A while ago I had this patient, let’s call her Doris, who was pretty far advanced into her dementia when I met her. This did not prevent her from being able to sing every word of every Frank Sinatra song, and yet she had a hard time stringing an ordinary sentence together.
One of the things we ask our patients when we first meet them are what their goals are. We may assume that the goal of anyone on hospice is a peaceful death, but the answers to this simple question are far more varied than you might imagine. Doris’s goal, for example, was simple and yet elegant: at 93, she wanted a boyfriend.
When she first told me this, I thought it was funny. As time went on, and she repeated this goal, along with various fantastical stories about the gentleman callers she had entertained since I last saw her, I began to take it more seriously. One day as we chatted, she told me conspiratorially that she was looking for the...[and here she stopped, trying to find the right word] “he-thing.”
In general, it’s a good rule of thumb for the hospice nurse to keep her private life out of the visit. After all, it’s all about the patient. But occasionally it seems appropriate, even connecting, to reveal some personal details. Dying folk, it turns out, get tired of talking about when their last bowel movement was. Sometimes they just want to hear something about what is going on in the world outside their bedroom, something about you.
I leaned in to Doris and confided in her that I too was looking for the ‘he-thing.’ She smiled delightedly. The most important thing, she said, suddenly weirdly lucid and coherent, is to find out what the other person needs and give it to them. I digested this wisdom for a bit. Then I suggested to her that we make it a race. Who would find a boyfriend first? Doris was one of the most positive women I have ever met. Everyone she came in contact with loved her. Frankly, my money was on her.
I have had other patients who asked me personal questions and I have had to weigh up, situation by situation, the advisability of sharing the details of my life with them. Usually, I keep it vague, direct the conversation back to them. But sometimes, like I said, it is part of the deepening of the nurse/patient relationship to share personal stuff. It’s vital to remain professional, but it’s human to share.
One day, a few months after I left my marriage, I was with a patient and his wife. It was a sunny Fall morning. My visits with them were very social. He had few symptoms, he had a lively curious mind, he was very bored stuck at home and he loved to ask me about my life. We talked about our kids, parenting, the weather in Ireland. Out of the blue that day, he asked me “are you married?” The dying sometimes eschew the constraints of our unwritten social rules of etiquette. They just don’t care any more: what do they have to lose?
I hesitated before I answered. How much to share? But beyond that, I had not been asked this question since leaving my marriage and I just wasn’t prepared with an answer. Was I married any more? I wasn’t divorced yet. But I definitely wasn’t married. Some kind of no-man’s-land, that phase where things have ended but the ink is not dry on the divorce papers.
I was, I said. He nodded knowingly. When people hesitate, he said, you know. Then his wife asked me quietly, with almost unbearable kindness, your daughter, where is she? I realized that these people actually cared about me; that for all my professionalism, my role as their healthcare provider, purveyor of pain meds and advice about preventing falls, they were seeing me as a person with a life, a daughter, a broken marriage. She’s with me, I said. I ended the visit quickly and left. Luckily I always have Kleenex in my car.
But it got me thinking, that visit, about how the professional boundaries can become blurred, and it’s not always a bad judgement call. I tried to codify some rules for myself. Never make the conversation about me is a good one. But if a patient is truly curious about me, if they’re bored beyond belief sitting in bed being ministered to, is it not okay to tell them briefly about my roadtrip with my daughter when they ask? I never volunteer the information, but I have had patients ask how was your weekend, then light up with honest sympathetic joy to hear about my Saturday at the beach, and it always humbles me. Would I, thrust into the last stages of my terminal disease, have such curiosity and joy about someone else’s vibrant life? I hope so, but I wonder.
Doris has long since flown to the moon with Frank Sinatra, but when I do eventually find the he-thing, I will raise a glass in her honor.
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