The French Horn Solo and the Magic Egg

I went to the symphony last night. It’s something I promised myself in my new single life: a symphony ticket and an opera ticket once a year. Both are so special to me that I only ever want to see something I know really well. Last night, it was Stravinksy’s Firebird.

It’s a ballet, of course, but I only ever knew it as an orchestral piece, something my dad would play on our record player when I was a kid. It is one of those special classical pieces that I have probably heard a thousand times since my childhood. When you listen to a piece of music that often, it collects memories from different points in your life and becomes a sort of touchstone, a bar against which all other pieces are measured.

There is a whole culture around a night at the symphony. It’s about opulence and glamor and, yes, privilege. Davies Symphony Hall is located downtown, right next to the opera house and directly opposite city hall with its delicately filigreed dome. It’s a cold, windy part of the city even on a warm Fall night and the Bay Area elites tend to scurry across the Civic Center plaza in their finery trying to make it to the warmth of their destination. I’m sure it’s not lost on anyone that to get to either building you have to pass a significant number of homeless folk huddled by their shopping carts.

I had dressed up. I was even wearing eye makeup, which I only ever seem to do when there’s a significant chance I will cry. As I walked into Davies Hall, I felt the specialness of where I was and what I was about to experience. Definitely a 1% moment.

But I had forgotten how vast the difference between listening to a recording of a piece you love and watching it performed live by a 100-piece orchestra in a building the size of an airplane hangar. Stravinsky, of all composers, hammers this difference home with his blazing crescendos and his unabashedly violent percussion. At one point the percussionists were literally running between instruments.

But in the Firebird, it’s the French Horn that steals the show. One of the things I love most about the piece is you have to wait about 48 of the 50 minutes for the most beautiful theme to emerge, and it is introduced by a single French Horn. This is the point in the story where the Firebird, summoned by Prince Ivan using the enchanted feather she gave him for sparing her life, directs him to the egg containing the soul of Koschei the Immortal. Ivan destroys the egg. Koschei’s spell is broken, his captive princesses are freed, and his palace disappears. Ivan is free to marry the princess he loves. I’m not really sure what happens to the Firebird. I guess she just goes on incandescing.

There are other gorgeous themes in the first 48 minutes, like the lullaby. But I knew I was really just waiting for that French Horn. And when it came, and built into the mad, crashing finale, I could feel the power of the music vibrating through my seat. It was a visceral, physical experience, the entire building seemed to be vibrating with it. Michael Tilsen Thomas was performing balletic feats to conduct it, and I thoroughly regretted putting on mascara.

MTT, it turns out, actually knew and worked with Stravinsky. He saw the composer conduct for the first time when he was ten. I felt like Stravinsky’s greatness was somehow channelled directly to us through him. I have heard conductors described as “that guy flailing up front” and I confess I really don’t understand what it is about those hand and baton movements, sometimes so very subtle, often not even seeming to be in time with the music, that hold it all together. But I have never seen an orchestra play without a conductor and examining MTT as closely as I could, it was clear that he was drawing the performance from the musicians in a way that I will probably never understand.

After the show, I filed out of the symphony hall with the rest of the fancily dressed patrons and walked the windy downtown streets to my car. I had parked in the dodgy unattended Turk street lot I always book a spot in when I go downtown. I was still on a high from Ivan getting his girl, and it helped to mitigate the fear that I was about to be mugged, or worse, by one of the shady characters hanging around at the entrance to the parking lot. Please don’t rob me, I’ve just been crying about a fairytale ending.

Made it to my car, and played the Firebird loud all the way home. If you have never driven across the Golden Gate to Stravinsky, I highly recommend it. Just don’t wear mascara.

Matilda and Me

I like to think of myself as someone who doesn’t care much for material things. After my daughter and our passports, I always thought that my journals were the only things I would rush from my burning house with. But now, there’s my bike.

I took her in to Sunshine Bikes Monday for a tune-up before the Jensi Gran Fondo next week. The guy looked her over and quickly estimated five, six hundred dollar’s worth of work. Now I love the folks at Sunshine, and I trust them like I trust my car mechanic. But his cavalier delivery of the estimate punched me in the gut. I made the appointment for the work and then walked out numbly without even giving my name. He had to call me back in: who are you? He was laughing at me, but I was thinking that’s a lot of overtime, mate.

This afternoon, I went back for pickup. Brand new tires, new drive train and chain, clean as a whistle. Looking great, and for only $405.25! I wheeled her out to my car and strapped her on the Thule. Then I had to run across to Good Earth to pick up the food I’d ordered. My bike rack has no lock, and I almost never leave my bike unattended. As I walked away  I had the horrible thought: what if she gets stolen in the 4 minutes it will take me to pick up my food? Everyone will say: you left your bike on an unlocked rack in town? What kind of idiot ARE you? I’ll have to post one of those sad-sack messages on Nextdoor and nobody will really care. I’ll have to put up Missing Bike posters and offer a reward. And I’ll have no bike.

It was still on the rack when I got back with the food. I drove home, fed dinner to Jessie and her friend, and immediately clipped in to try the new drive train and ride away my week with the dying folk. The drive train was a bit slippery, it made some clunky sorts of sounds. I don’t know bike mechanic speak, there’s probably a technical term for it. But it soon stopped making the noises and it got me up Pine Mountain. Plus I no longer had to worry about getting a flat on my stripped tires and having to walk eleven miles home because my daughter never answers her phone.

I was thinking as I rode how important my bike has become to me, as a thing. I’ve had many bikes in my life, all junkers or yard-sale bargains. My road bike is a Cannondale 900 and she was given to me by my friend Emma-Louise in a calculated attempt to make me into a road-biking addict. She is the only bike I have ever had with a gender and, yes, a name. 

I was on a ride early in my addiction when I suddenly realized that I had reached a point of such attachment to my bike that she needed a name. My cars have all had names. This is a subject of faint ridicule in my distinctly unromantic family, but I am impervious to that. My cars are named after greek goddesses. I’m currently driving Artemis, the patron deity of hunters, which is wildly appropriate since she is a Jaguar, but also a bit of a misnomer in that Artemis helped Xerxes to conquer Greece, whereas my car barely starts on cold mornings. 

At the moment I decided to name my bike, I had been humming Matilda by Alt-J. It’s a peculiar sort of song, the lyrics of which have never made the slightest sense to me. But it reminds me of Jessie’s first few weeks in high school, and her first real boyfriend, so although Matilda may seem like an odd sort of name for a bike (what would be a sensible name, you might ask? I have no idea), it stuck.

Somehow, in a fire, I will now have to grab my daughter, our passports, my journals and my bike. New drive train notwithstanding, I just can’t rely on her to evacuate the building by herself. Our passports are well hidden, and my journals of no possible interest to any thief, but my bike is right there in my storage behind the kitchen. So on the occasions when I leave home and don’t bother locking the door because hey, there’s nothing of huge value in my house, it’s a safe neighborhood, and possessions are only things...I now have to think about Matilda. 

I grew up in Ireland. Your head would be stolen if it wasn’t firmly attached to your neck. I had bikes taken, bags, and lots of spare change. Dublin pickpockets were generally under ten and impressively skilled. In my childhood home, we locked the windows. My dad even put a post in the ground behind the car every night, and it still got stolen. But I’ve lived in peaceful Marin for twenty years and I quickly came to love the notion that I could leave my car and house unlocked and everything would still be there when I got back. But now, there’s Matilda. 

I’ll come right out and say it: I love her, and I don’t want anyone else to have her. Plus I’m going to look pretty foolish doing the Jensi without her. So I guess I’m someone who locks their doors now.

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...

Hospice Nurse Gets Dating Advice From 93 Year Old

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. 

Why Do We Do the Crazy?

Why do we climb mountains? I used to wonder why anyone in their right mind would risk death to summit Everest. Because it’s there, seemed like a lameass reason to hand your life over to an avalanche or hypoxia. And now I ride a road bike on the narrow stretches of West Marin two-lanes, and frankly risk traumatic brain injury every time I speed down a hill, and I have to ask myself the same thing.

The question was loud in my mind last Saturday when I did my customary 90-minute ride to the Alpine Dam, and then decided to continue up Tam to Ridgecrest. This is a half-hour slog up a 2-mile hill without respite. Each switchback seems like it would have to be the last, but guess what, only the very top one is.

At the bottom of the hill, I was thinking about how very far away that lovely Ridgecrest road sign was. Then I realized that to embark on the hill at all, I had to put that thought firmly out of my mind, and dwell instead on the fact that the Seven Sisters views and rolling hills were waiting for me up there. But I also noticed that I wanted to ride up the hill for the riding up of it, and not just the reward at the top. The feeling of accomplishment is always a blast, and the slog up is always a slog, but I’m starting to appreciate slog for its own merits.

There had been a big wind the day before and the redwoods had shed their dry needle layer. The roadsides were carpeted with dusty brown, fragrant with sun and heat. The silence among the giants was peaceful. A handful of cars, no other riders. I felt that I had the mountain to myself and it gave me a solid sense of connection to a place I have come to know and love so well.

But there is also a first time for every hill, and that makes me wonder all over again: why do humans do this crazy stuff?

I’ve been wanting to ride the Coleman Valley Road in Sonoma for a long time. It’s an 11-mile stretch of serious climb out of Occidental to the coast, and it seems like a good next step for me, longer and steeper than anything I have been doing. It’s also one of the most stunningly gorgeous roads in the county. If I had a list of goal rides, it would be in bold with stars.

Yesterday I loaded the bike on the car and drove the hour to Tomales. I had researched various loop rides I could do that involved Coleman. Starting at Tomales would give me a 46-mile loop with the climb right in the middle. I checked my gear carefully: enough food, water, and my phone fully charged so I could consult Google Maps if I got lost. Ha! Me?

What I failed to take into account - because I am a moron - was the fact that I had just been sick. In fact, I was still a bit sick. It is a general failing of healthcare workers to admit to being ill themselves and I am one of the worst offenders. I had stayed in bed all the day before only because I was physically unable to get up. I was still too sick to go to work and risk compromising my fragile patients. But I was well enough, I reasoned, to shake the cobwebs off with a glorious ride.

I parked in Tomales and set off. Two hundred yards down the road, my legs were already feeling weirdly weak. Maybe start in Valley Ford? Or Freestone? I looped back, loaded the bike, and drove to Freestone. Much more sensible. How sensible I am. Freestone also boasts the world’s most amazing scones in its Wildflour bakery. Generally, a giant scone would be a gift that a biker would reward themselves with after a long ride, but I was there, it was lunchtime, I was hungry. I chose a pear/lemon/chocolate thing the size of a small island and when the salesgirl said brightly Enjoy the rest of your ride!  I felt it unnecessary to mention that my bike was still on the Thule.

Out of Freestone, the road to Occidental is a narrow winding picturesque few miles and, I remembered, features a photogenic red barn. Yesterday, the road seemed a lot wider and busier and as the trucks and F150s roared by me, I kept waiting for the barn. Had somebody taken it down? A better explanation presented itself when I spotted the first houses of Occidental and then the sign: Welcome to Sebastopol!

Instead of the sweet rural Bohemian Road north, I had taken Bodega Highway east. A 4.5-mile mistake. Moreover, by the time I made it the 4.5 miles back to my car, as any non-moron could have predicted, I was completely tapped out. 

So I loaded the bike back on the Thule, changed out of my kit, and drove the Bohemian to Occidental and up Coleman. I played excellent music and I have to say I was hugely grateful to be driving and not riding the mammoth hill. At the top, you see all the way west to the coastal ribbon of Highway One and the gleaming Pacific, and south to the Sugarloaf mountain and Salmon Creek. Another of those top of the world experiences.

I drove through the seaside town of Bodega Bay with its bright fluttering Candy and Kites store, and as the Pacific Coast Highway jogged inland at Doran Beach and wound its way on to Valley Ford, I noticed what a very very long way I would have had to ride had I stuck to my original idiotic plan. By Tomales I was worn out even from driving and still had an hour to get home. But the sunshine was eternal and spotless, and the views magnificent.

And Coleman Valley Road will still be there this Sunday and the next and the next. Plus now I know which way to turn when I leave the Wildflour bakery after my mid-ride scone!

Weekend Hospice Nurse Hits a Wall

I love being a nurse case manager. At hospice, this means you have your own set of patients. I get to know them and their families, their issues and needs and history and stories. Sometimes I start to feel like I’m sort of temporarily embedded in the family. Like journalists in Afghanistan, only with a much lower chance of being blown up. 

I do not love working weekend or holiday shifts. At these times, I’m seeing other nurse’s patients and it’s generally because they’re having an emergency. I don’t know who I’ll be seeing until 8:30 on the day. This could be exciting. It’s not. If I were an adrenaline junkie, I would have become an ER nurse. 

I was scheduled to work last weekend. Working a 6th day after a very full week was not my first choice for how to spend my Saturday. Maybe they forgot to put me on the schedule, I thought hopefully. Or there just won’t really be any calls, and I’ll tool around Marin waiting to hear, yardsailing and buying plants, and being paid?

Not quite how it worked out. When I logged in, I already had 3 visits and a check call on the docket, and I knew there would be more. I took a long draught of my coffee and started reading up on the patients.

I got the check call out the way first. I talked to the patient’s wife, who told me they’d actually had a good night and no, they didn’t need a nurse visit. So far so good! Yardsailing, anyone?

My first visit was a fairly simple one for a tiny birdlike woman who sat so still and poised and dignified on her sofa. All she really wanted was a shower bench so she could safely take a shower. One had been promised, but it had not shown up. How hard could a shower bench be? But it was Saturday of a holiday weekend. I knew if I ordered it through the regular channels, it would arrive Tuesday, earliest. Thousand dollar specialty wheelchairs I can order, but a $50 plastic shower bench I have to get special approval for from a supervisor.

When I went down to my car, I noticed I’d parked in a Passenger Loading Zone. No ticket though: good omen. I also noticed I had left my wallet at home, and forgotten to pack breakfast or lunch: not so good omen. Luckily, my daughter was able to meet me with the wallet outside CVS on her way to the city. They have shower benches at CVS. When I swung by bird lady’s two hours later, I parked in the Passenger Loading Zone again, the only parking space for a mile around. I’m rushing a life-saving shower chair to a dying woman. So go ahead and give me a ticket, officer.

Between bird lady and the wallet pickup, there had been a visit to another severe agitation situation. I had heard about the case a lot, and the patient was on daily nurse visits to control symptoms. So I had some mild trepidation as I repeatedly lost my way trying to find his house.

To my huge relief, the patient was sleeping peacefully. I showed the sweet young caregiver how to administer the scheduled morphine in the side of his mouth without waking him up. She was uncomplaining and perennially cheerful, and her main goal was to understand and be able to pronounce the names of the meds she was giving. Using google translate, she painstakingly typed out each medication I spelled and pronounced for her, and I watched in fascination as google dutifully translated it into the characters of her native language.

As I left the house, she called after me excitedly offering candy. You’re so nice! She kept repeating. Have some candy! We have candy here! I drove away thinking about how caregivers like her are the unsung heroes in our midst. Then I got lost trying to find my next patient.

I even got lost leaving this patient’s house, much as I had got lost trying to find it, only in reverse. At this point, the merits of working a mandatory Saturday after a full week, if there were any, were becoming really dim to me. As I turned onto yet another cul-de-sac trying to find the main road, I yelled I HATE working Saturdays! It really helps me in moments of excessive frustration to yell in my car. There may even have been an expletive in there. After all, it’s a safe space and nobody can hear me. Unless of course it’s a hot Saturday in September and all my windows are down...

They loaded me up with a final late visit. This house I found easily, but parking proved very tricky. I tried to get the jag up their impossibly steep driveway but just spun my tires, creating a burning rubber odor entirely incompatible with a dignified hospice nurse arrival. Finally I parked behind a neighbor’s truck and hoped they would not need to leave while I was inside. 

When I left, the patient’s wife, clearly suspicious of my driving abilities, gave me extensive advice of the best way to get out of my parking spot. On no account was I to make too sharp of a turn and hit their wall. I reassured her that I was used to getting the jag out of tight spots.  Then I promptly made too sharp of a turn and hit her wall.

The wall fared better than the jag, but the minor scrape blends in nicely with all the other minor scrapes. And the little burst of adrenaline was just enough to get me home. 

Hospice Nurse Goes Deerproof Plant Shopping

I have a new patient who happens to be staying in a house very close to where I live. When I drive out in the morning, I can actually see the window of the room where she lies, and I cannot help but think of her. This is one thing on a work day, when I am immersed in thinking about my patients anyway. But I have found it is quite a different thing on weekend days, when I am rolling out on my bike. Or in the early evening when I’m driving off to Fairfax Lumber to compulsively buy more deerproof plants for the deer to snack upon in my garden that night.

This has highlighted for me how I actually drive about the county of Marin in two very different frames of mind, and how the same world looks strangely like two entirely different worlds, depending on whether I’m at work or not. As a hospice nurse visiting patients where they live, I drive around the community all day from Monday to Friday. Evenings and weekends I drive around those same roads and neighborhoods but I feel that they are different.

Let me try to explain. When I am at work, as soon as I log in each morning at 8:30 and clip on my hospice badge, my world shrinks down to the worlds of my patients and their caregivers. I do see the rest of life as I drive around but it’s oddly irrelevant, almost as though I am viewing it through glass. I may stop at a local cafe to pick up a coffee, or drop quickly by the post-office, but if I’m in my work clothes, wearing my hospice nurse badge, and between patients, the world is sort of walled off from me and I feel that I cannot fully interact with it. My mind is busy with medication orders, concerns about a patient’s new symptoms, or the endless To Do list that comprises my day as a nurse. The time gets chewed up at a very constant and much faster pace than on a weekend day when I might meander from thing to thing with no rigid agenda.

Sometimes I take my daughter to the mall where, during the week, I often stop at a cafe between patient visits to chart. The mall looks distinctly different, depending on whether I’m at work or with Jessie shopping. It’s the same mall, clearly, but I’m engaging with it differently. At work, my focus is intense. The mall is really just a coffee delivery system, a place where I can sit in a booth and chart, make calls, and get med orders sent through. I barely notice the people around me, and two hours can go by like ten minutes as I try to get through the endless To Do list. Shopping there with Jessie on a Saturday, the pace of everything is slower. It’s like the mall, the people in it, the whole world has slowed down and opened out, because I’m not rushing to do thirty things in the next half hour, and because I can fully interact with everything that’s going on around me.

There has now been a blurring of the boundary between the world I’m actively engaged in (evenings, weekends) and that glassed-off-world feeling as I motor around the county as a hospice nurse. As I drove off to the gym after work this evening, I could not help glancing up at my patient’s window as I passed and wondering how she was, and how I will find her on my visit tomorrow. Did I order enough wound care supplies? How can we best support her friends as they care for her? And is she really on the best pain regimen going forward?

It’s fine for the boundary to be blurred, really. It’s not as though my boundaries are terribly strong to begin with. [Note to self: strengthen boundaries]. I check my work phone way too often nights and weekends when a patient is close to death. I sometimes take calls and answer emails after hours (strictly discouraged, you did not hear it from me). But the proximity of this patient to my home has made me realize the odd parallel existence of my two worlds and how I move between them almost without noticing. Now I’m noticing. And honestly, when I’m driving away from my house at 5:50pm on a Wednesday, I don’t want to be thinking about wound care supplies. I just want to be focussing on how Fairfax Lumber is closing soon and I only have 10 minutes to buy more deerproof plants for the deer to snack on.