Who Needs Bumble When You Have Weddings?

I’m going to a wedding today. Aside from my delight that this is the joining in matrimony of two lovely friends who met on their first day at hospice, I figure that weddings are traditionally a venue at which people besides the bride and groom find happiness. I mean, how many times have you asked a couple how they met and heard the answer at a wedding? Yeah. Me neither. Maybe it’s an urban legend.

Still, I’m feeling optimistic. Weddings are such cheery occasions and after going to see A Star is Born last night, at the end of a long week nursing the dying, I am well ready for some cheery.

I asked Ben, the groom (whose name I have changed to protect the innocent) if there were likely to be any single men in their 50s at his wedding. Preferably single men in their 50s who were not alcoholic, mentally ill, homeless, or addicted to banned substances. Any other criteria? Ben asked, looking concerned. Kind, funny, sweet? I said hopefully. Ben thought for a moment. No, he said. 

I’m still going to his wedding. Maybe he doesn’t actually know all his guests? Maybe his fiancee invited people he has never met? Maybe some random sweet, funny, kind, single guy in his 50s will wander in off the street, not realizing this is a wedding he’s not invited to, and everyone will instantly love him so much he will be invited to stay? And he’ll ask me to dance?

Damn. Just remembered: I’m a really crap dancer. Still, there’s always champagne toasts. Plus champagne actually makes me a better dancer. Eventually.

It’s a long time since I went to a wedding. I can only dimly remember that the last one was an extremely painful affair. Not for the bride and groom, they seemed to really enjoy it. But for me: because everyone’s wedding is all about me, and because I had recently left my marriage. I mean my first marriage. (This was a long time ago, does nobody get married any more, or do they just not invite me?) Anyway, I was in that raw, dazed, stare-straight-ahead-to-avoid-crying phase of the breakup and yet I felt it would be churlish of me to turn down the kind invitation to my coworker’s wedding just because I myself was deep in the fog of divorce. I mean how long can a wedding be? I reasoned. The ceremony is usually less than an hour, and then there’s great food, wine, and dancing. I can do this!

Sadly, I had not taken into account that the bride and groom were Hindu and Jewish, respectively. Jewish weddings, I know, can go long. There’s all the glass smashing stuff and the chuppah and the walking round the groom seven hundred times. Hindu weddings I knew nothing about. But I learned about them that day. The principal thing to know about a Hindu wedding is that if you think a Jewish wedding goes long, you have clearly never been to a Hindu one.

The wedding was at a fancy yacht club in San Francisco. It was a stunning day in the city, right on the water there. About two hours into the wedding ceremony, the Jewish part was still going  and my strength was beginning to fail. Deep into the third hour, when we switched over to the Hindu part and the bride and groom were promising through a weird sheet thing that they would love and honor one another for the rest of time, I went outside for some air. I stood there looking out over San Francisco Bay and all the fancy yachts and sobbing quietly. I really didn’t want anyone to see, in case they thought I was in love with the groom or something, but those sobs were coming from a deep place and they were hard to conceal. 

Happily, the ceremony only took about another two hours and then there was the fun part, by which time I was so dehydrated from crying that all I could do was gulp quantities of water, which made me need to pee a lot. Like I said, a fun day for all.

This one’s going to be much better. My friends kindly left two years between the end of my marriage (the second one, count ‘em) and the start of theirs. I am an emotional amazonian woman now. If I cry (if, ha!) they will be tears of sympathetic joy. And even if I’m the only single person at the event (please, no) I will bravely dance alone. I may be fuelled with a flute or two of bubbly, but that’s because I have no aptitude for dance and am not really one of those folks who love to look ridiculous in a crowd.

As for my friends, I wish them a long and radiant life together. But if their wedding ceremony goes more than an hour, I’m going to have to ask them to just stop now and cut to the fun stuff.

Hospice Nurse Contemplates Mysteries of Human Heart

Really this blog post could be just one giant question mark, because no matter how long or often I contemplate this mystery, it never seems to get less opaque and unsolvable to me.

In a previous blog post, my dog gave me some advice on a matter of the heart. He even followed up a few days later, enquiring solicitously about my progress. I think he fancies himself as an undersized fluffy off-white therapist now. The thing is, his advice is sound and he’s almost always right. This makes me a little crazy.

We were driving up Pine Mountain to go for a hike and I told him I had thrown down the gauntlet, after my fashion. Buddy asked me to explain.

That was your gauntlet? He said when I had finished. That doesn’t sound like a gauntlet to me.

It’s a metaphor, I said. It means -

I know what it means, Buddy said patiently. But a gauntlet? You throw it down in front of the other person. You say, here’s my challenge! What do you think of it? In relationship terms, that would mean you said hey, I really want to hang out with you for a variety of reasons, principal among them being that I like you. Do you feel the same way about me? Or are we just going to pretend this is some vague getting together of friends for a bland mutually enjoyable activity?

There was silence in the car. I looked defensively ahead, quietly wishing I was just going for a solo drive, without ever having offered to take my stupid dog for a walk. Bland mutually enjoyable activity? Who did he think he was anyway?

But of course, he was right. My gauntlet was still lying in the dust somewhere, having been completely missed by the person I thought I had quite obviously thrown it down before. We had engaged in a mutually enjoyable activity and gone our separate ways. I wanted my gauntlet back! Buddy suggested we drive out there and retrieve it after our hike and some treats and snacks and a nap. 

It’s okay, I said. It really is just a metaphor. And anyway, it failed in its objective. Which is fine. I mean, it wasn’t like the whole thing was...I trailed off.

More of a big deal than anyone could imagine? Buddy finished gently. He even reached down onto the floor of my car and came back up with a tissue stuck to his wet nose from the box I store there for emergency crying events.

Oh PLEASE, I said, laughing in spite of myself. How did you even...That’s just weird. But yes. What you said.

Buddy nodded. Or maybe he was just trying to get the wet tissue off his nose. Then he sort of sneezed a couple of times, which confirmed to me that the tissue thing had been a mistake for him. I reached over and detached the tissue.

Thank you, he said. So it didn’t really work. The gauntlet.

No, I said. And that is because it is not really meant to be. So can we just focus on our hike and the snacks and nap thing?

Buddy looked contemplatively out the windshield at the road ahead. 

You’re an optimist, right? 

Hopeless.

So nothing’s ever over till it’s really over? 

Where are you going with this, small white rescue dog of mine?

He did that thing fluffy dogs do where they bite their own paws, suddenly and savagely, as though they have just been attacked by killer bees. Then he resumed his contemplative stare ahead, as though nothing had happened. I don’t think you should give up, he said.

There was a heavy silence in the car. We had reached the pullout at the fifth of the Seven Sisters, and I had cut the engine. The sun was hanging low and pendulous over the ocean, spreading its heavy purplish-orange wash of colors across the sky and throwing the land into a relief of dark greens and black. It was dusk, and the possibilities of life and love and time, you could almost reach out and touch them in the light that was fading over the ocean. You could almost watch your dreams slipping down into the horizon in a last flash of green.

Don’t give up, Buddy repeated, so quietly I wasn’t sure I even heard him right. 

I reached into the back seat for his leash and harness. The minimalist tail wag he had been doing turned into a full body wag. He had to go stick his head out the car window he was so temporarily insane with happiness. We were going hiking! It was this lust for life, this innocent joie de vivre that somehow made me trust him all the more on the advice about my non-starter love life. I mean, if you can’t rely on your rescue mutt for direction, then where can you turn? I slipped his harness on, but I didn’t make him go on leash. We headed out through the tall dry sage-smelling grasses and a million burrs instantly got stuck to his fur and he looked back at me with his silly-happy dog grin and I realized that yes, my 17-pound rescue mutt was right. Until it was clear that all hope was undeniably and irretrievably lost, there was no way I should be giving up on the possibility of love.

Hospice Nurse Steps Out of the Room

On June 9th, 2016, California governor Jerry Brown signed into law the End Of Life Options Act, making California the fifth state to enact aid-in-dying legislation. The date is burned into my mind because it directly and significantly changed my work as a hospice nurse.

I have now had three patients who qualified for the law and went as far as getting the medications into their home. Two of these ingested them, and I have been present at a third patient’s death who was not my patient, but whose death I attended because the nurse case manager was unable to.

The law is complex and contains many safeguards to prevent abuse or coercion. A patient must know about the law and mention it to me for me to be able to discuss it with them. No matter how often someone tells me they are done with living and wish they could just die, I cannot bring it up with them. Unless they ask me about “that law,” my hands are tied. This has created numerous painful situations for me, as you can imagine.

They must also meet three criteria: they must have a 6-month prognosis (this is also a hospice prognosis); they must be of sound enough mind to convince two separate doctors two weeks apart that they understand that the medications will end their life and that they want to ingest them; and they must be able to swallow the medications. A family member can hold the cup, but the patient must be able to drink or suck through a straw. A patient who has a neurodegenerative disease and has lost the use of her hands is still eligible. However, this raises the difficult issue of which family member or friend will hold the cup from which she drinks.

When you come down to the fine details like that, you realize the full force of what this law implies. Anyone who is considered within six months of death due to a terminal illness can now take their death into their own hands and legally ingest a lethal dose of medication that ends their life within minutes to hours. Nobody needs to know. The coroner is not notified after the death and the police are not called, as they are for a suicide. This is legal death by lethal ingestion and for a patient on hospice, their death certificate lists their hospice diagnosis as the cause of death, not the lethal ingestion of medication. The email that the nurse attending the death sends out states just that the patient died, not how. That they availed of the EOLOA is documented in their chart, but you would have to be on the patient’s team to know it.

I cannot tell in any detail the stories of my patients who took the aid-in-dying meds due to the HIPAA privacy law. In some ways, this is a shame, because they are by far the most memorable deaths I have attended in all my time at hospice. However, HIPAA is law for a reason: privacy is paramount. 

But I can talk about how the law has affected me as a hospice nurse.

All death is profound. I confess I overuse that word because I just can’t find another in the language that covers it. But the aid-in-dying deaths are profound in a whole different way. When you watch someone die of natural causes, or their disease process, you watch their life ebb away often over long hours or days. The person may be surrounded by their loved ones when they die, or they may be alone. It’s kind of hard to orchestrate either way. And no matter how many times family members ask me the million dollar question, the exact hour and minute of their death is impossible to predict. 

When you watch someone die after the intentional ingestion of a lethal dose of seconal, you witness an act that is the culmination of a mindful, well thought out process. When I have attended these deaths, I have watched human beings who chose the time, place, and manner of their death with full awareness and with a dignity that you would have to behold to fully appreciate. Humbling. Inspiring. Indelibly memorable. 

I still carry with me the memory of making eye contact with a patient who ingested, right after she took the meds. I was outside her room. As hospice nurse, I have to step outside while the patient is actually ingesting. This is for my protection, to avoid any accusation later by family of coercion. In this case, my patient took the meds and immediately after, wanted to see me. A family member opened the door and she and I maintained steady eye contact as the meds began to work and she lived out the last minutes of her life. Eventually her eyes closed, she slipped into a coma, and I went back in her room and stayed with her and her family until she died. 

Over the months I had been her nurse, we had developed a close bond. She was not very symptomatic with her disease, so my visits were often more like long chats at her kitchen table. She shared her life story with me, as so many patients do. And she was curious about me. I was young enough to be her daughter. I had recently lost my mother and left my long marriage. These are the cases that can blur the boundaries of the nurse/patient relationship, but in this case, I never felt that our chats were anything but deeply beneficial to us both. She liked to give me advice, and my primary goal was to keep her comfortable and in her home until she died. When it came time for her to consider the EOLOA, I offered to be present with her when she ingested and she immediately accepted.

I knew it would be difficult to watch her take the meds, no matter how much I honored her for her unwavering resolve. As hospice nurse, I am not supposed to voice any opinion about someone’s decision to take the meds. I can educate and inform, but it would be intrusive of me to insert my own opinions in the matter: not my place to encourage or dissuade in any way. Nevertheless, she knew intuitively that I supported her fully in her decision and even though she would have done it regardless, I like to think that was a comfort to her.

After she died and I had stayed with her family for a while as they came to terms with what they had just witnessed, I went back to my office. I had been in touch with my team leader and the physician on call during the entire event. These days, we always send two people to ingestions, but back then, since I was the only team member my patient wanted involved in her case, I went alone. I felt strong and emotionally present throughout her ingestion, though I was anxious inside and had that feeling you have when you have prepared for something big for a long time and it’s happening right now. I felt able to support her family in their grief after she died. Then I drove back to my office and I fell apart.

Happily, I work with folks who, like me, know death intimately. But this was different, and the moment I saw my support team, it hit me with full force. A group of women sat with me in our conference room - my team leader, the doc, the head of social work - and I told them the story of the death, and I cried, and mourned my patient, and went over and over the difficult details of the event, and they listened with tons of compassion and they tried to get me to hydrate and to eat something. If I had had to go home alone, I think my grief would have been a lot more complex and would have lasted a lot longer.

As it was, I thought about my patient a lot more than I think about most patients after their death. When the anniversary of her death rolled around, I marked it - something I could not possibly do for every patient. I felt proud of her for taking ownership of her death, just as she had done for her life, and I celebrated that she had had the courage to follow her own wishes through to the end. There is a reason that the EOLOA is known in Oregon as the Death With Dignity Act.

As of today, there are six states that have legalized death with dignity acts. In January 2019, Hawaii will enact its 2018 law to become the seventh.

Parent of Teen Bangs Head Against Wall

I am the parent of a teen girl. She is seventeen. Ninety three point six percent of the time, this is by far the best thing about my life. The other six point four percent of the time I just want to bang my head against a brick wall because it would be more effective and productive than my efforts to parent her into the adult world.

Most of the time, despite the vast disparity in our ages and the depth of our life experience, my teen daughter operates on the assumption that she knows more than I do. In some ways, this is lamentably true. Anything to do with an iPhone, for example, makes me feel like a Brontosaurus. I try to figure out how the hell it all works, I really do. But any time I do something on my phone when she is watching, even if I have done it perfectly well a hundred times before, I just want to go outside and munch on leaves in tall trees, do what I actually know how to do without looking like an idiot.

Last night, on our way home from a night drive, we were discussing the inadequacies of my car. She was driving, and thus each time we got out of the car for something, I had to let her back in from the passenger seat because there is no outside handle on the driver’s door. There was also a bad smell coming from the engine, which I only noticed after we drove up a large hill. Usually I avoid large hills for precisely this reason. My car is twenty years old and its appetite for fossil fuels is insatiable. When I commented sadly about the bad smell, Jessie took the opportunity to point out the irony of my Love Your Mother bumper sticker with its picture of our planet. It should read Fuck the Earth, she said, laughing. Once again, she was right.

There is nobody like one’s teen for making keen observations about one’s shortcomings as a human being. The other day, while discussing food and things we like to eat, she mentioned to me how much she loved that her new boyfriend takes her out to eat a lot. Subtext, there’s never any food in our fridge. Okay, I admit I sometimes run out of milk, because she’s not home all the time and when she is, there’s no knowing whether or not she’s in a cereal-eating phase. Also, I don’t drink milk. So one third of the time there is fresh milk in the fridge. One third of the time there is sour milk in the fridge. And one third of the time there is no milk in the fridge. Occasionally, there is milk in the fridge that is so old it doesn’t actually pour out when you try to empty it down the sink. Has that ever happened in your house? See, life with me can be a really interesting science experiment!

She does have a point about the food thing though. I can cook a really great meal for a dinner party or Thanksgiving. But dinner every day? Not my forte. Why do people have to eat dinner every day anyway? Couldn’t it just be once or twice a week, and the rest of the time a cheese sandwich? Or old milk? When I am on my own, I sometimes have bread and butter for dinner and I do just fine. Wine is made of grapes, so as well as the carb and protein food groups I get my fruits in. This is an old joke, but I think it still works.

One of the best things about parenting my teen girl is that she opens me up to things I never did or had when I was a teen girl. Skin care products come to mind. Make-up. The other night we were at the mall, ostensibly to go shopping but in reality just to get free samples at See’s and Sapporo. It’s actually called Sephora, I just looked it up, but that will tell you how often I go to make-up stores. Sapporo is a Japanese beer. That will tell you something else about me, but it’s off topic. Jessie wanted to look at facial sparkle stuff and also to get a free sample of her favorite perfume, which the kind folk in Sephora will apparently decant for you into a tiny bottle, affording you about a month’s supply of perfume for free which would cost you $140 if you wished to purchase it, not for free, as it were. How she knew this is one of the mysteries of parenting. I did not know this. How did she know this?

Anyway, we marched boldly into Sephora, trying to look as though we were intending to purchase some of their perfume for $140 but first wanted just a tiny sample to make sure. She is really good at this, I could tell she had done it before. I, on the other hand, was setting foot in Sephora for the first time and I was instantly frozen with a sort of fear of make-up. It is a specific fear that comes over me when I am expected to know anything about this most feminine of topics. I was raised in a household of Irish men. None of them wore make-up. When I was about forty, some girlfriends were at my house and we were all getting dressed up for a party. One girlfriend opened my bathroom cabinet. Where’s your make-up? She asked. There, I said, pointing to my sad little collection of eye shadow and my one eyeliner pencil. No really, she said, where is it? The conversation went on a bit longer than this, but you get the drift. 

Now we were in a make-up emporium. The salespeople wore earpieces, like they were on the floor of the stock exchange. Most of them were gay men, whose make-up was more spectacular than Lady Gaga’s. I glanced around me, deer in the headlights. A saleslady came up to us with her earpiece and her fabulous red sproingy hair. Jessie confidently asked where she could find glitter highlighter and the saleslady pointed us to it. I complimented her on her hair because really, I thought it looked amazing. While Jessie tried on some glitter, I caught sight of myself in a mirror. I’m generally reasonably happy with how I look, but in Sephora, well, I looked a bit scruffy. I tried on some glitter too. Scruffy, but glittering!

Jessie got what she came for from a sales guy decked out like Ziggy Stardust, only crisper, and we exited giggling to ourselves. I had made it through my first foray into Sephora. I didn’t really give a damn that I don’t know what 90% of the products are for. Hospice nurses can’t wear perfume anyway in case their patients are allergic or sensitive. So I have a watertight excuse for not knowing what Naked Skin Highlighting Fluid really is or does. Or why it is made by a company called Urban Decay. Isn’t that a bit body-in-a-dumpster for a skincare product?

Next stop was See’s. I know my way round a box of candy pretty well so I didn’t feel too scruffy in there. Then Jessie wanted to go to Urban Outfitters and Free People. When we try on clothes in stores together, we have a huge amount of fun. But if I try on something that doesn’t look good to her, she has a special way of saying mom, no. It is similar to the way she cocks her head to the side and says mom when I do or say something that I think is funny or cool but she does not. It’s just the one syllable, but it is packed with delightful inferences. Principal among them is that any time I want to go outside and extend my crazy long neck up into the trees, I should just go right ahead.  

I treated her to a pair of pants in Free People. Usually she pays for her own clothes, but she’d spent all her week’s earnings on gas and I was brimming over with joie de vivre. She was so happy and it made my mom heart expand to around five times its usual size. These parenting moments roll in now and then and it’s important to seize them. Childhood is brutally short. The teen years may seem endless, but they are not.

Then we went into The Gap and I tried on a leopardskin fur coat. I didn’t even really like it, but I have a weakness for fake fur and at one point I used to wear a lot of leopardskin. There were no mirrors around but you really don’t need a mirror when you have a seventeen year old daughter. Mom, no. I put it hastily back on the rack. Fake fur looks silly on dinosaurs anyway.

Hospice Nurse Lurks in the Staples Pen Section

We live in a stressful world. I have a stressful job: it is heavy and it takes a toll. Nevertheless, I try hard not to bang on and on about how stressful my job is because it really doesn’t solve anything. If I had a dollar for every time someone told me how stressed out they are, I’d have retired to a tropical island by now. Four dollars for this paragraph alone.

I have been observing lately the things people do to manage their stress, and it makes for quite the interesting study. To give just one example, and because I can only really speak for myself, I sometimes find myself pretending I need something at Staples, just so I can wander aimlessly for a little while in the pen section. There is something very soothing about the pen section at Staples. For a start, there are pens of every style, color, and purpose. This is very pleasing to a writer. There are also copious quantities of stick-it notes. Stick-it notes are also soothing. Maybe they say To Do list, but there’s actually nothing on the list.

And there are random things in the pen section that catch my eye and make me wonder briefly whether I need them. I spotted a very attractive lockbox there the other day for $12.99. I caught myself thinking about possible reasons I could need a lockbox. Was there perhaps something I need to lock away from robbers? But they could just run off with my lockbox, so no to that. Maybe Jessie had something she would like to keep private from me? But she knows I never poke around her room. Plus she would just have to put something highly sensitive and private on her floor and it would almost immediately be covered in a thick layer of discarded clothing. I’m afraid to go in there, so no need for a lockbox for the daughter. Perhaps I had something I needed to lock away from her? At this point, I realized I had been staring at a thirteen dollar lockbox  for quite some time, so I moved on to erasers and pencil sharpeners.

Staples also has quite a wonderful section containing notebooks, planners, and paper products of all kinds. Anyone who knows me well knows that paper stores make me weak at the knees. It is difficult for me to pass by a Papyrus. I sometimes have to cross the road. When I was in Florence, pretty much feeling that I was in a perpetual state of bliss anyway just because I was in Florence, I came across a store full of Florentine paper. Hand-made, one-of a kind leatherbound books of the stuff. I spent a very long time in that store. Mealtimes came and went. I took some photos, so I can still go back there in my memory if I want to. I do want to, sometimes, when things like rotten supreme court confirmations go down. I want to very much.

The cleaning fluids section of Staples can also be a little bit soothing in a general sort of way. All those sponges that have never yet had to sponge up anything disgusting. All the products purporting to bring Freshness and Sparkle to your drab life. The thing about managing your stress, though, is that it always seems to be lurking there in the background ready to creep up on you again. So the cleaning fluids section is a bit of a crap shoot: if my house is really dirty, it just makes me feel guilty and inadequate. I start suspecting I don’t know the right cleaning products to buy like everyone else does. I have to move rapidly on to envelopes then. It’s hard to go wrong with envelopes.

The most important thing to remember about Staples is that you should never ever approach the cash desk there. I did that the other day. I only had three items, they weren’t even heavy enough to require a basket, and they cost me $103.64. Printer ink. It’s a mistake to even have a printer because, as everyone now knows but is powerless to do anything about, printers cost about thirty bucks but keeping them in ink requires a second mortgage. I was also buying myself a wireless keyboard for my iPad. This was a big treat and I have waited two years to get one. Still, it contributed handsomely to the tab. The third item I can’t even remember. Maybe it was a lockbox? The point is, when the cashier said the total and I glanced stricken at her computer screen, sure she must have made some mistake, all the benefit that the pens and the cleaning fluids and the envelopes had provided was instantly wiped out. Paper, email, or both for your receipt? the cashier asked. Why do there have to be menu items for my receipt? Why do I have to choose between three things just to get a reminder that I spent a lot of money? I thought of asking her to mail it to me registered mail, but I was too busy trying to calculate how much I had spent on printer ink since buying my printer.

Out in my car, I sat in the sun for a bit listening to music. Music is cheap and almost never fails to reduce my stress levels. And sitting in my car is good because I love my car even though nothing says cleaning products like its interior. I think I am done with Staples. Next time I need a lockbox I’m just going to order one online.

Hospice Nurse Falls Off Her Bike

I fell off my bike the other night. When I leave my house, I immediately hit a small hill. Usually I have prepared by putting my bike in low gear as I end my ride, so when I roll out on the next one, the hill is easy. That night for some reason my bike was in too high a gear. I was also really tired after a bad night’s sleep and a tough day at work. As I started out with no momentum, I realized I just didn’t have the strength to power up that small hill. And I was clipped in. So as I struggled to simultaneously shift gears and get some pedalling action going, I saw the bike slow down as though I were riding through molasses and, also in slow motion, I failed to clip out and fell off sideways onto the road.

Some good road rash and a banged up knee. And ouch, some wounded pride, even though nobody saw me. But also the shock of falling and that sense of time slowing as you watch the inevitable unfold and are powerless to prevent or reverse it. It’s sort of comical, and yet also deeply jarring.

It got me thinking about - what else? - the dying process. I know, that’s what my ride was supposed to be clearing from my mind. But there’s just no accounting for hospice nurses...

A friend in Ireland had sent me a link that day to a British palliative care doctor giving a talk on how we in the West have become so afraid of death, and how we need to reclaim the wisdom of it. Her core message was powerful and I wholly agreed with it. But in describing her experiences of people dying, I felt she really sugarcoated it. To hear her describe death, you would think all dying folk just start sleeping more, slip into a peaceful coma, maybe have a bit of rattly breathing, take “some medication”, and then slide off into the Great Beyond.

There is a pervasive myth in our society of ‘the peaceful death.’ Curiously, I have found that this myth is in some ways as pervasive within hospice as without. 

Everyone hopes for a peaceful death. As a hospice nurse, I feel the powerful draw to describe all deaths as peaceful. After all, what family member, absent from the deathbed of a loved one, wants to hear “well, they labored for three days to die and all the morphine in the world couldn’t really help them.”

When a patient dies on hospice, the nurse who attends the death sends out an email to the entire company of nearly 400 people announcing the patient’s name and basic details about the death: where it occurred, who was present. This is confidential information disseminated purely to prevent any team members from showing up unknowingly to care for a patient who just died.

It always amazes me what a high percentage of these emails contain the phrases “passed peacefully” or “expired peacefully.” The word “died” is rarely used, and usually “with family at the bedside” is appended. This latter is potentially a good thing. If true, it means the hospice nurse was able to do her job well, the death was expected, family were notified in time, and the dying person was surrounded by loved ones. Ideal death: check!

Sometimes, these terse emails tell a very different story. “No family present.” Or “Patient had no family or friends.” Or sometimes the brevity of the email speaks volumes to what the nurse is not saying.

I have been present at many, many peaceful deaths. I have also worked with very difficult, distressing deaths. Sometimes all the medication in the world cannot control the dying process so that those gathered at the bedside can feel confident their loved one is not suffering. Sometimes, the dying person looks or sounds like they are suffering but research and experience tell us it’s likely they are not - that they are in too deep of a coma state to feel or be aware of anything. But sometimes, it’s painfully clear to everyone that the dying person is partially or fully experiencing the labor to leave their bodies. It is hard work to come into this world and sometimes it is hard work to leave it.

I could write an entire book on the use of morphine for the dying. Suffice to say, it can be highly effective in the alleviation of three different symptoms of dying: pain, labored breathing, and excess secretions (the ‘death rattle,’ a term you will never hear a hospice worker use). This is why hospice doctors prescribe it and hospice nurses administer it so frequently, and sometimes in such high doses.

But in regards to the palliative care doctor’s sugarcoating of how people die, I just want to say this: every Wednesday afternoon, my hospice team holds their weekly meeting. Typically lasting 3-4 hours, it allows us among other things to process the deaths that happened during the previous week. Here, in the sanctity of our confidential windowless room (sort of like Las Vegas, only with fewer slot machines) we tell the stories of how our patients died. And regardless of the ‘passed peacefully’ wording of the time-of-death email, our stories tend towards the truth of how things actually went down. 

Whether we were present at the actual death, or soon after as the time-of-death nurse, or only spoke with family members on the phone the next day, we get to process how it was for this person to leave the world. And let me tell you, we dispense with the sugarcoating. After all, part of the goal is to process our emotions; also to figure out whether we could have done things better, and if so, how. If the patient had difficulty breathing at the end, were we able to get an appropriate morphine dose on board? Did it help? Were we able to educate the family adequately on what was happening? If there was terminal agitation, did we recognize it in a timely way? (This particular end of life symptom can masquerade as numerous other things and be difficult to diagnose.) Were we able to effectively treat it? Again, could we help the family understand what was happening to their loved one? Did we help augment the patient’s care system? Were there special needs at this death, lessons to be learned? How would we do it over? We laugh, we cry, we support each other and give team members lots of snaps where they are due. 

In short, when someone is dying, it can be a drawn-out process and for those sitting vigil, time can really slow down as they watch the inevitable unfold and are powerless to prevent or reverse it. Hey, sort of like falling off a bike! Except of course that I picked myself up and rode to the Alpine Dam and back by dinnertime. And by the time I got back I was much less absorbed with the dying process than I was with how to soothe road rash.

My Dog Advises on Unrequited Love

My dog is small, off-white, and fluffy, and he has a weepy eye. This makes him look the epitome of the sad rescue mutt, a role he has played to the hilt every day since we rescued him more than seven years ago and gave him a cosy loving forever home. Depending on when he was last groomed, he can also look like a hobo. And he is now a Dog of Divorce, and honestly he plays that too. Nevertheless, I have discovered that he gives excellent advice on love.

Now Buddy is an unassuming sort and would never dream of giving advice unsolicited. But once you ask, he has plenty to say. I discovered this on the way home from the grocery store yesterday. He had waited patiently in the car while I wandered around United Markets stocking up on essentials and daydreaming about the guy I like. 

When I got back into the car, Buddy climbed on my lap and looked up at me as though he really had something to say but didn’t quite know how to start. What do you think, I prompted him. Do you think he knows I like him? Buddy wagged his tail, thrilled that I had finally broached the subject he had been longing to address. 

Have you told him? he said politely, as I started the car. 

No I haven’t told him, I said impatiently. He looked at me, blinked a few times. Ok, I said contritely, I know, you are just trying to help. About a thousand times. I have told him about a thousand times. Buddy cocked his head at me. But only in my thoughts. What can I say, it’s been complicated.

I get it, he said understandingly. Honorable. But what about now?  

I don’t know, I went on as I steered out of the parking lot, I feel like I’ve reached out, like I’ve been really bugging him actually, really unsubtle. But maybe I haven’t. Maybe he has no idea. It’s just so tricky. I don’t want to humiliate myself. 

Why would you humiliate yourself by telling a guy you like him? Buddy said. When I like a girl, I just go right up to her and sniff her butt.

That’s wonderful news, I told him, but not very helpful to my cause. 

Explain to me, Buddy said, curling up in the passenger seat and looking at me intently, what would be so humiliating? If you tell him and he’s not interested, he’ll let you know, right? And you can just go find someone else to like. Or he might have no idea you like him, and it could be a nice surprise. Plus if you tell him, and he likes you too, you could go for walks together in the park! You could even...

Yes, I cut him off quickly, seeing where this was going. But what if I told him and he really wasn’t interested but he didn’t want to hurt my feelings, so he maybe asked me out, but it was all awkward and he really didn’t like me at all and I didn’t even end up liking him, and the whole thing was a mess? 

Huh? said Buddy, but I went on, warming to my subject. Or what if I told him I liked him but he wasn’t interested and then I had to interact with him going forward in the minor way we have to interact and it would be all horrendous and embarrassing? He might tell his friends how awkward the whole thing was. Because I’m recently divorced, you know, so probably a bit of a nut job. And then his friends would know, and even if I didn’t know they knew, and even though I don’t actually know any of his friends, I’d kind of suspect and it would be crushing.

Buddy was quiet. 

I’m new at this, remember, I went on. It’s been nearly twenty years since I was single. It’s frankly terrifying, the whole scene. And confusing. I mean, my entire life, I always let guys be the ones to approach me. But now I’m in this place where I feel that if I want something, I should reach out and try to make it happen. Why should guys have to do all the hard work? Plus time...there’s just generally less of it than there used to be. Are you asleep?

Nearly, he said. Dogs are so goddam honest it kills me. But I am also very confused. You humans, you make everything really complicated when it’s actually all quite simple.

Are we talking butts again? I said. He shook his head. In fact, he shook his whole body and stood up and turned around a couple of times, then settled back in exactly the same position. Let me get it straight, he said. You like this guy, and as far as I remember, you have for a while. But you have never told him, even now, when there is no apparent obstacle. You have reached out a couple of times in ways so innocuous and tentative that there is honestly no way he could reasonably suspect you like him. In fact, you don’t want him to suspect it. Even though you do like him. Because then you’d feel really vulnerable. Is that the gist?

Yes, I said humbly, secretly impressed that he knew words like innocuous and vulnerable.

What do you like about him? He asked.

His name, I said.

That’s it?  Said my dog, and he raised one eyebrow in that way dogs have, even though they don’t actually possess eyebrows.

No that’s not it,  I said impatiently. But this is complex and confidential information about my innermost feelings. And you’re my dog. So what about it: do you have any advice for me about unrequited love?

Buddy closed his eyes and snuggled his nose down into his paws in the way he does when he’s deeply ready to take a nap. I do, he said happily. Just tell him. It’s only three words, and they are all one syllable. I.Like.You. 

We drove the rest of the way home in silence. His nose twitched a couple of times and I had a suspicion what he was dreaming about. But as we turned onto my road, he said quietly: Also, it isn’t unrequited until he actually tells you he’s not interested.