Among The Thorns

There are people ailing everywhere.  In the rich part of town, in the poor part of town, in the city, in the country… you get it.. Everywhere! People are also able to stay in their homes for longer periods of time when they are ill.  Medical professionals travel to them and provide the best care possible.

Over the past couple of days, I have traveled to a more rural part of town and to the grittiest area of the scariest neighborhood.  Walking into a run down apartment building, with graffiti on the front door and what looked to be years worth of dirt on the floor, I was not sure what to expect.  Still orienting, was super glad to have another nurse with me.  I’m not normally scared of places like that.. When I was 18 and a know it all, I moved to NYC and lived in an apartment building that wasn’t far off in appearance from the one I was walking into today.  The subway tiled white portico heavily spider webbed in grime and debris.  The hallway walls were once white but have since grown to be a yellowish color from years of cigarette smoke.  Apartment doors were missing numbers and a few looked like they had been attacked by hungry beavers… shards of wood left in the place of a once sturdy door.  Luckily, our destination was on the first floor because the steps leading up looked to be straight out of a haunted house.

We were greeted by our patient.  You see, not all hospice patients are laying in bed and on their last breath.  Cheerful and pleasant, he invited us in and motioned for us to sit in the two plastic lawn chairs.  As my preceptor did her assessment, I began looking around the room.  It was a tiny little place.  Most decent closets are bigger than the living room was.  The patient’s glasses reflected the two sources of light in the room – the TV and a string of Christmas light surrounding some Native American art.  There were no doors separating the rooms and I could see through the makeshift curtain that a tiny kitchenette and the bathroom could be found on the other side.  The air in the room was heavy with the smell of cigarettes – so heavy it felt like it made its way into your pores.  Hey.. I guess if you are on hospice, there’s no reason to worry about the dangers of smoking.

As the patient talked, I was struck by the kindness of this man.  He spoke of taking care of neighborhood stray cats – he would put out food and water.  You could almost feel his sadness as he told us stories of people being evicted and they would just toss out their cats.  This man, who had really nothing, was feeding these poor animals.  This man, who didn’t have enough money to pay for his medical care, was taking what he could to help the animals.  His sadness was halted abruptly when the topic of conversation switched to his grandson.

His face lit up as he talked about babysitting the little toddler.  The child and pap would dance and eat Popsicles together.  He talked about seeing the little guy grow up and how great of a man he would be.  As if he had a crystal ball, he knew that his grandson would go to college and that he was trying to put away what he could for it.  In that moment, sitting in that tiny apartment in what most consider the worst part of town, I realized that people who have so little material possessions are the first to want to share them.  It’s almost as if compassion and sharing diminish with the more we get.  This man really had nothing, but was giving everything.

He knew his prognosis, yet, he was worried about those around him.  He worried about who would take care of his cats and all the strays.  He worried about how his girlfriend would survive without him.  Not once did the talk about himself.  Not once did he try to illicit sympathy for where he was living or for the road that he was walking.  He didn’t miss things because he had never had them.  The more we have, the more dependent we become on things for happiness.  The more we have, the less we give.  It is sometimes the poorest people who are the most generous and the happiest.

As we got into the car, the other nurse was complaining about how she had to get home to change her clothes because they were pungent with the smell of old smoke and a thick musky odor.  Crazy as it may sound, I wasn’t so much in a rush because the smell was of a man who reminded me that being generous isn’t about how much you have but rather your willingness to give.

 

That Smile

The day began really early today… Much earlier than I would like.  The coffee didn’t have a chance to even make it to my gut before we were on our way.  We were going to see a patient… younger who had been diagnosed with ALS.  As typical for me, I was full of nervous anticipation.  It’s a good thing that the nurse I was with was a morning chatterbox because her ongoing conversation kept my mind from wandering.  It was a long ride to get to the patient’s house, but we had to get there before her partner left for work because he wanted to be there with her.

Her smile caught me from the moment I entered her house.  She has lost use of her fingers… able to just have very gross movements of her arms and legs.  Her thumb was the only finger she could really use and that was used to give a thumbs up when she agreed with something.  To try and quantify the vortex of emotions that engulfed me would be futile.  I’m not even sure such words exist in any language.

My heart broke for her as she tried to communicate, sometimes without much success.  As the disease was ravaging her body, she was losing the ability to control any of her own shell.  A far cry from being heavy, it took 3 people to help move her.  I kept putting myself in her shoes.  How would I feel if words no longer were able to exit my mouth?  Would I want to be around if I could not reach for my own glass of water?  I am sure that she has her moments of faltering when no one is around, but, at that moment she was brave and full of joy.

That smile… her laugh that sounded like it was rattling her soul.  We teased her about causing trouble and doing the shimmy shake to avoid pressure sores and she would close her eyes and laugh.  It’s hard to fathom that 3 months ago, she was just like me.  She could walk and talk.  The decline was so rapid that not her nor her partner have had any time to process it all.  Would anyone be there for me if I couldn’t wipe my nose or have another spoonful of food?  Yet, like her knight in shining armor, he saved his maiden from the toils of her condition.  He has to feel helpless because he can do nothing to stop the deterioration of his love, but, aside from leaving for work, he was ever present.

Are we really more than just our bodies?  With so much emphasis on our physical appearance, can our souls be just as important?  This sweet woman gave me the gift of understanding that it is so.  Her mental capacities are totally intact.  She is staring down the tunnel of the unknown and doing so with that smile.  It’s my job to get her to that end of the tunnel with empathy, compassion and dignity.  That’s the least I could do to thank her for that smile…..

Day One

Nervous anticipation, fear, uneasiness, sadness and an eagerness to learn the ropes.  I’d say all of those things smooshed together is exactly how I felt this morning.  That feeling of uncertainty because I don’t know what I am doing is almost overwhelming.  Sure, I can assess a patient – but, I look for signs of life and not signs of impending death.  Guess, what?  That’s how the cookie is going to crumble from now on.

The patients today were all very sweet and kind… some older, some not so old.  All pleasant and happy to see their usual RN (I was kind of an added bonus.. a little tagalong.. Kept having to say “I’m a new hospice nurse, but, an old nurse in general”).  I wasn’t sure how to really introduce myself or what I should and shouldn’t say.  I let the usual RN take the lead.  Some had family around… some were in a nursing home.  Some could talk… some could not.  One was actively dying… I don’t imagine that she will make it through this evening.  She was staring off… like those about to pass do… What was she seeing?  Do you see whatever awaits us in the afterlife as you are dying so that you aren’t fearful?

I’m not sure the answer to that question and I don’t know that any of us, with any degree of certainty, will be able to correctly answer it.  I would love to imagine that it is that way.  Her daughter was next to her.. telling her that she would be ok and that it was ok for her to let go.  Flashbacks flooded my mind, because about 4 years ago, I was doing the same.. not as a nurse, but as a daughter.

I don’t know how people do it.. How they are able to compartmentalize things… How they are able to not bring their own personal experiences into things.  I can tell ya’ll right now that it is not that way for me.  The rich tapestry of experiences that I have had will play into being a hospice nurse.  In a lot of ways, I know that it might make me a better one because I will be able to understand the feelings, be they good or bad, that my patients and families are experiencing.

So, my first real day as a labor and delivery nurse of death is complete.  Life is such a fleeting idea.  It sounds cliche but this makes me want to hug my loved ones harder.  It makes me want to not give up.  I don’t just think hospice nursing will make me a better nurse, but, it will make me a better person.

The Night Before

The new journey starts tomorrow.. Exciting first line, right?  Catchy… Well, it’s true.  Tomorrow my career really takes a totally different turn.  You see, for the past close to 10 years, I have been a nurse.  I’ve been a med surg nurse, I’ve been a step down nurse, I’ve been an ICU nurse and finally, I was a perianesthisa nurse.  Tomorrow, that kind of nursing is gone.  You see, all this time, I’ve been trying to save lives.  Starting tomorrow, I’ll be helping lives let go.

Hospice nursing wasn’t always something I was interested in.  Anyone who knows me knows that I loved being the nurse at the head of the bed when something was going south.  Analyzing the heart rhythm, making snap decisions about what meds to give and thinking quickly in order to try to save that precious soul that was in trouble.  I still do get that jolt of adrenaline thinking about it.  How am I going to go from the nurse that dueled with death to the nurse that holds the hand of a person who is willingly making that journey?  The truth is…. even I don’t know.

My favorite aspect of nursing was always the patient interaction.  I loved working nights when the patient’s needed bathing because I could spend time with them and just let them open up to me.  The stories I have heard, the laughs I have had and the tears that we have shared.  There is nothing like being that support for a person in their darkest hours.  My nursing practice always included actually sitting on my patient’s beds, holding their hands and actually trying not to speak but to listen.

In my mind, that’s what will be the part of hospice nursing that will suit my nursing the best.  Just listening… to patients, to families and to coworkers.  This could be the path that leads me to my more precise calling.  Nursing is and always will be my calling, but, maybe hospice nursing will be my particular niche.  I do wonder, however, how a girl who is scared of death can help guide others along that journey towards it?

It’s kind of like being a reverse labor and delivery nurse.  They take a pregnant woman on a journey to birth and I take someone on the reverse journey.  A labor and delivery nurse cannot tell her patient exactly what the journey of parenthood will be like.  In the same vein, I cannot tell a dying patient what and how to expect this passage will go.  I have no doubt that it will test my fortitude, my emotional and mental boundaries and my capacity to always want to heal.  Perhaps though, healing is exactly what I will be a part of.

Not all of us will be lucky enough to die exactly how we would like to.  Hospice patients are given that benefit.  They choose to pass at home.  They can choose to be surrounded by loved ones in their final moments.  That is something that will not be the same for the vast majority of the population.  These folks have decided that they have come to terms with their illnesses and choose to have a quality of life rather than a longer quantity.  The only word I can use to describe that is brave.

So, come on this road with me.  Hear the lessons I learn and feel the emotions that I do.  This blog will be candid.. it will be raw and it will be emotional.  This is one nurse’s journey into the unknown…..