protection.

Willa is the daughter of York, Pennsylvania's fire chief and charted her own course in the high-drama world of emergency services. Part of the little known field of pre-hospital nursing, she was the EMS training officer in Montgomery County's Fire and Rescue Services and helped to develop its paramedic program.

It's easy to see how two such lives would cross, which they did in 1970. It almost feels intrusive to look through their photograph albums, their joy in each other is so obvious, intimate and powerful. There's their marriage in 1981, scuba diving on the Great Barrier Reef, hot air ballooning over the Alps to celebrate a birthday, enjoying friends in every corner of the world, and just being at home with the rabbits.

Rabbits?! "I think he'd be a little embarrassed over the bunny picture," Willa confides. This "man's man" was devoted to their series of long-eared house pets.

In 1997, David decided to slow down a little. David's version of slowing down included ten trips to Bangkok and journeys to Kuwait, where he had reorganized the Kuwaiti fire service after the Gulf War. After a trip to India, he noticed a profound weakness.

"It seemed logical that he could just be tired," Willa remembers. "He was diabetic, and he went through the usual work-up. He also had a bone marrow biopsy, but we were told not to worry and went off to the beach."

The beach trip was cut short, and a visit to Georgetown's Lombardi Cancer Center soon confirmed that David had leukemia. Used to fighting their way through difficult situations, they researched their options and chose a full-scale assault on David's cancer. They thought they were winning, but the organ damage from his toxic treatments left him with serious new problems.

David underwent months of grueling therapy for the multiple complications that beset him. Drawing on her professional experience, Willa saw herself as the coach: "Keep trying, we've come so far." But David was not getting better and she was haunted with feelings of failure. She began to stay at David's side in the hospital, night and day.

Concerned that she was at the breaking point, David sent Willa home to rest. It was time to take stock of the situation. Willa recalls wondering if he wanted her permission to die, and when she returned to the hospital, they had a frank discussion. "He told me that I was thinking with my head and not with my heart," she recalls.

David discontinued his agonizing drug therapy, and they went home. "We weren't giving up, but we were trying to be practical," says Willa. "We still hoped that some liver function would return, but it didn't. David's doctor, John Saia, told us that hospice could help if things continued on this course. And yes, it was upsetting to hear that word."

Willa was impressed that David called Montgomery Hospice himself. "I think he mostly wanted to know that I'd be taken care of, that there would be someone to share the load. A staff member came to our home the very next day, a Saturday, and explained what it was all about. We signed up, even agreeing to the Do Not Resuscitate order." Willa pauses as Shadow, her brown rabbit, comes through the room to give her a sympathetic nuzzle.

Willa says they received so much more than they anticipated. "Michele was the perfect nurse. She had a sense about his privacy and need for control, yet still could manage the most difficult challenges. When Lisa the social worker visited, David told me, 'I'll just leave you two to talk.'" The opportunity for private times with Lisa allowed Willa to work through her unreasonable expectations to be the perfect caregiver. "She helped me realize that I could be a healthcare worker who also happens to be a wife - or I could be a wife who also happens to be in healthcare. I had to give up something, and it was tough. So I gave up David's morning care to Daphne, and I believe it gave me energy for loving."

Willa has special words of praise for Daphne, the Montgomery Hospice home health aide who helped with David's heavy care. Their volunteer, Bill, knew how to be present without being intrusive, and Willa could leave the house during his visits for short breaks. The on-call nurse was summoned during the night more than once when symptoms suddenly changed. The whole team worked together to keep the couple in their Silver Spring home.

Catherine, Montgomery Hospice's chaplain, assumed an important and delicate role. Although David declined spiritual care visits for himself, Catherine talked with other family members and became the liaison with one of David's children by an earlier marriage. Though Willa and the daughter had maintained a cordial relationship, old wounds and a lengthy estrangement between father and child could not be healed easily. "It is very sad," Willa wistfully acknowledges, "but my responsibility was to honor my husband's wishes." She is grateful to Catherine and the other team members for their understanding.

Willa began to sense an invisible wall around her husband and talked to the hospice team about it. "I guess there really is a process of separating out," she now reflects. "I know that dying people are beginning their good-byes, but it sure is hard." After a weekend with a house-full of family, including David's son and daughter-in-law, this private man recognized that everyone needed to connect, to make their own contribution. He told each visitor how loved and special they were - "gifts of speech," as Willa calls them.

Then the "good day" came, when everything seemed so much better. "The wall just came down, and we wordlessly knew that we were working together for the same end and could accept whatever happened." Willa told Michele that she hoped this wasn't the "up time" that sometimes comes before death. But she saw the subtle clues.

"That night, David (Jr.) and his wife had been sleeping on the bedroom floor, and I was in bed beside my husband. We told him he'd given us everything we needed and that he was where he wanted to be. It's hard to explain to people that it was a beautiful experience, but it was. It was peaceful, pain-free, and full of love."

"I've had some time to reflect on this experience," Willa continues. "I have a good friend who has just been through an ordeal with her husband's death in a hospital. There was emergency room chaos and disagreements, then she was told she couldn't be with him since visiting hours were over by the time he was assigned a room. She's full of recriminations, and I just keep thinking - gratefully - that I have no regrets."

Willa is still amazed that Montgomery Hospice accomplished so much more than just good pain control. "I didn't expect the depth of services and the network of support that hospice has. The nurses, aides, social workers - all of them - they have this special level of intuition. It's experience. They just know.

Willa enjoys calls from Vicki, Montgomery Hospice's bereavement worker. She stays close to her stepchildren, including David's estranged daughter. Willa says that she wasn't quite ready to celebrate Christmas, but she gathered some family around her for New Years to mark a new beginning. "We talked about David a lot."

She is now starting back to work in EMS consulting. She believes that her professional outlook has been affected by this terrible and beautiful journey. She thinks about the difference between the act of resuscitation and saving life, in all its richness. Willa has just experienced the latter.

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