International Travel in Covid: Leave Your Aqualung Cylinders at Home, People!

I’m sitting in my tiny seat on British Airways Flight BA830 out of Newark International Airport to London Heathrow. The cabin crew were just called to their manual demo positions, which means it’s time for us to watch them fasten a seatbelt. Listen up people, this could be new for you. I’m not kidding, the captain just said that some of the features of this aircraft may be different from anything we have encountered before. Now I’m curious. 

But after listening avidly for a few minutes, it’s just stuff like high heeled shoes must be removed or they will tear the slide as we make an emergency landing over water, handily employing our underseat flotation devices. We may need to pull on a colored streamer to release our oxygen masks, he’s saying. And we need to secure our life jackets with a double bow at the side. Hold up, THAT’S new.

My seat is so cramped that my elbows are pinned to my sides as I type. This is ok because it actually makes typing faster and after seven hours of international travel already today, I have lots to say. First, it came to my attention as I stood in the security line, that acids, alkalis, wet cell batteries, and apparatus containing mercury; also deeply refrigerated, flammable, non-flammable and poisonous substances such as butane, paints, propane, firelighters, and aqualung cylinders are not allowed on my flight. I cast my mind over the contents of my luggage. Nope, pretty sure I left all my wet cell batteries and firelighters at home.

Nevertheless, after I had removed my shoes, coat, scarf, and taken out my laptop and laid it the right way in the plastic tray (not the way I had laid it, that was the wrong way) my carry-on still got flagged. I watched it get shunted onto a special little conveyor belt behind the scanner and there it sat for fifteen minutes while the woman in front of me, who was traveling alone with a baby, had every snack and sippy cup closely inspected. The TSA agents moved with glacial speed. Then they opened my bag after asking me if there was anything sharp in it. You mean the spear? I said. But I said it quietly to myself, behind my mask. Sometimes I love the pandemic.

They took out the beautifully wrapped gifts that my husband’s daughter had given me for my dad and held them up. Candles, I said, and cookies. The agent tore open the package of homemade beeswax candles, inspected them and then put the mangled package back in my suitcase, beside the torn bag of cookies she had also opened. Apparently these items posed no terrorist threat after all. It was a close call though. Whatever happened to that beeswax candle bomber?

Getting to the airport today was just the culmination of an arduous process that is part of our new world: an hour and a half last night uploading documents into British Airways’s Verifly app so I could check in online. I had to upload proof of vaccination, negative Covid test results, passenger locator forms for both the UK and Ireland, eleven years of bank statements, and a photograph of the top of my head against a plain white background. Then I couldn’t check in online. Verifly sent me to ba.com which sent me to Verifly, which sent me to ba.com. Online check-in broken. Who could have imagined?

I still love flying. We just took off. I was listening to my chosen take-off song, I’m With You by Grouplove, which is a fabulous screaming-down-the-runway song. The ghostly yellowish mist that shrouded Newark Airport gave way to the fog of low lying clouds. Our Boeing 787 lifted effortlessly off the ground and into the sky, and I sank in to the fact that instead of being evening it’s after midnight. Flight: routine and miraculous as waking up in the morning.

On the other side of the darkness is my dad, stuck in a Dublin hospital for nearly a month now, and my middle brother, who has also flown home to rescue him. We’re going to spring him from dodge, get him home for Christmas. We’re going to have a tree and dried fruit pudding and brandy butter and Christmas crackers, and I’m going to make my mum’s homemade ice-cream. Like most Irish recipes, it’s mostly cream, butter, and alcohol of some sort. Actually just boozy cream and candied peel because the butter is all needed for the brandy butter. By the end of the meal the effect is pretty much the same.

The airline beverages cart just came around. Despite my clear intentions not to dehydrate myself on this flight, I accidentally notice that when the woman in the seat in front asked for some Chardonnay, the stewardess handed her two of the little airplane bottles. Free. British Airways: every now and then in this gloomy world, there’s a little glimmer of light.

International travel may have got a lot more arduous but the principles haven’t changed. I’m flying at a ground speed of 664mph and an altitude of 39 thousand feet and in just five and a half hours I’ll steal glimpses out the oval window of my favorite London sights: the Westminster Houses of Parliament, Big Ben, the Thames and the Eye. Strangers have given me fleece blankets and a scratchy little pillow and free pretzels. I don’t like pretzels but I put them in my bag. You never know when you might have to make an emergency landing over water and need some food.

In a little while, the dinner cart will come round. I’m not one of those people who complain about airline food. I love it. Those piping hot little plastic containers with the metal lids that say Fly, making you wonder momentarily what’s in there. It doesn’t matter, someone else is cooking, and no washing up. Also, I can’t help remembering some comedian’s joke in the recent US election about people who were undecided over voting for Biden. He said they were like folks on an airplane who were offered the chicken or a plate of shit with broken glass in it, and they asked how the chicken was cooked.

After I soak up my fill of London from the air, I’ll take off again a couple of hours later and fly across the blip of the Irish sea until the east coast of Ireland comes into sight. Then there will be the sights that are part of my DNA: the Poolbeg chimneys, the spread of Dollymount, the Hill of Howth with its narrow isthmus where my dad’s house is, with water on both sides, a life informed by the sea. I’ll have that rush of strange familiarity as we land in Dublin airport and I see the double-deckers and the signs in Irish, Slí amach, ná caith tabac, and hear the accents. I’ll probably cry. An immigrant of 32 years, but you never quite get over the sight of the Poolbeg chimneys.

Have you got the right time? my dad said on the phone with me this morning. We were laughing about old Dublin sayings. His favorite is the job is oxo. I’ve never met anyone else who knows this phrase, and even my dad doesn’t really know where it came from, or what it means. But he uses it liberally, and as far as I’m concerned it’s as good a positive take on this world as any. 

I may not have been permitted to bring my mercury containing apparatus with me on this trip, but I have some beeswax candles to light in our window on Christmas Eve. I’ll pull some crackers with my bro and my dad and he won’t have to spend Christmas in Beaumont eating gruel. If he asks me, I’ll give him the right time. Four hours forty-seven minutes to my destination and the job is oxo.

Hospice Nurse Considers Hiring with LinkedIn

The other night I was making myself a cup of ginger tea in a vain attempt to ensure myself happy dreams. The teabag had one of those little tags attached to its string with a comforting saying. I look forward to reading comforting teabag sayings sort of like I read my horoscope occasionally, hoping it will tell me that everything is going to be okay and I am about to come into a surprisingly vast sum of money.

My teabag saying was this: When fear is forcing you to give up, call upon your heart’s courage to continue. I stirred the teabag disappointedly about in the hot water. I had been kind of hoping my teabag would tell me someone else’s heart courage could be called upon for me to continue. To be thrown back on my own resources by my teabag was deflating. Plus that night I had my usual crappy dreams. That’s the last time I’m relying on ginger tea.

I have been thinking lately though about the resources I draw on for strength to continue. It’s not that I have such a terrible life. In the grand scheme of terrible lives, I have it really good. Also, it’s not a competition. So some mornings as I drive around between my nineteen dying patients, I feel quite sorry for myself and my stress load seems temporarily unbearable and I cast about to see what sources I can draw on to make myself feel better.

In the absence of teabag comfort, there’s always Deepak Chopra’s Infinite Potential podcast, which I have been tuning into lately. Deepak describes this as a metahuman miniseries about what makes us conscious beings and why it matters that we are. The main thing I love about this podcast is his introductory ad honoring his sponsor, LinkedIn. It affords me endless joy to listen to him extol in his impeccable Indian accent the virtues of mindful hiring. It is little wonder, he intones earnestly, that someone is hired every eight seconds using LinkedIn. Even though I don’t actually run a business, it just makes me want to rush out and hire someone.

After he has glorified mindful hiring for a bit, he goes on to interview some of the great minds of our time: Dr. Oz, Don Hoffman and, well, those are the only two great minds I have heard him interview so far. But just listening to him riffing with Mehmet Oz about the heart as I drove to work the other day set me completely on fire. Oz told a story about a mentor of his who pioneered a method of open heart surgery on kids in the 1950s whereby he hooked the mother up to the kid so when the surgery was underway, the mother’s blood was coursing through her child’s veins while their heart was temporarily stopped for the procedure, and her lungs were oxygenating her child’s blood.

This idea just made me start leaking tears on my drive up the 9G towards the Kingston Rhinecliff Bridge. Then Oz talked about how he lamented to this mentor that his open heart surgeries had a 25% fail rate. So one in four times, he would lose a child and have to go out and break the news to the waiting parents. His mentor said well my fail rate could potentially be two hundred percent, because I could lose both child and mother. 

Now I was crying in such a way that I could barely see the road. Nothing appeals to the hospice nurse sensibilities like a potential two hundred percent surgery fail rate.

But the two of them also talked about how the heartbeat continues from the moment in utero when fetal heartbeat is first detectable (and here they played a recording of that rapid fetal heartbeat I recalled so vividly from my first pregnancy ultrasound) to the moment it flatlines at death (cue recording of an ICU monitor going from intermittent to continuous beep). 

The essence of hospice care is that death occurs outside of the ICU, ideally in the home environment. There’s no hookup to machines, no flashing lights, no beeps. Often the moment of death goes unrecorded. Family members find the person dead in their bed, or the death occurs at some difficult to determine moment while loved ones are in and out of the room. Sometimes the dying wait to be alone. Sometimes they wait for a specific person to be present. At least, that’s what we like to think. In reality, there’s no saying exactly why a person dies the moment they die except that their heart just stops beating.

And yet, that moment is a profound one. I have laid my stethoscope against the chest of a recently deceased patient many times, and each time I feel again the weight of what has occurred. I am struck by the absence of sound. Where moments ago there was the familiar lub-dup of a heartbeat, no matter how faint or irregular, now there is silence. If it’s a patient I am familiar with, I will have listened to their heartbeat many times and be familiar with its peculiarities. And now I’m putting my steth against their left chest wall, and there’s nothing.

When a patient dies on hospice, a nurse usually makes a visit we call a pronouncement. It sounds like we declaim something from the rooftops, but in reality it is usually an extremely quiet moment. Families can decline this visit, but mostly they want a nurse to come and support them at the time of death. Some families actually rely on the nurse to convince them that the death has actually occurred. I have been called to homes where a patient was so clearly dead there was no way anyone could dispute it. And yet the family need me to tell them, sometimes they need me to go through the motions of listening for a heartbeat with my stethoscope. I have to do this, and then turn to them and say something like your mom is gone, or he has left us for them to begin their process of grieving. It can be a curiously formal and final moment.

For me, it is sometimes a heavy responsibility, and sometimes a moment of black comedy. I have pronounced patients who were so clearly dead it felt sort of ludicrous to apply my stethoscope to their cold chests. And yet, that can sometimes be what the family needs, and that is what you do. 

Aside from my life of pronouncing people dead, I do like to listen to instructive podcasts, enlivening music, and to read the odd horoscope. Just now for example, a random online search of my daily horoscope told me that responsibilities at home and upsets in my circles of friends could distract and stress me. Make an effort to balance it all, instructed my online psychic confidently and yet completely unhelpfully, and you’ll make it through the day. It’s 9:26pm. Maybe I’ll just go on LinkedIn and see if its mindful hiring practices will get me through the last two and a half hours.

Hospice Nurse Turns up the Loud

I was driving to my first patient the other day. It was a beautiful Fall morning in the Hudson Valley and I was heading south from Kingston in the golden early light. My patient had taken a turn for the worst in the previous few days and I wasn’t sure whether he was going to recover or continue his downward trend. I felt that this morning’s visit was going to be pivotal. A mile south of the 199, I got a call from the son. His voice was unusually tense. We aren’t doing too well here, he said. I noted the use of the plural. Dad is sort of gasping for breath and he isn’t responding.

I had been driving on autopilot, chilling to some mellow music to get me into the hospice nurse frame of mind for a Wednesday, but in that moment my whole being shifted into a high gear. Okay, I said in my calmest voice, it sounds like your dad is leaving us. Does he look comfortable? Is he struggling? Yes, the son said, and no. I’ll be there in six minutes, I said. 

I sped up. I switched the music to something loud and insistent. And I turned it up louder. For those six minutes, very loud music and some over-the-speed-limit driving helped me to prepare for what I could imagine was waiting. I had a short talk with my patient in my head. He was this straight-up, no-nonsense but very lovable guy. Tommy, I said to him (not his real name) if you are going, I’ll try my best to keep you comfortable. I promise I’ll make this the best that it can be. Then I said to him in my head: I’m really sorry, hang in there, I’m driving as fast as I can.

When I got to his apartment, his son and daughter in law were sitting with him and I could see at once that he was close to death. Unresponsive. Flaccid limbs. Breathing agonal - what I call fish-gasping, which means breath that is coming in short infrequent gasps from the abdomen, really just a convulsing of the lungs due to medulla oblongata brain activity. His oxygen saturation was in the 30s. There was little to no frontal cortex brain function.

I spent the next three hours in his room with various family members. My memories of those three hours are like a time-lapse video. People came and went. My patient sat in his chair with his brain and body shutting down. I checked his pulse periodically. I went into the kitchen. I went outside. I talked with various family members. I texted the hospice team to let them know the patient’s status. I asked my supervisors to cover my 11am visit. I want to see this through, I texted, but I knew that this could be wishful thinking on my part. 

After more than three hours, I had to leave because I knew he could take many more hours to die and I had other patients to see. It can be a tough judgement call, when to leave an actively dying patient to take care of your other folks. There’s only so much help available from a hospice team already stretched thin. 

I made sure the family had everything they needed and knew to call me as soon as he passed. Twenty minutes down the road, I got the call to say he had taken his last breath. I made a couple of calls to reschedule my immediate visits. I also texted a hospice text thread that reaches over 50 staff: Tommy just died, on my way to pronounce. This would prevent any other staff from calling or visiting. It also, in my mind, allowed staff who had taken care of Tommy to learn of his death, grieve him, and send their good thoughts to the family.

In the three hours I spent with him as he died, and during my visit after his death, some moments stand out in my mind. I remember lurking in his kitchen, trying to afford some privacy to one of his sons who had showed up to say goodbye. For various reasons, the most involved son had asked me to be present in the room when this son visited. While I felt that my presence was something of an intrusion, I also understood completely and honored the request. Families are complex beasts. From the kitchen, I could not help hearing some of the words this son was saying to his dying father. These are the moment that get seared into a hospice nurse’s memory, the ones we carry with us in some compartmentalized part of our brain. I will never forget what I heard.

Nor will I forget the moments early in my visit when the catastrophic change in my patient’s condition was still new and raw to his son and daughter in law, and also to me. The three of us were gathered around him and his son reminded his dad of a precious and moving promise they had made each other. Then he started singing to him. That undid me. Paper masks don’t stand up too well to tears. Between the three of us, we were using up all the tissues in the house. I fetched a toilet roll and we started using that.

Is it okay for the hospice nurse to cry along with family at a death? Absolutely. And are there times where we need to rein it in and allow the family space and freedom to grieve while a professional holds the space for them to do so? Also yes. I just knew intuitively that in this situation, they would all be fine with me grieving alongside them. So I gave myself permission to do so. Plus it would have been pretty hard, if not impossible, to rein in the tears on this scene.

When I finally left there after the death, when the family was gathered at the bedside and I had notified the mortuary of the timing for pickup, I drove south to the visits I had pushed out till later that afternoon. I had a half hour drive to gather myself, and a few minutes to spare along the way. I tried to think how I could spend the time to both nourish myself and to honor my patient.

I passed a wonderful farm stand I had recently discovered. They had Fall color pots of chrysanthemums on sale. I had bought a pot a couple of weeks before to honor another beloved patient after attending his death. It had been hard to choose from the beautiful colors, but I had restricted myself to a single pot, dark red. I pulled over. There were just a few pots left now and they looked a bit ratty. The owner gave me a deal on two plants the color of Tuscan sunshine, and explained to me carefully how to keep them alive over the Winter. I stashed them in the back seat of the car. 

As I drove to my next visit, I was thinking how intense my morning had been and yet how lucky I am to do this work that I love, to meet the people I meet and see the things that I see. In the back seat, the mums glowed a glorious deep yellow. I could hear Tommy telling me how beautiful they were. If I plant them in the earth, let them die off to sticks in the snow, then cut them down to six inches when it thaws, I just might see them come back from the dead next Spring.

Hospice Nurse Goes Thrifting for Wedding Dress

Key West is renowned for several things: it’s the southernmost tip of the continental United States, it’s the birthplace of key lime pie, and it was Hemingway’s home from 1931 to 1939. During these years, he wrote Death in the Afternoon, the Green Hills of Africa, and To Have and to Have Not. I know this not because I visited Hemingway’s house on Wednesday and got a guided tour, but because I use the Internet.

I did visit Hemingway’s house on Wednesday, if you count standing outside the high brick wall that surrounds his property and air-typing while your daughter takes your picture. We arrived in Key West around 10am. It was already steaming hot and parking was scarce. We drove by the house and could see it was overrun with tourists. I mean, who are all these people who arrive well before you at the places you want to see, even when you set out at 8am?

Apparently they were all people who were willing to purchase tickets to shuffle around Hemingway’s house in a pack following a guide. I’m sure it’s a great tour and I would have learned a lot. We’re just not the ticketed tour types. Plus as I told Jessie, reports are in that he wasn’t very nice to women. She asked how I knew this. I knew it from watching a fictionalized movie about him and Martha Gellhorn, but I improvised and said because he was married four times. Single eyebrow arch from the daughter.

Fair point. One of the things I wanted to do in Key West was shop for a wedding dress. If you have ever gone shopping in Key West, Key Largo, or indeed Miami, you will know that unless you want to get married in beach bling you are bang out of luck shopping for a wedding dress. I’m not looking to be married in white this time, or even ivory. Any color will do. But I also don’t want to be married in a paisley silk halter-neck with flounces.

And yet this was pretty much all we saw in Miami Beach on Monday. We made forays into a few boutiques on Collins Avenue. I optimistically tried on some flowing ruffly creations. They looked okay in Miami, but I knew that transported to the Hudson Valley in early October they would look exactly like what they were: beach bling. Jessie tried on some fun creations too: she looked spectacular, but she already has her dress for the wedding. We tried Macy’s. Surely the staid old department store would have something classier? Turns out Macy’s on Miami Beach is all about…paisley flounces. 

Undeterred, we hit some thrift stores on the Keys on Tuesday. I felt in my bones that I would find my wedding dress at Jolene’s Hidden Treasures and Boutique in Tavernier. The moment we walked through the door, the feeling intensified. The place was a trove of unique clothing, everything from stetsons to scarlet sequins. Jolene was bustling around in the back and called out to ask us if we were looking for anything special. My mom’s getting married, Jessie said brightly. Then we both giggled silently at each other. Jolene was on it immediately. I have the perfect dress for you! she cried, it just came in! I stood very still, waiting to see my dress.

She emerged from behind a clothing rack holding a giant white mass of gauze ruffles. It looked like a big meringue, circa 1980. Think Charlie’s Angels are all marrying the guys from Miami Vice. I smiled weakly. Actually I said, hoping I could keep the horror out of my tone, I wasn’t planning on doing the white thing this time around. Her face fell. She clearly thought she was going to see me leave with meringue dress.

We poked around for a bit and I tried on some interesting creations, but none of them were quite right. I’ll admit it: shopping for your wedding dress in a thrift store is a shade optimistic. I tried on a lovely pale green thing that swept down gracefully to the floor. But it had a thread pulled in the front and it looked a bit scruffy, even for me. Besides, getting married in pale green just seems a bit…pale.

Key West was no better. After we peered over Hemingway’s brick wall at his very shady and gracious house, we checked out a few dress shops. Sundresses with lace. Sundresses with sequins. In one store, I told the helpful assistant that I was looking for my wedding dress. What time of year are you getting married? she asked. Umm, I said, trying to think how to phrase it, kind of late next week sort of time. She looked at me pityingly and pointed to some sundresses.

So maybe I’m not getting my dress in Florida. Or my shoes, unless they’re going to be glittery flip-flops. To console ourselves, we headed to Fort Zachary, lauded on Google as the best snorkel beach in the area. There were two flaws in our plan: one, Fort Zachary was next to a naval base so our beach experience featured frequent low flying military craft and two, we forgot the snorkel gear.

It didn’t matter. Life on the Keys has a way of working out just fine. We sizzled gently on the beach for a bit and then swam out in the aquamarine waters where the Atlantic meets the Gulf of Mexico. Jessie waxed lyrical about how Cuba was just out there. I turned to where she was pointing. There was a little pile of rocks about a hundred feet out with a single bird perched motionless on top of it. What, those rocks there with the bird? I said in a silly English accent I learned from Monty Python. We both cracked up. 

I’m heading back to New York. They have dress shops in New York, I feel sure. Macy’s in Poughkeepsie will have classy gowns that flow about my body and have never been worn by others. I’m kind of sad that I didn’t find my dress at Jolene’s Hidden Treasures and Boutique. But I have a full nine days, only five of which are work days, to find my dress and shoes. How hard could it possibly be?

Where are All the Fish?

One of the main things the Florida Keys are famous for is big game fishing. But where you have big fish you also generally have little fish, and I had read before my trip to Key Largo that the John Pennekamp state park features America’s only living coral reef. Naturally, I was excited to snorkel.

Like most airbnbs I have experienced, ours featured pretty much everything we could want, including snorkel gear. In fact, like most airbnbs I have experienced, it was decked out nicer than my own home. Especially the kitchen. How come everyone’s rental property fridges are better than mine?

The snorkel gear, however, featured only one set of goggles. I slung them into our beach bag as we left for the beach, and I asked my daughter what she was going to do while I snorkeled. She laughed dismissively. We both knew who would end up trying out the gear first.

We got to the John Pennekamp State Park in eleven minutes. Everywhere on the Keys is eleven minutes away, and you don’t really need Siri because it’s all just one long road down the narrow strips of land, with tiny side roads. So you drive from your tiny side road onto the long straight road and then you drive eleven minutes north or eleven minutes south and then you are there. I still use Siri.

The park entrance was a tropical delight, mysterious and overgrown. I half expected a T-Rex to come charging out of the trees. There was an entrance fee, but we felt it would be worth it to snorkel on a live coral reef. The beach was pretty tiny and not crowded at all. Why was it not crowded on America’s only live coral reef beach?

We set out our towels down one end, between two peculiar-looking cannons, which turned out to be Art. The sand was really hard, think concrete, and within ten seconds of lying down I had been bitten numerous times by some tiny vicious bugs that looked like swarmy sorts of ants. Big welts started to rise up on my arms and hands. Time to snorkel!

We waded into the balmy water, and Jessie applied the snorkel gear. I told her how stupid she looked and floated on my back while she launched into her hunt for stupendously colored fish. A minute after her launch, I could hear her snorkelly voice coming up through the breathing tube. Mom. There’s no fish. Just stones. 

I turned over and peered into the clear water. Stones. I saw a flash of bright yellow, but it was a leaf. Chuckling quietly to myself I floated some more, while Jessie gave up on the snorkeling and went to put the gear back on the concrete beside our towels and the swarmy ants. I thought perhaps we had a couple of clues as to why the beach was so empty. But the water was fantastic and I was in the tropics and really, what were a few nasty welts when there was also the promise of mojitos in the late afternoon?

After our swim, I lay on my towel and listened to the ebb and flow of other humans on the beach. Americans on the beach tend to spend most of the time arranging their stuff, and very little time actually enjoying beach activities, such as lying motionless on the sand or floating in the water. A large family came and plunked all their stuff down ten feet from the cannon to my right. They spend a half hour unpacking their gear and putting it all on. Eventually some of them had enough gear on to wade out into the water looking for tropical fish. I silently wished them good luck. After a few minutes, I could hear their snorkelly voices calling out how there really weren’t any fish. 

But then I sort of zoned out for a while and when I next looked up, they were all out out by a distant buoy, swimming around it in a tightly packed school of humans. It looked like they were seeing some action. Turns out the buoy marked a fake wreck that had been placed near the start of the reef to give a fake home to all the tropical fish. Even though this smacked a little of a gated condo community, I couldn’t help feeling we just hadn’t persevered enough in our snorkeling endeavors. 

But by then it was perilously close to mojito hour so we packed up and drove the eleven minutes south to our airbnb, from which we could walk to Snappers, a tiki bar and restaurant on the water. Having a tiki bar within walking distance of your accommodations really is a genious move. As our hostess had written in her welcome note: “Snappers: walk there, stagger home.” I had already sampled their Key Lime Coladas, dessert in a glass. Their mojitos were just as spectacular. 

Sadly, my daughter is nine months shy of legal drinking age, so only one of us could order a cocktail. Being Irish, however, we have found a strategy to address this shockingly unfair situation. I order an alcoholic beverage and she demurely orders a juice that is the same color as my cocktail. She quickly drinks most of the juice and I tip half my beverage into her glass. That way, we both get a little buzz going and nobody needs to lose their liquor license. I look like a lush who guzzles cocktails in half the time of normal humans, but it’s a small price to pay. 

After our ten dollar mojito and some food, we decided it would be much cheaper and safer to drop by a liquor store and stock up on our own at-home mojito making kit. The airbnb fridge had tons of ice cubes waiting patiently in its pristine freezer section, but I hadn’t noticed any limes, rum, or mint. 

However, even half a mojito was enough to send us into an early evening stupor, and when we came to it just seemed like too much trouble to have to drive eleven minutes to a liquor store and another eleven minutes to get limes and mint. 

Tomorrow we are venturing south to Key West, the southernmost point in the continental US and birthplace of key lime pie. I think some writer guy used to live there too. The internet boasts of world class snorkeling on America’s only living coral reef. Maybe they’ll even have some fish. If not, we can always console ourselves with half a cocktail.

Hospice Nurse Accidentally Goes on Holiday Alone

I wanted to call this blog post Mom of Teen Finally Succumbs to Worry, but then I remembered my daughter is no longer a teen. Mom of Twenty Year Old just doesn’t have the same ring to it. Still, the point of this story is that as a mom I have always tried not to be a worrier. I’m just not the what if type. But sometimes, events stretch even my natural stores of chill. Saturday was one of those times.

I was sitting in La Guardia waiting for my flight to Miami. I was feeling a little concerned that I hadn’t had a text from my daughter saying she was boarding in San Francisco, or had landed in Miami and was shopping on Collins Avenue while she waited for me to join her. This was our plan. She was getting the red-eye Friday night and I was to meet her Saturday afternoon. What could possibly go wrong? 

Putting out of my mind all thoughts of how her car could have gone off the road or her plane fallen out of the sky, I decided her phone must have run out of juice. I texted her a couple of photos of my airport experience. No response. Then I called her. Straight to voicemail. Finally I caved and texted shopping on Collins Avenue already? check in with me. Nothing.

Now I was finally worried. I got a coffee so I could be worried and jittery. I checked my phone every 0.8 seconds. Finally…a call!

Her: Mom?

Me: Where are you?

Her: In bed. Mom, wait, my flight’s not tonight???

Her flight was not that night. It was the previous night. She had not been on it. Suffice to say that for half a minute, at Gate C44 in La Guardia airport, I lost my cool. You got the day wrong? How could you get the day wrong? Then I shifted into my calm-in-a-shit-storm mode and within fifteen minutes we had her booked on another red-eye flying out that night. She’d be joining me a day later than planned. No big deal I finished my coffee, boarded my flight and settled back to enjoy a day alone on the Florida Keys.

Travel just fills me with delight. It makes me feel like a citizen of the world. The plane banked over glittering Manhattan and I said an affectionate farewell to Central Park, the Empire State and Lady Liberty, icons of my new home. Then we cruised for three hours down the East Coast of the US. It was a route I had never taken. Miami from the air looked every bit the wealthy playground I had imagined. Collins Avenue stretched gleaming along the beach front and the cruise ships lined up at the docks like tiny white toys. 

Miami airport is pristine. The shopping is informed by Cape Canaveral and water sports. There was a long line for the rental cars and I was the only white person in it. As I drove my vehicle out of the parking garage, I was feeling like Intrepid World Traveler, able to navigate any system anywhere. Then I turned the corner towards the exit and my phone went dead. Oh no! Now I have no map, no Siri, I don’t know where I’m going…WHAT THE HELL??? A moment later, the dash screen lit up with google maps and the directions to my airbnb. The phone had just gone momentarily dark while connecting to bluetooth. Yessssss! Am intrepid world traveler again, handily overcoming all obstacles in my path! 

A mile down the highway, I’m taking in the endless palm trees and the sunshine and the new greens and blues when splat! splat! splat! It’s 91 degrees and sunny, but it’s raining. Not only that but the raindrops are the size of dinner plates and I’m turning the wipers up to top speed and back down because one minute it’s raining hard and the next it’s not raining at all. Different. Meanwhile, cars are zooming past me on all sides. Floridians drive really fast, and they weave. A lot. I’m still a fairly polite Californian driver, but a year of trips into New York City from the Hudson Valley have taught me to handle aggressive driving. When you drive into NYC from Hudson, there’s a certain point around Yonkers where the road etiquette switches sharply from sedate upstate to insane city. It’s like a gear shift. Comes in handy when you find yourself heading south from Miami on a Saturday afternoon.

Once outside the suburbs the scenery changes fast: it’s flat and low and there are no trees, only what look like mangrove swamps. There’s a sense of the ocean on both sides though you can’t always see it. And everything slides subtly back into the 1950s: the buildings all pastels and rounded corners, the famed highway with its bridges and shabby turquoise wall dividing the lanes. I can feel Hemingway’s prose rising to describe the place. He no longer dreamed of storms, nor of women, nor of great occurrences, nor of great fish, nor fights, nor contests of strength, nor of his wife. He only dreamed of places now and the lions on the beach.

After I check in to my airbnb, I wander down the gravel road to Snappers, a tiki bar and seafood restaurant on the water. Table for one. A Key Lime Colada and some fresh shrimp. I’m sitting five feet away from the ocean that stretches off east to the Bahamas and south to Cuba. Finding myself accidentally having dinner alone in the balmy air of Key Largo is just about the best way I could have imagined to recharge my depleted Covid hospice nurse self. There are no lions on the beach that I can see, but I’m okay with that.

Everyone has to miss a flight at least once in their lives, it’s a rite of passage to adulthood. And it taught me a valuable lesson: if you find yourself accidentally on holiday alone, always treat yourself to a Key Lime Colada. On second thoughts, make that two. 

Nursing in the Time of Covid

This morning I was working out in our basement, which gives me ample time to contemplate the accumulated rubbish of our year here. There’s the broken microwave, a barstool that doesn’t fit anywhere, and my old sturdy UCSF faceshield. Also a pair of thick plastic goggles that, when I wore them way back at the start of Covid, made me sort of feel like I was snorkeling in Hawaii. Without the warm water or tropical fish of course, and yet with a chance of drowning.

The sturdy faceshield made me think back on the early days of Covid, and I realized that the pandemic is now old enough for me to have a kind of nostalgia for the beginnings of it; a sort of warped yearning for the weirdness of the early days, the sharp awfulness, the quiet. I remembered putting that faceshield on in the windy parking lot of a California nursing home back when I got dressed in my PPE according to the instructions on a flimsy sheet of paper. The parking lot was cold. The wind kept threatening to whip my instructions away. My plastic bag blew down from where I had secured it, ready to hold my dirty PPE when I was done. 

This was back when PPE was being rationed out weekly in ziplocks. Back when Covid was tearing through the nursing homes and the deaths went unrecorded as Covid deaths, but we all knew. Back when I would come out from a visit and take off my gear slowly, carefully, according to the instructions on that flimsy sheet, and tie it all up in a plastic bag and walk it around to the trash bins in back of the nursing home and get in my car and carefully sanitize my hands and then tear out those little saniwipes and wipe down my keys, my phone, my steering wheel, the gearstick. Mostly I was thinking how crazy this all was and how could I possibly get sick with all the precautions I was taking. Sometimes I was crying from fear.

And here we are today: Covid was kind of over for a minute, but not really. Restrictions were lifted, but they’re back. Numbers were down, numbers were vastly underreported, numbers are flying up, numbers are inflated. Covid’s over, Covid’s here to stay. Option e: All of the above.

So how does a hospice nurse respond to the current moment? We follow the protocols that are handed down to us. They change every few weeks. I have three documents, decision trees about what to wear to a visit, depending on whether a patient is vaccinated, whether their family is vaccinated, whether they have been in the hospital, out of state, had visitors from out of state, if so which state. It’s dizzying to just write about. My trunk is full of different kinds of masks.

When someone is suspected of having Covid, or of having been exposed, they become what is called a PUI - a Person Under Investigation. So CIA! I personally think the term was invented by an FBI agent-wannabe. Then there are UVPs: unvaccinated persons. They don’t necessarily have symptoms or exposure, but we have to wear a special kind of mask for them anyway. Nothing says get the goddam vaccine like our special kind of mask.

And yet hospice goes on being hospice. People go on dying in the ways that they always have, and some new ways: because whatever you can say about death, you cannot say that it is predictable.

Last night before I went to bed I checked my work phone. I do this when a patient is close to death. With some of them, I cannot help myself, I check my phone before bed, when I wake in the night, and first thing in the morning. Last night I learned that my patient, a 45 year old mother of two, had died just after 8pm. There was a flurry of texts among her day team and the night staff. The death was excruciating, fast, brutal and chaotic. When I visited yesterday morning, her family did not even want to admit that she was dying, yet I could see that she only had hours to live.

She was from a different country, the family spoke another language, and they had very different rituals around death. It was a crash course for me in their culture, about which I knew little. To communicate with them, I had to use the language line on my phone. I spoke in English to a translator, they spoke to the family, the family answered, the translator told me what they said. Any conversation so parsed  would be tedious. I stood in their kitchen, it was my second time in their house. My side of the conversation went something like this:

Please tell them she is very close to the end of her life.

Please tell them I am so very sorry.

Please tell them that giving her food now will cause her more distress. 

Her body cannot tolerate food any more. Her body cannot tolerate fluids.

Please tell them I know this is terribly hard to hear.

The translator made my words into unintelligible sounds. The family listened, wide-eyed. They cried. They had many questions but really they were all the one question: what can we do now?

Please tell them that the best thing they can do for her is sit by her bed, touch her, tell her that they love her.

They did this. I gave her some pain medicine, and I left them there by her bedside. Outside her house I sat in my car for five minutes to gather myself and then I drove to my next patient. In the old days I might have taken a half hour to recover from this visit. But my caseload is so high, there is no time between patients for anything but trying to stay caught up with the mountainous workload.

The night nurse said that when the patient died, her mother threw herself on her body and cried hysterically. I tried to imagine lying across the body of my daughter.

Hospice goes on being hospice in the time of Covid. Mostly, people keep dying of the things they have always died of: cancer, heart disease, poor choices. Despite the virulence of the Delta variant, being vaccinated made a huge difference to the fear factor of my job. Boosters are on the horizon. And with vaccination rates slowly climbing, I’m wearing fewer and fewer paper gowns.

Nineteen months in though, burnout among healthcare workers is increasing. Nurses are quitting the field. I love my work, and I am clear I don’t want to do anything else. But I’m about to have nine days off, my longest vacation in two years, and I’m going to clear the trunk of my car of all traces of PPE. It can go in the basement with my sturdy plastic faceshield and the spiderwebs. And my work phone. I might put that down there too. Right after I change the outgoing message to I’ll be out of the office until September 27th and I won’t be checking voicemails…