Hospice Nurse Spring Cleans Her Contacts

I was home sick from work yesterday. It was the kind of sick where I was too fatigued to wash dishes or sweep the heinous dust bunnies up from the many corners of my house, but not so sick that I had to lie in a darkened room and take chemicals. After some early morning work texts and then some serious sleeping, I woke up and I was antsy and I had to do something. I made some work calls, so that my more compromised patients and their families wouldn’t need to know I was home sick. This is because I am a rescuer and have very poor boundaries. Then I found myself lolling on my wicker couch in the sun on my patio with my work phone in my hand and I hit on the excellent plan of cleaning up my contacts list. Productive, but only with movement of two fingers: perfect!

Normal people don’t often have to clean up their phone contact lists. I mean, how many of your friends are so much no longer your friends that you have to delete them from your phone? Hopefully the answer to that is not very many. If not, you might want to seek some help.

But hospice nurses: we accumulate hundreds of contacts over time, most of whom as the great wheel rolls become deletable, either because they have - let’s just say it - died, or because they are the family member of someone who has died. I know this is weird, but when I looked at my work phone contacts list, most of the people on it were dead. I have not had the bandwidth or inclination for this particular task for a very long time. 

So I sat there on my comfy wicker couch with many pillows and a steady supply of La Croix, and I started to scroll through my contacts list. The first thing I noticed was how often I had referred to patients only by their initials. This was in my early days at hospice when I was hyperalert to the HIPPAA privacy laws and felt that even on my password-protected phone it would not be okay to refer to patients by their full names. LW? Who was LW? And RD, son of MP? Who was MP? Who was his son RP? How could I have forgotten all these people?? But how could I be expected to remember them when there are 676 permutations for two alphabet letters?

That was the easiest round of deletions. If I couldn’t even recognize the patients or their beloved family members, deletion was just a matter of Edit>Delete Contact. I was making good progress and I had not even felt a pang. It felt kind of clean. Like I was getting the dust bunnies only without having to wield a broom. 

Then I began to pay attention to the names. They were interspersed with the living, those names of dead folks. Interspersed with the names of doctors and coworkers and pharmacies and xray labs. Some of them I still struggled with, and it distressed me that I might have taken care of a patient in their last days and weeks and now not even recognize their name. But some of our patients are only on hospice for a very brief time, so I reluctantly cut myself a little slack for not remembering someone I had taken care of for a few days four years ago. 

Then there were the names that stood out to me. Some I remembered so well, because I had thought of them many times since they died. Driving around the county seeing patients, I frequently drive past the turnings or the very houses of people I have cared for. I get visceral memories of what it felt like to turn onto their road, to make those visits, what their situations were, how their deaths went, how the families took it, what they needed, what the challenges were.

Sometimes I have memories that are so specific that I hold them to me like secrets, like the secret heart of my job that makes it both so special and so unbearable. Like the patient I had near my own home, whom I would always visit on a Friday afternoon. Her house was down a very long, very windy, very leafy road. Her decline happened over a whole Spring, so over the course of my visits her road burst from its Winter bareness into it Spring splendor. Just when the wild roses and wisteria and roadside forget-me-nots and wild onion were in their greatest profusion, and the rains were in their heaviest April unpredictability, I was visiting her as she succumbed to her terminal disease. I used to listen to the one song as I turned onto her road: Nathaniel Rateliff’s Tearing at the Seams. It had a sense of desperation to it that perfectly mirrored my sense of helplessness as my patient approached her death. I looked at her name on my contacts list. I was not ready to delete it. 

Others I had a hard time with also, but I figured it was time to let go. That patient up in the hills of Marin whom I came to love and admire so deeply, and whose death was such a struggle that I remembered physically holding him down in the bed one night way after my shift ended as he battled terminal agitation and the meds that would help him were inexplicably delayed. There was his name, and his wife’s, and his wonderful daughters, with whom I had so many long heartfelt conversations in their sunny kitchen with all the windows overlooking the pool and gardens. I’m sorry, dude, it’s time I let you go from my phone. You are still in my heart. And you always will be.

And the patient whose family had placed her bed in the very center of the family home, right next to the pool table and directly beneath the billiard lights. She struggled to die, wore a crucifix, and there were often ten to fifteen family members present, all trying to do right by grandma, all in their own individual ways. There was enough food in that house at all times to feed the five thousand, but if two family members were on the same page about what was right for the hospice nurse to do for grandma, it was a good day. I wished them all peace of mind and familial harmony as I deleted her.

OMG and the guy I was afraid might go for me with a kitchen knife? His name hit me like a brick between the eyes. This was a guy who had made a career out of helping people, and by all accounts he was very good at it. But Alzheimer’s disease had been unconscionably cruel to him, and in his dementia he had become a danger to himself, his wife, and his hospice nurse. I had to notify the pharmacy delivery service to drop the meds on the doorstep and on no account to engage with anyone they met because the situation was not really well controlled, and my job is primarily to keep everyone safe.

I had a vivid memory of one of my last visits with this patient. I was alone with him in his wife’s bedroom, which I had perhaps ill-advisedly let him wander into. He was calm and docile on this day, and I could catch brief glimpses of the kind and intelligent man he had been. We moved around the room together. He was clearly looking for a place to rest, but the bed I kept trying to direct him to was not it. He wanted to lie on the floor. I found him a blanket and tried to make the floor more comfortable for him. Comfort was not his priority, more some kind of primal state of being that I had little understanding of. We had fleeting moments of some kind of communication in that room that I will never forget. He died a few days later. Rest in peace, my friend, and peace and comfort to your loving all-forgiving wife as I delete you both from my phone contacts list.

After a while, and as I got closer to the A-list of patients, I realized that I was crying fairly consistently. I had reached the point where the dead patients on my phone lists were the patients who had worked their way into the very innermost chamber of my heart. The young mom with small kids who battled cancer for years and who died early on her own birthday. I had attended her death, because I told her mom she could call me any time of the night or day if her daughter died. Strictly against hospice policy and a serious breach of healthy boundaries, which I recognized at the time but felt powerless to resist. I will never regret it, but I will also probably never do it again. There is only so much a hospice nurse can bear. Each death is only one of 13 or 14 patients I have at a time and I can’t get up at 5am for everyone. But she was so special. She is still in my contacts.

I got to R before it occurred to me that crying in the sunshine on my patio during a sick day was probably not the healthiest way to recuperate. I put my phone down. I drank a whole peach-pear La Croix. I blew my nose. The pale creamy-pink fuchsia I had bought myself was cascading languidly from its pot for my delight, and the gardenia bush I’d purchased on the same nursery run was just dying to burst into bloom. There were bearded iris, madly huge daises, rose geraniums and a random sprinkling of wildflowers in bloom in my garden. The jasmine was more blossom than leaf. The pale pink wild roses at their height. Look at us! Yes, there’s lots of death, but we are life, and we keep on coming, every Spring! Don’t be sad! Look at us!

So I looked at them all. And I decided that as well as being sad for all the great people I have taken care of and lost, I would celebrate their lives by exulting in my own beautiful garden, with all its weeds and unexpected blossoms out of nowhere, its volunteers and forgotten beauties. If I can bring every patient I will ever take care of in the future moments of relief and joy like I get from looking at my garden, then I will feel like I have done more than a great job.