A Day in the Life...

Yes, I’m a hospice nurse. So no, it should not surprise me that I witness death more than occasionally. And yet when I do, it is sometimes deeply surprising, deeply mysterious, and depending on the circumstances, deeply unsettling.
This morning, I had an early call from the daughter of my dying patient. From what she described, I knew he was close, possibly on the very brink of death, and I told her I would be there as soon as I could. I drove the 40 minutes through Friday morning traffic and I confess to having yelled more than once at a driver who was less than speedy to turn a corner or start up at a green light.
When I got to his house, my patient was indeed close to death. His family were gathered around his bed. This man had been vital and almost fully functional when I first met him just eight days ago. Now he was transitioning out of his body, out of his life. Pancreatic cancer. My private name for it is the rapacious beast. I have another less polite name for it also.
It was an ordinary Friday morning. As he took his last breaths, I saw someone walking their dog on the road outside his bedroom window: the uniquely ordinary as a backdrop to the extraordinary scene unfolding in the room. The sacred and the profane.
I tried to keep him comfortable. I tried to comfort his grieving family. I told them that what we were seeing was not unusual, and that he was probably beyond feeling distress. We say these things, we hospice nurses, and we hope that they are true.
I left them and went upstairs in their house to put in some medication orders. I just felt bad about leaving them there, and as though I should stick around just for a few minutes. Finally, there was nothing more for me to do and I went downstairs into his room to tell them I was leaving. As I got there, I witnessed, as they did, his final breaths. I watched him die.
Eight days before I had chatted with this man about his hospice prognosis, his goals for care, and his plans to fly across the country this week to see family. The rapacious beast had other plans. I stood in his bedroom as his wife and daughters said goodbye to him, and I felt like an intruder. I had a job to do - to confirm the absence of a heartbeat or breath, to note a time of death for his death certificate, to call the mortuary and arrange for the collection of his body. It all seemed like an intrusion on this family’s terrible grief.
I thought about my own mom’s death in 2015, how it felt to me that day as though the world had changed forever. I remembered wondering how anyone could be having an ordinary day that day, when my world had shattered. Today was like that for this family. I was witness to the shattering of their lives.
When the time seemed right, I took care of the details I needed to and I left them.
I had four more patients to see. As I drove to the next visit, I realized my own grief was too strong for me to stuff it down and just go about my day. I pulled my car over on a side street and sobbed. People were out walking their dogs. There were men doing roadworks. I sat in my car and felt wracked with a sadness that wasn’t even fully for my patient or his family. Sometimes it’s like all the deaths, all the losses mount up and the sadness of one triggers the accumulated sorrow of all of them. I called some members of my team hoping to talk with someone. Eventually I connected with my awesome team leader, and I cried on the phone with her and she listened and talked me through the meaning of our work. She reminded me of our capacity as hospice workers to help people who are suffering. And she honored the heaviness of what we do.
Then I drove on to my next patient, and the next, and the next. Happily, like pretty much every day doing hospice work, there were funny and absurd moments throughout the rest of my day and I probably laughed nearly as much as I cried.
Plus it’s Friday, so tomorrow I will get on my bike and ride out into the wilds of West Marin where the Spring flowers are bursting out on the roadsides and hawks soar on the thermals and at the edge of our continent the waves just keep on washing up on the beach like there’s no yesterday and no tomorrow.