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Caring for others has been a focus for Naomi McCarty since her earliest years.
"I took care of my brothers and sisters," says Ms. McCarty, RN. BSN, CHPN, now Nurse Manager of the Hospice Program of Princeton HomeCare Services. "It was instilled in our family that you cared for others. My parents and relatives set the example."
Born to Nicholas and Vivian Marie Dashcund in Chicago, Naomi was the oldest child of seven, including four girls and three boys. Her parents both served in World War II, her father as a navigator overseas in the Army Air Corps and her mother as an Army nurse in Louisiana.
When Naomi was six, the family moved to Closter, N.J., where she grew up.
"I loved school, especially English and science," she reports. "I enjoyed reading biographies, and I admired Clara Barton and read about her. I also read a series of popular girls' books about nurse Sue Barton.
"All my teachers were good, but I especially remember Mr. Jannarone, who taught English and writing in high school. He really pushed us to our limits, and always challenged us to do more."
Basketball Whiz
The winner of a number of trophies, Naomi was a whiz at basketball and baseball, playing in recreational leagues. Singing was another talent, and she joined school and church choirs, lending her alto voice to many performances and services.
In high school, she worked on the school newspaper and year books, and also had after-school and weekend baby-sitting jobs.
"Our family was on a strict budget, and we didn't have a lot of extra money for entertainment," recalls Ms. McCarty. "We did have wonderful family vacations, going out to the midwest to see relatives. We'd always leave at 7:30 on a Saturday morning, and Dad drove to Chicago, and then on to Minnesota. I loved the trips out there."
Ms. McCarty's heritage is Russian and Norwegian, and many of her relatives of Norwegian descent settled in Minnesota.
By the time she was a student at Northern Valley Regional High School in Old Tappan, N.J., Naomi knew nursing was in her future. Influenced by her mother and aunts, she sought a career in which to serve others.
"My mom was a nurse; also my aunt and my great-aunt," says Ms. McCarty. "My great-aunt had been an Army nurse in World War I. My mom and aunts were definitely an inspiration to me."
After graduating from high school in 1964, Naomi received a scholarship to the University of Wisconsin School of Nursing. A four-year and two-summer program, it offered an excellent education, she recalls.
"We were given all the care basics, and also went through all the rotations, including ob/gyn, pediatrics, surgery, psychiatry, and community health. We worked on the floor of the hospital, and I also especially liked community health, when we went to the patient's home to do an assessment. I really enjoyed the visiting. I also very much liked delivering babies in the obstetrics rotation!"
Small Potatoes
"The professors were excellent, and I particularly remember one who influenced me, and demonstrated that things are not always what they seem. He gave us the results of a study which showed that small potatoes from South America actually had more nutrients than our big Idaho potatoes. That taught me not to assume and not to impose my values on others."
Graduating with a Bachelor of Science in Nursing, Ms. McCarty and her husband, Richard, whom she had married while in college, moved to Westwood, N.J., and she worked at Pascack Valley Hospital.
I was a charge nurse in the evening shift of the surgical unit, with 47 patients," she remembers. "There was no recovery room for patients then, so there was more responsibility for the nurses. Later, I switched to the Education Department, creating videos about the new technology and changes in practice. I also taught a refresher course for the nurses, which I enjoyed very much."
After several years at Pascack Valley Hospital, Ms. McCarty, now the mother of a daughter Nicole, and her husband moved to Pennington in 1976, where a second daughter, Rachel, was born.
In addition to working in the office of a physician specializing in family practice, Ms. McCarty and her husband became owners of the Hopewell House liquor store in Hopewell.
She enjoyed working at the doctor's office, in time becoming office manager. Interaction with the patients was a plus, and she came to expect the unexpected. "We had two deliveries and two deaths in the office," she recalls.
Long-term Care
In 1990, Ms. McCarty joined Princeton HealthCare Services as a visiting nurse, another very positive experience. "It was a wonderful education," she reports. "I saw people of all ages — I did heel sticks (blood tests) for newborns, saw kids in full body casts, and people over 100 years old."
Ms. McCarty was soon appointed long-term care supervisor for an area that covers a 20-mile radius from the Princeton Medical Center, including Mercer, Middlesex, and Somerset counties. It was also during this time that she became involved in the hospice program, resuming an interest that began when she was in nursing school.
"Hospice became a Medicare-approved program in 1981," she explains, "and Princeton Hospice was one of the first certified in this area."
Dedication at the highest level has been a hallmark of her career, and in 1996, Ms. McCarty was named Hospice Nurse Manager. In that role, she oversees the program which includes 12 nurses, social workers, home health aides, volunteers, and two chaplains. Her commitment does not go unnoticed.
"I have known Naomi since she was a nurse in the long-term home care program," says Barbara Yost, Executive Director of Princeton HomeCare Services. "She is the consummate professional, and she has made our hospice program what it is today. She is an advocate for the patient, the caregiver, and their families, and she is very supportive of her staff. Naomi demonstrates compassion, caring, and patience in everything she does."
Hospice is a team effort, enabling patients with terminal illnesses to live their remaining days in as much comfort and dignity as possible, points out Ms. McCarty. "Once it has been determined that further medication and treatment are not appropriate, the doctor can recommend hospice. The physician knows that hospice is part of the continuum of care."
Holistic Approach
The mission of the hospice program of Princeton HomeCare Services is dedicated "to providing compassionate clinical care to patients with life-limiting illnesses while supporting their loved ones. The team uses a holistic approach to meet the emotional and spiritual needs of both patient and loved ones as they work through end-of-life issues, while supporting the hope of a full and meaningful life for as long as possible."
"Hospice patients have been diagnosed with a terminal illness and a life expectancy of six months or less, if the disease progresses as expected," explains Ms. McCarty. "Most are in their own home environment, although they can be in assisted living facilities or nursing homes."
Patients are all ages and coping with a variety of illnesses, she adds. "We see kids, people in their thirties, forties, fifties, and older. That can often mean that the hospice team is working with multiple generations in the family — spouse, parents, children, and even grandparents. There can be a lot of family dynamics."
In the initial assessment, a plan of care is set up. Typically, hospice nurses visit a patient one to three times a week, depending on the need, and Ms. McCarty accompanies the nurse in a supervisory capacity once a month. She especially enjoys these home visits and the chance to be with patients.
"Many times, patients are relieved once hospice is in place," she notes. "Now, they can talk about death and plan for it. There is an opportunity to say the words you need to say: 'I love you.' 'Thank you.' 'I'm sorry."
The hospice experience varies from case to case, she adds. "It can be very personal and intense depending on how the trust factor develops and on how much the family will let you in. One of the most important benefits of hospice is educating the family about the dying process. It can take some of the fears away. And it also provides a reassurance that the support group will be there for them."
Special Qualities
Such a time of close personal interaction with a family during these most difficult circumstances requires special qualities in a hospice nurse. The conditions surrounding their work call for a person who is compassionate, patient, flexible, and a good listener, says Ms. McCarty.
Hospice nurses range in age from the early thirties to 60. "Life experiences do help," she notes. "If they have lost someone close to them, they know what it is like. I also determine if they are comfortable using the words 'death' and 'dying'."
Certainly, it does require a special person to involve her- or himself in such a situation, and difficult though it is, it can also be one of the most meaningful experiences of their nursing careers, often with unexpected benefits, says Ms. McCarty.
"You learn how to live your own life. You benefit and get a better balance of what is important. The significance of making that phone call; don't let time slip by. If you want to take a trip, do it. And, I feel I take something from everyone I meet. They give me added dimension. I learn from everyone."
Helping patients to be more comfortable during this time is important on many levels, she adds. "For example, if patients' pain is controlled, they have more energy for the family and friends who come to see them. They can be involved."
The volunteers play a significant role in a patient's outlook as well. "It is important that the volunteer be comfortable with death and dying and know how to be present for patients and the family," says Ms. McCarty. After a training program, a volunteer is assigned to a patient whom she or he visits two hours each week. Currently, there are 70 active volunteers in the Princeton area, with 50 assigned to patients.
Bar None
"Volunteers can be helpful in a number of ways," explains Ms. McCarty. "They can offer companionship, help with household tasks, or help kids with homework. Sometimes, they can sit at the bedside, just to be present."
Helaine Isaacs, Volunteer Coordinator for Princeton Hospice, has worked with her for four years, and emphasizes Ms. McCarty's own ability to be "present" in any situation. "Naomi is the most thoughtful, compassionate, and caring person I know — bar none. She has the wonderful gift of being present with whomever she's with at any particular time. And what she brings to hospice and what hospice reinforces for her is an 'attitude of gratitude'". She expresses gratitude frequently to her staff and all those she works with. I think the world of her."
Through its bereavement services, the hospice program continues to offer the family help after the death of the patient. Families are remembered with condolence letters, and two memorial services, commemoratingpatients, are held each year.
"Life was never the same again, after anyone you love has died; never so gentle, never so innocent, so pliant to your will ... (anonymous).
It has been said that grief is the price we all pay for love, and grieving is a very individual process. "Some people don't acknowledge grief when the death occurs, and grieving can come later," observes Ms. McCarty. "Our bereavement program is on-going, continuing to provide support.
"No two deaths are the same," she adds. "It is inspiring to see families who didn't think they had the strength, wisdom, and courage to care for the patient be able to do that. It is a very meaningful experience."
Wonderful Advocate
Princeton resident Joy Weinberg, who was formerly head of the Princeton Hospice Program, and now works with her, believes that Ms. McCarty is an important part of that experience. "I think Naomi has been one of the prime reasons hospice has grown in this community. She has an extensive out-reach into the community through all the areas of her career and volunteer work. She knows people from all walks of life, and she goes out into the community, speaking to groups about hospice. She is a wonderful, wonderful advocate for the program."
Adds Ms. McCarty's friend, Lockie Proctor, who sang with her in Princeton Pro Musica: "I have never met anyone who is more completely suited for the job that she has. What makes Naomi so special is that she is one of the most compassionate, kind, and spiritual people I know. I can't imagine anyone more empathetic. She is always positive and manages to do this work in a very upbeat way, looking at the best in everybody and everything. Not in a "Pollyana" way, but in a practical way. She is just very giving."
Time away from such emotionally demanding work is necessary — a truth Ms. McCarty emphasizes to the nurses — and in her own case, music has been a welcome diversion. She has continued her love of singing — "I sang with Princeton Pro Musica for a number of years, I am always listening to WWFM, the classical radio station, and I go to concerts when I can," she says.
"I also used to garden — it's a great stress-reliever and gives you a sense of accomplishment. You take an area and weed it, and then it looks great. You have achieved something. Now I live in a condo though, and there is not as much opportunity."
Extended Family
Grandmother to 15-month-old Gillian, who lives in Hamilton with mom and dad, Nicole and Peter Horvath, Ms. McCarty spends as much time with her as possible, and also visits her daughter Rachel in Alexandria, Virginia. Blessed with a very large extended family, including her own mother, seven siblings, cousins, nieces and nephews, Ms. McCarty is in touch with them often.
They were all on hand, along with 100 other friends, at a surprise birthday party for her last year. "It was wonderful, an incredible event," she says. "People from all different aspects of my life — nursing, music, family. All people I wanted to get to know each other. It was very, very special."
In addition to her responsibilities at hospice, Ms. McCarty serves as an EMT with the Pennington First Aid Squad one night a week. Her nursing experience is a valuable resource in this emergency work.
Hospice is never far from her thoughts, however. "I hope I have the ability to continue this type of work for many years," she says. "Hospice is a wonderful support system, and what is so good is that it continues to grow. I am proud of that. When I began with the program in 1996, there were 13 patients on a daily basis. Now, typically, there are 58 to 65."
The need for hospice will grow even more, she believes. "Hospice is something people should become knowledgeable about because of its benefit to family and friends who may need it later. In the past, most people died at home. After World War II, they began to die in the hospital. But in 1995, the Gallup Poll did a study, and found that most people wanted to die at home with family and friends."
And that is what hospice can provide. An opportunity to spend one's final days on earth surrounded by kindness and grace.
