At a casual gathering the question inevitably arises. “Where do you work?” I always hesitate to reply, knowing that my answer will most likely hang over the conversation like a slightly unpleasant odor. So I take a deep breath and say, “I work as a hospice nurse.” The answer elicits a moment of silence while the questioner grapples with the unexpectedness of the answer I give. A quick mix of surprise and terror crosses the questioner’s face, and he or she manages to say, “Oh. How interesting.” Usually at this point the conversation gently shifts to safer topics, such as the price of gasoline or the state of the war in Iraq. But sometimes the questioner will flash a quick look of interest and say, “Wow. Isn’t it really hard to watch people die all the time?” Yes. But I learn so much from my patients about how to die with dignity and how to fully live the life we are given.
Take for example the small town doctor. She was a woman of quiet courage and strength. She devoted her whole life to the population of indigent patients that she mostly served. As a physician she was dependable and competent. She had delivered my child. So when I heard she was to come onto our service, my heart sank to my toes. What could I as a relatively new nurse offer this woman?
I had not seen the good doctor since before her cancer had taken hold of her body, and as I drove up to the house, I was very nervous about what I would find. I walked up to a large sliding glass door and peered inside. Lying gaunt and grey on the bed was the patient, face drawn in pain. I did not recognize her. But when she opened her eyes and smiled, I saw the shadow of the person I had known. Her eyes closed again, and I stepped into the house. Her husband was at her side. As I hugged him, I began to cry. “She’s really much better,” he said, clumsily patting me on the shoulder. Then he began to tell me of the plans they had to keep seeking aggressive treatment for her once she was stronger, though it was painfully evident to me that she would most likely never again get up out of the bed she was currently lying in.
Days turned into weeks, and the denial of the patient and the family stood as a fortress between those of us who desperately wanted to help ease the doctor’s suffering and the family who so desperately wanted the patient to miraculously return to her former life. Little by little we were allowed to give the morphine she needed, allowed to help clean her body, allowed to hold her hand. But the siege was still raging, and time was running out for the patient to assess the meaning of her life and prepare herself for what lay ahead.
Then one day I came into the house and saw the doctor fighting for breath. The rattling in her chest was a harsh, grating sound. But she was alert. I came to her side and she looked at me. She gasped, “I…am….afraid.” I gently took her hand and asked, “What are you afraid of? Dying?” She shook her head no. “Not…..dying,” she said, “dying….with…suffering.” She began to cry. When she composed herself she said “I…thought…of…you….last…night.” She then told me of how the night before she had been horribly short of breath and was sure she was going to die then. She said she had never experienced that before herself, but she had treated me for years for severe asthma and had seen me struggle with fighting to breathe, and now she understood how I must have felt. I squeezed her hand and my eyes welled up with tears.
I am not sure why, but that moment was a part of the turning point for the patient and the family. Family finally realized that they needed to keep her comfortable. And the patient finally realized that death was near. Several days later the patient passed comfortably, surrounded by those who loved her best.
My job as a hospice nurse is to help the patient find the tools he or she needs to live fully until the moment of death. Sometimes patient needs are concrete, such as the need for pharmacological aides or durable medical equipment. But often the things that are needed are not easy to quantify. We all live different lives as human beings. We have individual interests, lifestyles, and needs. However, death is the great equalizer. We all will die, no matter if we are multimillionaire executives, or bag ladies on the street corner. We have no choice about that fact. How we face that fact and what we do with the time we are given is totally up to us. How we live will impact how we die. As a hospice nurse I have learned how to laugh louder, live stronger, and cherish those I love. My patients have taught me that.