Hospice Nurse Reads the Room

I wanted to write about something else entirely, but inventing that title made me think about my reading material. Most people probably spend some of their leisure time reading things that are somewhat related to their profession. In my case, this causes everyone around me to groan. I have been known, citing just one example, to lie on the beach on a glorious Summer day reading a book titled “How We Die.” My friend Connie has the photograph to prove it.

In my defense, it really was an excellent book and I highly recommend it. Especially for the beach.

But what I really wanted to write about was how, besides the so-called ‘skills’ a hospice nurse has to have (wound care, meds, pain and symptom control, keen assessment abilities) one of the most important aspects to the job is the ability to read the room.

Any visit I make to a patient, but particularly the first, necessitates a rapid and astute evaluation of everyone in the home, how they operate, the nature of their interrelationships, sources of stress and aggravation, and what they are not talking about. Sometimes it’s hard to move for the elephants in the room.

So dad might be in the bed and there are three grown children in the house, plus a caregiver, some in-laws, a dog, and a parrot who periodically tells me sharply to shut up. The admissions nurse may or may not have had the opportunity or inclination to make notes about family dynamics. If I’m lucky, a social worker might have made their initial visit before me and I’ll likely glean a lot of psychsocial nuggets from that report. But essentially, I have to hit the ground running and make some quick decisions based on what I see. As I visit more, the family story slowly unspools. Sometimes it’s more like a rapid unravelling. There’s nothing like death for undoing the most stoic of us.

There’s also nothing like mom or dad lying on their death bed to resurrect all the family ghosts and demons. Sometimes these have long been locked away by grown children who moved far from home to avoid them. But now mom or dad is dying and it’s time to come home and spend time in a small room with your siblings, or your half-siblings, or that aunt you haven’t spoken to for twenty-four years since she got drunk at your wedding and insulted your wife.

As hospice nurse, it’s my lucky lot in life to enter the room with all of these long-buried grudges, family feuds and misunderstandings. Sometimes I can feel them simmering beneath the surface, but I don’t know exactly what they are. Until one day, daughter #2 pulls me aside and bends my ear for half an hour about how controlling, narcissistic, and generally mentally unbalanced daughter #1 is. It’s my job to listen, express compassionate understanding, and come to a rapid decision as to which daughter is actually the crazy (or crazier) one.

But it’s not all bad either: sometimes an impending death in the family is an incredible opportunity for people to come together and show the very best of their love and humanity. There really is such a thing as the deathbed reconciliation, I have witnessed it myself, and it’s a beautiful thing. As for the deathbed conversion, I’ll leave that for another post.

I had a patient who was a holocaust survivor. Like all holocaust survivors, she was extremely advanced in age. It was my honor and privilege to be privy to some of the stories of her life, which she told me over the months I was her nurse. Ironically, I was nursing her towards her death at the same time that my own mother, a survivor of the London Blitz, was dying six thousand miles away. My patient knew about this, and it was something that caused us to bond very closely. It was never my intention to take the focus off her own situation, but such was her selfless nature, she would often ask me how my mom was doing, and how I was coping with being so far away from her as she was dying.

My patient had a son. Frankly, I envied this son having had such a wonderfully close relationship with his mother. At the same time, I witnessed the incredibly difficult time he was having letting his mother go. It really doesn’t matter whether we are seventeen or seventy when our mothers die, the loss can be just as searing. 

At a certain point, my patient seemed to be having trouble. I could tell she was fighting to hold on to her life, even as her body was completely worn out, and she had confided in me that she was ready to die. One day, she told me that she knew how hard of a time her son was having. I asked her if it would help if I spoke privately with him. She said yes. 

I remembered my aunt telling me that when my uncle was lying on his deathbed at age 53, he had asked her to let him go. Ravaged by cancer and with four children in their teens and twenties, he needed her to give him permission to leave. Somehow, she found the strength to do so. 

I have seen many grown men and women subconsciously try to prevent their elderly parents from dying. I sought the right opportunity and took the son aside. I was nervous, intruding on the intensely private mother-son bond they had shared for decades, but in essence, what I said to him was: your mom needs you to let her go. It was extremely difficult for him, but he told his mom that it was okay for her to leave, that he would be okay. My patient died shortly after, one of the more peaceful, dignified deaths I have ever seen.

So scoff all you like at my beach reading material, how we die is a subject that never ceases to engage and fascinate me. In between the death books, I do read other things though. For example, I just finished a memoir by the Marin County Coroner. Hmm, perhaps I should just finish here...