Friday, December 25, 2015

The true meaning...

Christmas eve is always an interesting time at our house.  We eat soup and then get ready for the service.  After everyone is ready and dressed, we take the family picture.  It takes quite a while to get a decent picture and then we leave for church.

Christmas eve at our church is a great night.  I think this is our 24th year of sitting in a pew on Christmas eve.  It is a wonderful family tradition.

Last night, my mind was on my sweet patient that was close...the angels were coming and it was just a matter of when.  I had spent the day getting her family ready for the transition and helping them with the feelings that they were feeling and the ones to come.

We sat in the same place we always sit at church and watch the crowds come in.  The church was beautiful as always and I was feeling hopeful for the new year and tender for this family.  As the service continued and the songs were sung, I couldn't get my mind off of this family...wondering how she was doing, wondering if they were sitting with her holding her hand on this last christmas eve.  After communion, and the end of the service was near, I had decided that if I didn't hear from them, I was going to call them and check in.  The church had begun lighting the candles for the last song and I watched my candle flicker as they dimmed the lights.  I was listening to the multitude sing "Silent Night" and staring at the blue and yellow of my candle and thinking about how life is so difficult  and yet so good in so many ways.  Just as we started the second verse, I felt my pocket vibrate and knew.  I pulled my phone out of my pocket and saw that familiar number.  As the lights were low and the church sung...I walked into the office and called the number to hear what I knew had happened.  Through a voice muffled by tears, I heard the words, "Terry, she's gone."

As always, regardless of how ready you are, it feels like the world has shifted on it's axis and honestly, for this family...it has.

I arrived to find the windows open and the fire roaring.  The snow was gently falling and the peace in the house was deafening.  They were tired, relieved and so proud of how they cared for her and even as we did all the things we do after a person dies, they continued to feel comfort in the love they gave her.  The husband told me of sitting with her and being there holding her hand until she took her last quiet, peaceful breath.  He took comfort in her comfort and peaceful face and she slept and finally left this earth.  

After we had finished, we sat by the fire and talked.  We looked at pictures and they told me stories of this amazing lady.  It's so interesting to listen to the love of a family at this time and the things that meant so much to them and what they are going to miss.

It was after midnight when I finally left and I hugged them so hard that I thought they would break.  I was so proud of how they loved her, cared for her and spent every minute making her comfortable and know that she is and was very loved.  

I drove on the deserted, snow covered roads home with some instrumental Christmas music playing on the radio.  I thought of this week and the journey that I got to be a part of.  I shed a few tears as I thought of the future for this family and the pain that accompanies loss.  Then,  I thought of my family and hoped that they had opened that one present that we do on Christmas eve and that they had a nice time.  

I walked in the kitchen and the lights were on.  Then, I heard , "Mom, is that you?" and saw my boys walking up the stairs from the basement.  "We waited up for you just to make sure you were good, " they said, and sat and talked to me for about an hour.  I went to bed with a peaceful and full heart.  It had been a wonderfully holy and difficult Christmas eve.  It had also been a blessing and honor to be part of such a intimate and special time with this family.  And then, to come home to a family of my own who understands my work, honors it and cares for me.

Life is such a difficult, messy and heartbreaking  journey.  But, it's also such a rich and holy journey with such intense love and loss that it makes you want to cherish every moment there is.

Tonight, I say...love your loves, tell them so, kiss them and feel the softness of the kiss. Then you know that when you can do that, you have felt the true meaning of Christmas...and life. 

Merry Christmas,
We'll tawk tomorrow,
I love you,

Wednesday, December 23, 2015

The eve before the Eve...

Some days this job of mine makes me swallow hard and choke back emotion.  Today was one of those days.  Not because I can't do it anymore but because there are just some stories that hit so close to home that you can put yourself in the shoes of the person instead of staying the safe distance to walk with the family.

My day started with a visit to check on the family and comfort the patient...change the sheets, wash the patient up and make sure the medications are on target.  I spent a nice hour in her room making her comfortable and doing the things I love about nursing.  When I was finished, she had a peaceful look on her face and fell gently to sleep.

I called the family into the living room and made them sit down to talk.  I asked them if they had any questions and they began to ask. They asked the hard questions, and sat and listened to the answers without tears.  Finally, the question that I had been waiting for...why am I not crying anymore even though I know I should be?

That is a question that families will sometimes ask and sometimes they will feel too guilty to ask because they think they should be crying more. 

I asked them the story of the illness and what it was like for the last year while she navigated treatment.  They told me how she was diagnosed and she started the first treatment with good results.  "The tumor shrunk to half it's size" and they were flying high hoping for the best.  They moved on with life and began the new normal of someone living with cancer.  Three months later, the patient went in for a scan and the cancer was back...and the tears came.  They rallied and she had another  round of treatment and that was difficult but they were ready for the fight and stayed in it with her.  Sadly, when the scans were done, they showed a progression of the cancer as well.  The tears came again with the thought that they weren't winning the fight.  She did everything right and when an experimental chemo came along, she jumped in with full faith that this was going to be the thing that gave her more time with her family.  That treatment took a toll on her and it was clear to the family members that it wasn't working...and that's when the tears came at night on the pillows so as to be totally positive during the day.  And now, while we wait for the angels to come, the tears have run dry...and they feel guilty because as they care for her and watch her sleep, they are hollow.  

As they told me the story, my tears flowed...watching the pain of a family losing it's leader, caregiver and the one that kept the family humming.  We talked and talked...about how they are going through this now and feel numb but the tears will come.  I said," Don't go looking for the tears because they will find you" and I believe it.  Sometimes, it is a gift to be focused on the care and to be able to put all the emotion in your back pocket until it comes bursting out after the person has gone.  Sometimes, if you think too much about what you are going through, you wouldn't be able to finish strong.  The family listened intently and I think they heard me.  I also told them that this is "holy" time and that they were doing everything right.  She was clean, comfortable and in her own bed with her family by her side.  I told them to tell her everything they wanted to tell her even if she was told already...and to know she hears them.

When the visit was over, we all turned to the Christmas tree that was up in the living room with only lights on it and talked about Christmas past.  They aren't in the mood for Christmas and I can understand why.   I gave one more speech of the day and I meant it.  Christmas is a time that families gather and celebrate.  Families make it a point to be together and to try to cherish the time together.  That's what this family is doing...and doing it well.  They have been together through this for a year and now, when it would be easy to have someone else care for their loved one because they feel ill equipped, they are all in...loving her all the way out of here by being by her side and caring for her every need.  If that isn't a way to celebrate the love of family and what Christmas is about...nothing is.

So on the eve of Christmas eve, offer a prayer, good intentions or anyway you communicate to the universe for comfort for the folks that have hollow hearts from the pain of losing someone...and maybe, when the tears do come again, they can feel them and know that they did everything right to care for their loved ones and it gives them peace and comfort.

It's been quite a day...
Have a wonderful holiday season, Merry Christmas and Happy New Year!
We'll tawk tomorrow,
I love you all,

Thursday, December 3, 2015

I always thought he'd go first...

Yesterday I spent most of the day with couples.  Couples that have been together for a long time.  It is always a learning experience for me to watch as they negotiate this  time of life.  The time that when we are just "talking", we refer to it as "some day" but never think that the "some day" will come.

As I've written before, losing a partner...maybe the love of your life or a partner in crime is never easy.  Even when you are watching that partner change before your eyes due to treatment or pain or sadness due to the circumstances.  Yeah, I know when we are really close to the end, most folks pray for a quick, peaceful ending but not until the cold, hard reality hits .

I sat on the couch and leaned forward for the questions.  These are a set of questions I ask at every visit.  They become the basis for our  talks and the basis for the persons care.  Today, the questions went fast because the symptoms are under control.  "Hurting anywhere?" "No"..."Are you still taking the same medication dose that we switched you to last week?"  "Yeah"...and "that's taking care of the pain?"  and we go on from there.

My patient is comfortable and doing what she can to make each day it's best.  For some folks, they have to tell the story of treatment and how it went and what she felt during it again and again.  At this visit,  she tells me that she was blindsided by what she went through and was really surprised that the treatment didn't work.  When that conversation comes up, and it frequently does,  it's interesting to hear the caregivers take on it.  Seems to me that when a patient goes to hear the diagnosis and the treatment options, they hear only half of the information...the parts that talk about how this or that treatment is going to work and although there isn't a cure, they have a good chance.  The caregiver, on the other hand, frequently hears that there is no cure and the odds...the numbers that the doctor gives for the treatment chosen, aren't great.  For a lot of couples, it is the dance of love...letting the person make choices and trying to be a cheerleader although they know what they heard.

I notice that my patient got really quiet while the caregiver was telling the "odds" and "cure" story.  I watch her face as he talks of the ICU hospital trips, the symptoms and the loss of control.  After he is done talking about that stuff, I quietly ask her what she was thinking...not demanding an answer but wondering if she wants to talk.  To that question, she replies, " I always thought he'd go first".  A quiet settled on the room and the caregiver agreed after wiping tears from his eyes.  "Yeah" he said," we talked about it and the numbers shake out that the husband outlives the wife and she is left.  That's how we always planned things, money, wills, everything as we got older.  I thought she would be taking care of me."

For me, that is one of those moments when I swallow hard and turn my head.  I don't want them to see me cry because it is such a beautiful moment for a couple to see the deep devotion they have for each other...even if they never thought they had it.  I looked over at my patient and asked, "did you think he was going to take such good care of you" to which she replied, "no."  It wasn't a mean "no" or a "no" that had years of resentment tied to it.  It was a pure, sweet surprise that this man was going to do whatever it takes to make his wife of 45 years comfortable and know that she was loved and cherished.     

I looked across the room at the husband and told him how sometimes spouses cannot do this and  we figure out other ways to care for their loved ones.  He was surprised and said he may need help, but they weren't going anywhere.  They took comfort in being in their home, with the animals and the belongings that they have together over 45 years...the pictures of memories and love shared during their time together.  "I wouldn't have it any other way" he said and looked over at her.  They exchanged that knowing glance of a life weaved together for so many years that is changing. We talked more of the gift of being home and being together and being able to do whatever they want that day.  My patient was taking all of this in and watching her husband as he talked of the upcoming changes and his plans to make things easier for her.  I could see her eyes change to admire his thoughts and caring.  

When I finished and began to say goodbye, I reminded them of how lucky I was to be part of this journey.  I talked of things that happen during this time that are unexpected and comforting even though it is hard to see that.  The patient nodded her head and winked knowing what I meant.  That while time is short, this patient is going to be loved so well and so completely until it is not an option.  Then, this husband will rest in the knowledge that he did everything right to care for his partner of 45 years.  

When my heart gets tired and I wonder why I keep doing this kind of nursing, a day like this happens and makes it crystal clear.  We make plans every day on how things are going to go...and then they don't.  We have to change our plans mid-living and go from there, doing the best we can.  Thankfully, I get to see that every day.

So remember, plan well, hope for the best and when the plans change drastically...just love.

We'll tawk tomorrow,
I love you all,