Thoughts on Hospice and Other Things

(This was a journaling assignment for the CNA program I just completed)

Hugging a woman, tearfully grateful that no one was hurt when her house burned down one Christmas taught me that I am, in fact, not the center of the universe (a shocker when you are 17).

Hunters found the body of a sweet old veteran with Alzheimer’s who had gone missing out in the sticks a month after we had called off the long, extensive search for him. When the coroner's report revealed he had likely been alive during the days I had been working on the search, I cried my heart out. The “what-ifs” bothered me for a while, but I came to believe that we can only do our best for people, and even then, we can’t save them all.

Having “situational awareness” and “keen observation skills” drilled in to me during my training as a search and rescue volunteer and EMT soon seeped into my daily life, immersing me in all the beautiful little details of life that many people are too busy to notice.

I learned to wear my seatbelt, never smoke, use a helmet, avoid drugs, practice safe sex, and never drink and drive the hard way: by taking care of good people who suffered the consequences, in the ambulance, the ER, the OB-GYN clinic, the spinal cord injury / traumatic brain injury rehab hospital, hospice. As a result, though, I have a deep-seated, emotional commitment to those rules that is very difficult to break.

Feeding an older man struggling with Parkinson’s who had accomplished things in his lifetime such as interviewing Martin Luther King Jr. reminded me to respect the wisdom and dignity of those who’ve been here for a while.

I witnessed grace beyond anything I could ever imagine attaining, in a nun embracing her last moments on Earth.

Sitting by wives, husbands, children, brothers, sisters and friends as they spent their final few hours and days with their loved ones, inspired me to make a conscious effort to never take someone I care about for granted.

And in the last minutes of my last hospice clinical, sitting alone with a woman in the still silence of her room, holding her hand as she took her last peaceful breaths, affirmed that death is not to be feared. Walking out the hospice doors and back in to my own life, reminded me that the world goes on without us.

They say we are in a profession of giving. I believe it is an honor and privilege to help those who invite us in to the most private aspects of their lives; to have them trust us, our skills, our hands, our minds, and most importantly our hearts when they need help the most. I believe that in giving care as your life’s work, you receive so much more back.

Near the end of my first shift at hospice, walking out of a room as the sun dipped, beautiful, rich singing suddenly filled the hall. It was coming from one of my patient’s rooms. Curious, I knocked and entered. I realized it was a woman singing prayers in Hebrew, emanating from a stereo on the bedside table.

The patient’s daughter, sitting at her side, explained that the woman with the otherworldly voice was her own daughter – the patient’s (we’ll call her Eileen from now on) granddaughter. She was an opera singer and college student. When she flew in to visit a week before, she sang these Jewish blessings for her grandmother. Although Eileen was nearing death, suffering severe dementia, and often incoherent… she made one thing clear to her family and grandchild… “blessings,” she had repeated over and over again. So the granddaughter sang for her for hours. Before she had to depart back to school, the family recorded a long CD of her singing for Eileen to enjoy over and over again.

Later I returned to Eileen’s room with dinner. Her daughter had gone home for the evening so it was just her and I. She required total assistance, likely would only have a few bites, and was down to just saying the word “yes” at this point. I paused as I uncovered her meal. It was Friday evening - Shabbat eve. Friday evening and Saturday comprise the Jewish sabbath. I grew up in a Jewish household, and knew that this meal held special significance to this woman who clearly valued her faith.

“Eileen, you know, my father is Jewish. I even got close to my bat mitzvah. I remember some of the blessings, but it’s been a long time. Would you like me to try to say a blessing over dinner?”

“Yes,” which was her invariable reply now. I wondered if she comprehended what I was talking about, and if she did, if she really intended to say “yes.” I reasoned that at worst, she’d think I was crazy, and at best, I’d help a dying woman uphold an important spiritual ritual.

I went ahead, held her hand, and let the prayer loose in the sing-songy nature of Hebrew blessings. I hoped that I didn’t butcher it as we sat in silence for a moment or two afterward. I was probably eleven years old the last time I had recited it.

“Perfect,” Eileen whispered – the only time I’d heard her say anything besides “yes” in my 24 hours with her as a patient.

No one had died during my first shift. Midway in to my second shift, I heard the toll of the bell, marking the passing of a patient, out in the hall while caring for someone. Although it was not our patient, I asked to help with postmortem care since I hadn’t seen it yet. One of the nurses guided me and explained the process. The patient who had passed was in her mid-fifties. I noticed that both the nurse and the CNA were about the same age. I wondered if they ever mulled it over… if it ever bothered them to see people their age die or if it just made them grateful to be well. It was striking to watch the healthy, able-bodied nurse deftly attend to her duties, standing over a deceased woman of the same age whose body had been ravaged by cancer for years.

“You put up one hell of a fight, Jill.” the nurse said reminiscently as she pulled the sheet over her face. We closed the door and went back to work.

In the last hour of my last shift, the CNA I was following pulled me in to one of our patient’s rooms. Her condition had rapidly declined in the few hours since I’d seen her last. The CNA said she thought she was very close to passing, and since the woman was alone, asked me to stay with her. I sat by her side as I talked to her softly, just letting her know I was there and she wasn’t alone. She had a bible at her bedside, so I read a few passages.

Her hands and arms were cold, she had no radial or brachial pulse, and her carotid pulse was so weak and irregular it was hard to detect. I followed the pattern of her breath as I smoothed her hair from her forehead. She would be apneic for as long as 20 seconds, give a few labored breaths, and stop breathing again. Cheyne-Stokes? She did have congestive heart failure, among other things of course.

It struck me that I could assess this woman all I wanted, name her conditions, consider the pathophysiology going on, whatever, but the best thing I could do for her is sit by her side and just be present. I don’t think many people want to die alone. As the last minutes of my shift drew near, the CNA returned to the room with a stack of charts.

“I’m going to finish my charting up in here,” she said, and it was understood between us why. I was so grateful that I didn’t need to leave this woman alone in her final moments. I said goodbye to the patient, thanked the CNA for all of her help, took a deep breath and walked out the door as I heard her soft voice offering comfort to the dying woman.


Anonymous said...

I love to see you grow and your thoughts on paper are a sweet poetic remmanince of your growth

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kringtom said...

....i cried when i read this..really, i am touched within my heart....i will try my best to finish nursing...i really wanna be a hospice nurse....