During the two months that Regina Holliday's husband, Fred, was hospitalized with cancer, he received a tower of "Get Well Soon" cards, each a reminder of the friends and family who cared about him. But when all hope for recovery was gone and he entered hospice care, the cards stopped coming.
"You get cards and messages when you are fighting the good fight, but the minute you are done fighting, people don't know what to do," Holliday said. "Once they hear the word hospice, they tend to shut down."
Holliday is now lobbying Hallmark, the world's largest distributor of greeting cards, to offer a line of cards specifically for those entering hospice.
Holliday, an artist who became a health care advocate after her husband died three years ago, said she wanted to help people find ways to talk about important end-of-life issues. Last year, when she was asked on a tweet chat about ways to encourage these kinds of conversations, she said the answer was for Hallmark to create hospice cards.
"They have an amazing reach into every corner of America. If they create a card on this topic, they will open up the conversation nationwide," she said.
As Holliday views it, everyone dies, and about 1.6 million people enter hospice each year, according to the National Association for Homecare and Hospice. Impending death represents a phenomenal marketing opportunity for Hallmark, she said.
But how to get Hallmark interested in a line of "Have a Nice Death" cards? It took Holliday a year to engage the greeting card distributor on the topic.
At first she called Hallmark directly, navigating unsuccessfully through several layers of customer service, she said. Next, she tried reaching Hallmark through personal connections and back channels, all to no avail, she said. Finally, she created an online petition on change.org and began to tweet about her campaign on Twitter.
Hallmark, a privately held company based in Kansas City, Mo., quickly responded to Holliday's tweets last week in two ways.
The Hallmark internal search engine now recognizes the word "hospice" and the phrase "end of life," and suggests cards to match. Before Holliday's campaign, the first search term returned no matches and the latter brought up a slew of Bat Mitzvah cards for celebrating a Jewish girl's rite of passage into womanhood.
The company also released a statement on its website titled: "Viewpoints: Greeting Cards for People in Hospice Care," which says, in part, "Hallmark offers nearly 100 cards to help people share words of support for a range of life situations, including cancer treatment, serious or terminal illness, grief support, recovery/rehab and other difficult times, as well as cards for caregivers."
While Holliday applauded both moves, she continued to push Hallmark to create cards that addressed end-of-life issues head on. She said current cards with sayings such as "Cancer Is Tough, but "You Are Tougher," are nice, but miss the mark.
"This is the last thing a hospice patient with cancer wants to hear," she said. "Too often they have been told that this is a fight, cancer is a battle. What is hospice? Losing?"
Linda Odell, a spokeswoman for Hallmark, said the company was not ruling out developing a line of greetings to address end of life but pointed out that many of the company's current offerings, including blank and customizable greetings, could be used as a jumping-off point for starting tough conversations about virtually any situation or relationship in life.
"In reality, this is a really sensitive subject and a delicate line to balance. Some feel the need for a card to express these difficult thoughts, while some feel it's inappropriate to have such cards," Odell said.
Holliday hopes Hallmark will take up messages for end of life and hospice soon, as well as for numerous other formerly taboo topics, including miscarriage and addiction.
"Clear messaging gives us permission to talk about life and death," Holliday said. "We need to see a "Hospice" header right beside the "Get Well" and "Thinking of You."
ABC Tweet Chat on End of Life Issues
At 1 p.m. ET today, Dr. Richard Besser, ABC News' chief health and medical correspondent, will host a one-hour tweet chat to discuss important end-of-life care issues. Experts from the Conversation Project, the Mayo Clinic, AARP, TedMed and Aging Care will be tweeting their advice and support, along with various hospice representatives and caregivers.
You don't need to be a Twitter expert to follow the conversation or jump in with questions and comments of your own. To learn how you can participate, click here.