Sunday, September 25, 2016

Life lessons...

I admitted him almost a year ago.  He was admitted into hospice because he didn't want to go to the hospital and something was going on that wasn't good.  The hospital didn't agree with him and every time he went in, he became confused and needed medications that didn't make him less confused.  He just wanted to stay home and let the chips fall where they may...

I knew it was going to be a long time before he left us and let his wife know.  This may be a long haul, I said, and as he gets sicker, things get harder.  She thought she understood but appreciated the information and wanted to do the best she could.  

We made it through two more birthdays and two more anniversaries...the 63rd and 64th.  It was clear last week that we had finally come to the crossroads of his life.  He was fading...

Throughout the last year, she would sit by his bedside and read to him or watch TV or a movie.  She would tuck him in at night and then sleep with an ear open to hear him "sing-song" her name.  The calling out singing her name came during the last few months when he really wanted her close...wanted to hear her voice and have her in the room.

Sometimes, when I showed up, he would call out for her and she would say, "he has been doing this all day and then when I go to him, he doesn't need anything."  I always thought to myself...he loves her so much after all of these years and just having her close by gives him comfort.

I would visit twice a week and fell in  love these two people.  We became attached and I was invited for multiple dinners, cups of coffee and birthdays and anniversaries.  If I said no, on my next visit would be the cake saved for me.  I know the boundaries became blurred but I was getting so much more from knowing and caring for them than I could give and isn't that what life is about?

Most visits, we talked about how thankful we were that he didn't have much pain and how sometimes he wouldn't sleep...how he called for her in the night.  I told her I thought he just wanted her close because she was his comfort.  I would often marvel that they were married for 60 + years  and ask her all the secrets.

As the year went on, my entrance into the house became predictable.  I would call out my standard, "hello, it's Terry the nurse" and walk into his room, gently say hello and kiss him on the forehead.  We would talk of what was new, if he was in pain and what his "girl" was doing.  One of the last times I saw him, I told him he looked "extra handsome" and he told me that he couldn't help it.  I agreed with him...he couldn't help it.

Their 64th wedding anniversary passed a few weeks ago.  I arrived to see him all dressed, with his hair slicked back and his "getting out of bed" clothes on.  I asked his wife what was up and she told me it was their 64th anniversary and they had friends coming over to have lunch.  I walked in singing, "Happy anniversary, baby" and he smiled.  While I was asking him the usual questions, she gently rubbed his forehead and bent down and gave him a kiss.  Then she jokingly asked him how many years they were married.  It took a long time for him to answer and then he said, "well...64." I was amazed and she beamed.

He dozed off after a while and I went to the kitchen table and she offered me coffee and asked me if I was in a rush.  I decided I wasn't and out came the wedding album.  I sat and looked at page after page of these two young and beautiful kids that started a life 64 years before.  She told me the stories of their courtship and the ups and downs and how they ended up here.  She had a sparkle in her eye that made her look like that girl in the picture again.

Early last week, as I said, he began to sleep much more and was losing his awareness.  The time, I tell families, " that they have one foot on earth and the other in heaven" and the end is getting closer. These times are when, as a nurse, I visit every day to make sure the family feels supported and strong as they watch their loved one fade.  It is a holy and tender time for the family.

On Wednesday, it was apparent.  He was quiet and comfortable but not responding.  His wife and I sat at the table with our coffee and talked.  We reviewed the plan and all the "nursey" things that I have to do to make sure things go smoothly.  

We sat quietly for a few minutes and I felt the tears well up in my eyes.  I began to tell her how honored I was to stand beside her as she took such good care of her husband.  I was thinking about how much I learned from her over this year about what an enduring love looks like and how to keep going when you're tired.  I watched her keep her grown family involved with letters and cards and visits and care for them too.  She was an amazing example of how to care for a loved one for the long haul.  She handed me a tissue and then took one for herself.  She thanked me for helping her think that she could care for him at home even when she was tired.  She thanked me for continuing to show up and when he didn't need care...spend time with her.  By the end of the visit, we were both feeling so lucky in this difficult and predictable time of life.

He died this weekend after "a long illness."  When I left late Friday afternoon, I told her it was going to be this weekend.  She sat close, held his hand and read to him.  She said she talked to him and thanked him for all the years and life they lived together.  She told him she wouldn't have picked anyone else.  Finally, as she sat, she said she noticed that his breathing had changed and wondered what was going on.  Then, she said, it was so quiet and he just didn't take another breath.  She watched him for a long time after to make sure what she thought was right and then thanked God that she had the privilege of being there and holding him close up until his last breath.

I arrived in the morning to coffee and muffins and breakfast for me.  She was so thankful for his quiet and peaceful passing as well as the intimacy of being with him alone like the beginning of their 64 years together.  It was heartbreaking and joyful at the same time.

I walked into the room and he was gone.  I placed my stethoscope on his chest, kissed his forehead, like I always did, and thanked him for letting me be a part his life.  I made the phone calls and sat with his wife.  I sat quietly while the world and her friends got news of his passing.  

I watched her tell the story with peace and comfort as she knew she did the very best for this man that she could. I reflected over our time together this last  year and hoped that I would  to be able to do the same thing for my husband should I be in the same position.  

64 years of marriage...of love.    From the stories of their life together, it was not an easy love all the time...but it was an enduring love that lasted through it all...and I got to learn and watch and that in the last year. 

So again, I am thankful to have been a part of an amazing journey of what is good, right and holy.  

We'll tawk tomorrow,
I love you all,

Sunday, August 21, 2016


I have been thinking about time, that we have 1440 minutes in the day but there are people who seem to have less time than others.  There is no such thing as less time than others in a day...although when I was raising kids, I felt like I had less than other folks.

So now, I think about time in a life.  I had less time with my mother and less time with my father in this life.  My sister had less time with her son and less time with her husband than she ever wanted.  So then, if you look time from that standpoint, some people have more time than others.

Whats the rub?  Well, we don't know who will have more and who will have less.  We just don't know who will leave earth too soon or who will leave earth well after they were ready to leave.  That's the rub.

That brings me to those who kinda know that time is running out.  I mean, in my brain, I think my time is running out because I am 52 and the years ahead are not guaranteed.  I think about when I was younger and thought that I had so many years ahead to do the things I wanted to do that I felt like it was okay to put it off.  But now, at 52....thinking about my mother leaving at 72 and my brother in law at 59...well then, time is becoming more precious.

I see it everyday in a different way.  I see my patients who have that dreaded diagnosis and have decided they are done with treatment or they have been told that there is no other treatment to have.  They have been given the ticking clock of life and they know time is running out.  

I care for two patient's that are very frank about what is going on.  Most visits, they tell me they are dying and just don't want to suffer.  I had the honor of sitting with one of my patient's for a couple of hours the other day.  Her husband needed to go to town but would not leave her alone.  I looked at my schedule and decided it would be fine to sit on her couch and visit for an extended time...to understand her better and to know how else I can help this family.  At first, we were quiet and watched the Olympics but then she started to talk.  "I know I'm dying, and I'm not afraid, really...." she said.  I just sat and waited..." I just don't want to suffer, is all.  I have pain now and it is okay but I just don't want to suffer."  After waiting what felt like 5 minutes, I asked her what suffering looked like to her...and she slowly answered.  " I don't want to be in bed awake with pain and trouble breathing...If I have to be in bed full time, I want to sleep and be comfortable." 

I agreed and told her that makes total sense to me.   Then I told her how I have witnessed death without suffering and told her exactly how we would keep her comfortable and how we would support her husband.  We finished our conversation and turned toward the Olympics again.  

Her husband called 10 times (no lie) to check on her.  He is her caregiver, her one and only and he will be beside her to the end.  He has put off all of his hopes and dreams, jobs and plans and will stay by her side.  When she got her diagnosis, they made the plan and have stuck with it.  

There are other situations that aren't so cut and dry.  Time is used up with work, caring for families, and doing the things they need to get done.  Or, the dying person feels like a burden and doesn't communicate how things are going.  I have been a spectator in situations like that too.

Jim tells me I have a warped perspective on life and living.  I look at death and think that for whomever is dying...it is "showtime" for the family.  This is it, no do-overs, no way to wish things were different and time is going to move forward and your mother is going to decline and die whether you are with her or finishing the big project on your job.  I remember telling my patient one day last month as she said told me her daughter just got this job that she really wanted and could not come to care for her, "  She is going to get tons of jobs, she's young but she only has one mother...."

Listen, I made a ton of mistakes in that area.  I was too busy while my mother went to chemo and radiation for lung cancer.  I wasn't there...I didn't rub her back while she was vomiting and I didn't get the chance to take her to lunch when she felt good.  I was there when she was dying in the living room, fairly unresponsive but comfortable.  But I wasn't there...I regret that so much you have no idea.  

I could claim that I had two little kids and a job, that they probably wouldn't give me off, that the kids would have been pulled out of preschool, that we didn't have the money...I could claim all of that because it was true.  But you know what, after almost 20 years, I wish I was there.  I do.  I wish I would have loaded up Christie and Mac and took them to Florida and sat on the couch and listened to her complain.  I wish I would have had her yell at my kids because that's what she did.  But again, as my kids used to say, "wishes are life what ifs and they don't happen."  

So you can't get back that time.  I can't and you can't.  But what we can do is look forward knowing that we can use the time we have better.  Learn from our mistakes and make sure that if  you claim that something means a lot to you...you are spending your precious time on that...

I didn't have the sense when I was 32 to know that I would be without both parents at 41 years old...that my kids would be without grandparents.  I do have the sense now to gently help my patients and families understand how lucky they have to be here together at advanced ages, and what an honor it is to be there for your parents when it is there time.  I tell them what an example of love and devotion it is for their kids to watch.  

We all get old, we all die...we all get 1440 minutes in the day.  Now, it is up to us to decide what is important and spend as much time on that because when all is said and done, we don't get do overs and we can wish things were different but often that is not helpful.

Think back to your kids and how they were little and how for most of us, they are big.  That is what is happening to our parents and to us and when it is my time...I can only hope my kids are hanging out by my hospital bed telling stories of the good family times while my morphine keeps me quiet and comfortable.  That is my wish...but I have time to at least do that for others right now with my time!

We'll tawk tomorrow,
I love you all,

Monday, August 15, 2016

The life of a Hospice Nurse...

I sat in her living room and we talked.  She had just woken up from a nap.  The medication for pain makes her sleepy at times.  I asked her if she still had pain and she said she did not.  I looked around the living room and took stock of the furniture...a floral covered couch, some older chairs and end tables and coffee tables from the 70's.  It reminded me of my mother and what our living room looked like.

I gazed at this woman who I have fallen in love with.  She is old and dying but at the same time, she is everything I want to be when I get old.  She fiercely loves her children and loved her husband before he passed away.  She is smart and worldly and kind...so kind.  She is a quick wit and she is very compassionate and most of all, understanding.  That is just the beginning of this woman that I have the honor of caring for as she leaves this world.

We talked about life and kids and getting ready.  She gently rubbed her cheek and talked about how hard it was on her to watch her children watch her decline... and how she wanted to spare them of that.  We talked of how hard life is and how blessed she has been to have the time she has had.  But, we agreed,  to stay and worry about pain and fatigue and to feel like you are not living this life...is no life at all.

We cried...because it is time to leave but it doesn't make leaving any easier.  Then we talked about how it does.  How in many ways she is ready to go...but in other ways she is not.

I left the house thinking about how lucky I am to be with her at this time and how I can make sure she is taken care of beautifully....as if she was my mother...

Then I got in my car, took a deep breath and went to the next house.

That is the job of a Hospice nurse....

I am so lucky to be able to be with this amazing woman at this time in her life.

We'll tawk tomorrow,
I love you all,

Sunday, June 26, 2016

A week or two in the life...

It' been an interesting last two weeks in this life.  If you  have a minute, I'd like to tell you about it...

Last week, we had the privilege to drive to Mexico and build a house.   I know you've heard this story before but this one is worth hearing.  Another perspective on life...

This trip was hot...probably 105 degrees daily and the sweat from manual labor made me a little gritchy.  As the week went on and the house was coming together, I noticed that the father of the family, while with us, wasn't helping.  That is an odd occurrence.  When we start building in Mexico, there is no shortage of help from the males in the family...they are helping and having a part in making the house "their" home.  This father was always helpful but for the most part, sat in the shade and watched.

Because I have been on a number of builds, I started to wonder if there was something going on.  The last day, after an amazing lunch they made for us served sitting under pop up tents with cold coca-cola with ice, I got my answer.

Jim, my husband, after lunch wandered over to the family and sat down.  In his best Spanglish, he began to talk to the family and I noticed they were laughing and very comfortable.  I pulled up a chair and joined them and began to try to communicate.  Jim walked away and I was left to sit with them.  The father, Jose', had lived in the US and could speak some english and I could fake a little spanish so we were golden.  After spending a few minutes making small talk, Olivia, Jose's wife, began to talk to Jose'.  Best I could understand, she asked him to tell me why he was so thankful for a new home.  Finally, he looked at her and smiled and began to talk to me.  

He spoke  English very slowly and at first, I thought it was because he was really struggling with the language.  As I looked closer, he was choking back tears.  Around Christmas, he wasn't feeling well and went to the emergency room.  After some rudimentary tests, they told him to go home and get his affairs together because he was going to die.   He was diagnosed with  Lymphoma and he had a week to months.  All he could think about was taking care of his family and that included somewhere for them to live.  At that time, and still today, they were living with his brother and his family in a small place.   While thankful for housing, it was still many family members in a really small place that wasn't his own.   As he thought about getting his affairs in order, he wanted to be able to leave them with a roof over their heads.

Then, upon hearing of his illness, a friend of the family suggested that they apply for a house through Casas por Cristo.  They applied and usually it takes a year to two to be approved for a home.  This family waited about 6 months and a house was to be built. 

Now this "home" that I refer to is small.  It is about 300sq feet, has a door with a lock, three windows, three light sockets, a concrete floor.  It translates into two bedrooms and a larger room to be whatever the family wants it to be.  There is no bathroom or kitchen or plumbing for that matter.  You get the picture, nothing fancy.

But to a family that has lived in places that are made of wood pallets and cardboard and some plastic to try to keep out rain...this is a palace.  And for a man who is looking at the end of his life with a wife and two teenagers with nowhere to live...this is a mansion. 

How would you feel if you were in need and a group of 15 whom you've never met showed up to help?   And would you be able to sit and watch these strangers with sweat dripping off of them everywhere build you a home and ask for nothing in return?  Could you just be thankful?  I am not sure I could but I hope that if I am ever in those shoes, I could accept the gift and be thankful.

Before we say goodbye, we dedicate the house to the family and we offer prayers and good wishes for them in their new home.  We pass the keys and hold them in our hands for a bright future.  Then after that, it's the family's turn.  As we stood, the story came out and we all were so thankful that we could help this family.   Needless to say, there wasn't a dry eye...

We drove 14 hours home on Saturday and it was difficult.  If you wanna know the truth, I hate the drive and I complained the whole time.  Actually, early in the build, I was named the "designated complainer" because I never shut my mouth!

Monday was a new day and it was time to get back to work.  Some of my patients had some issues while I was gone and I was happy to come back to the cool mountains and deal with them.

I have a couple that have been married for 65 years and celebrated while I was gone.  They had a party and all the family showed.  It was a joyous time.  

Sometimes, after a big holiday or celebration, folks who are dying decide it is okay to go and begin to decline.  This is what happened with this couple.  In the mean time, the husband was having some more issues with his health and staying on his feet.  He was starting to fall and needs to go to rehab.  The wheels were put in motion for that to happen and  Tuesday, it was going to be the conversation of the day...sending him to rehab for a tune up.

It was a beautiful day on Tuesday and we just had a hospital bed delivered to his wife.  She was quiet and comfortable and obviously declining.  He was sitting on the couch with his coffee reading a book.  It was very peaceful and honestly, lovely.

My job was to convince him that he needed to go to rehab and needed to get stronger and safer at home.  I sat next to him and held his hand and said nothing.  Frankly, I didn't know what to say and I thought I knew what he was going to say...

Finally, I started the conversation asking him how he felt and letting him know that we were all worried about him.  He looked me straight in the eye and asked me how his girl was doing and if this was "it".  I gently told him that I think her time is coming and it will be soon but not today.  I told him we were going to keep her very comfortable and that she would have no pain or anxiety as she slept.  He teared up and choked out a sob...then told me he wasn't going to rehab right now.  He had been with her 65 years and rehab could wait while he saw his girl off this earth.  Then, he got quiet and stroked my arm thanking me for understanding.  Needless to say, I teared up and accepted the thanks.

Yesterday, almost a week after we watched her begin her decline, she peacefully left this earth in the bed in the sunny living room surrounded by her husband of 65 years and her daughter.  She was quiet and comfortable and right where she needed to be and just how it needed to be.    When I arrived to take care of them, I sat with the husband and told him what a great job he did caring for her until the end.  He teared up again and choked back a sob and struggled to say, "I hope so...."  

We all make decisions in life and after they are made, we hope they are the right ones.  Sometimes we never know they are the right ones until years later and sometimes we know right away.  We have to just decide and then go with the flow.

One decision that I know is right 100% of the time is to love and serve others.  I know it's right because I never feel such peace in my heart as when I am in the middle of things like that.  Does that mean you have to drive 14 hours in the car and then endure the heat and try to speak spanish?  Nope...it means, look at your life and when you see a gap somewhere, fill it.  If it is stuffing envelopes for a cause you think alot of...do it.  If you grown child needs your help with your grandkids....do it.  Whatever you do is good, right and holy if it is out of a giving and loving heart...and I made the rule that you can even complain!!!

As we watch our world crumbling and people become more afraid of each other...the only thing that we can do that is easy...is to love and serve.

We'll tawk tomorrow,
I love you all,


Sunday, June 5, 2016

Life's work...

Thursday night as I watched a bunch of overpaid boys try to hit a baseball in front of a crowd of 32,000 people, I looked down at my phone to see a familiar phone number.  It was the number of the home that I had been calling frequently to check on as the person was dying.  I quickly ran up the stadium stairs and dialed the number knowing what the voice on the other end would say.  "He's gone..." which is what I expected...what we all expected.  In fact, it was what the family and I said we wanted over and over.   "He was so peaceful and we were all with him and we cannot thank you enough for all you did."   He was gone and all that was left to do were the phone calls.

I went by the house the next day to say hello and good bye.  They were sad and relieved and so proud of how they came together and cared for their dad, husband and brother when they would rather be doing anything else.  I reminded them of what an honor it was to help them do that and the comfort as time goes on will be immeasurable.

End of life...dying...leaving this world...whatever we want to refer to it as, is something that we think will happen someday but never think that "someday" will come.  Until it does.  Until you have a funky pain that you can't ignore anymore and go to the doctor.  Then all the things you thought about dying change when it is you or someone close to you.

The amazing thing about getting a diagnosis that isn't good, is you see where the "rubber meets the road" with the people you love.  I have the opportunity to see it every day and am humbled.  Even the most fragmented families come together to help a person they love move on.  They break down, they complain, they yell and scream at each other, but when the person is on the way out, they come together, sit by the bed and love each other.  Every time...

This death was a relief for the family in so many ways.  I always say to the family when they are ready to hear it...."you die the way you lived."    What that looks like is sometimes difficult for families.  If you were a difficult person in life, you are going to be a difficult person in death.  If you worked every day and never stopped and were strong as an ox, you will die that way...not easily, not able to relax and get comfortable without work.  Then the point comes when they rest and go on into the night after they are done with the hard work.

This gentleman from last week was like that.  He was a handsome man, unbelievably hard worker and desperately sad that he was leaving this world.  The cancer cells grew and took parts of him, but it did not take him.  When I met him three months ago, he was sad...about being diagnosed, about having to leave this earth and about not being able to finish all the work he had planned.  He ran from the moment his pain was under control until the moment he decided to lay down.  Then, he worked in his head for the time it took to get everything in order before he could leave.  His family stood by telling him they were ready, that they would take care of everything...and still, he needed to do the work.

Finally, last week, the work was done.  The family said they could see that he was finally done working and went to sit with him.  They said they didn't say much as they had already said it all when a tear escaped out of his eye and he peacefully drew his last breath.  He had done it all...the work of living and the work of dying.

I have heard the saying, " If you love what you do, you don't work a day in your life" and I believe for this man...that saying was true.  

I have been spending much time thinking about my work.  I came to the conclusion last week that I don't think of it as work.  I think of it as what I am "supposed" to do.  That it is my ministry, my calling that I was led to by the hand of God.  I know it sounds crazy.   

I remember my mother dying in the living room in a hospital bed in Florida those 20 years ago.  I remember sitting by her watching her breath quietly all day.  She was done and she had done all of her work.  There wasn't agitation or pain, just quiet peace as she breathed in and out.  We did the day...the surreal feeling you have when you are in the middle of something that you cannot control and wish was not happening.  We ate, we drank, we sat and watched TV and talked to her...almost like nothing was going on but we were about to watch our mother leave this earth.  I was 31 years old with a 3 and 1 year old.  Just starting out on some of my life's work.

Finally the day was over and we all went to bed, except for my sister, Chris...the oldest one.  She decided she would sit with my mother for a few more hours before she called it a night.  

A few hours later, my sister opened the door to the room I was sleeping in to tell me she thought my mother was gone and could I come check her.  I walked over to the bed in the living room and confirmed my sister's diagnosis.  My mother was gone... into the night when my sister dozed off to the peacefully rhythmic breathing while she held her hand.  Her work was done and she was gone...

We did what families do when a loved one passes away at home...we called the doctor and we called the mortuary.  They picked her up as the sun was coming up in Shady Hills, Florida.  I remember calling Jim after that and waking him up to tell him I no longer had a mother on earth.  I was sad, relieved and thinking it wasn't true...but it was.

I remember as I stood at the head of her hospital bed in the living room, I  looked into the kitchen, and around the room and saw my siblings.  My brother was reading the paper in his lazy boy, my sister was going in and out of the kitchen doing her "work", and my father was standing at the foot of the bed with his hands on my mother's  blanketed feet saying nothing.   I remember the overwhelming feeling of sadness mixed with comfort and then  I remember hearing a small voice in my head... "You oughta be doing this for people, it's nice to be home." 

I returned to Swedish and continued to work in the hospital all the while thinking of that small voice.  Then, I decided it was time to try hospice.  It was the right choice.  I ran away once and tried other nursing again but always feel the pull of my ministry and feel incomplete when I am not caring for the living and the dying.

This comes at a time when my children are trying to figure out their life's work.  My daughter, an engineer, is in Peru with the Peace Corp trying to understand hers.  I believe she will find what she is looking for.  My middle son is unemployed and will begin the search of what he wants to do while he tries to understand his life's work.  It's a difficult task.

So, my guess is, that when you have found your life's work, it isn't always perfect or easy but it is right.  It's what we know in our heart is right even when it feels so hard...and it is the joy our hearts desire when it is right.  

The question is then,  "what is our life's work and does that work change?"  For me, "am I to be a nurse for another 15 years or do I do something else?  Is it normal to be so "soul" tired at 52?"  

As my children begin their journey to figure out their life's work, I find myself wondering about mine...

Any advice, insight and answers are welcome...

We'll tawk tomorrow,
I love you all,

Saturday, May 28, 2016

The Seasons of Life...

I spent the day digging in the dirt.   My flower beds were covered in mulch that Jim had ground up after cutting down trees and placed over the flower beds to keep them warm through the long winter.

My favorite two beds are on my patio and they get tons of sun.  I had that patio done after my father passed away with the money he left us...so it is a place I love to go and to have people over and to have my flowers blooming.

As I dug the mulch out, I could see the little sprouts of the daisies and columbines and other things I planted but can't remember.   All I could do is rejoice that they are coming back.

It reminded me of the seasons of life...

Today marks the official beginning of "empty nesting" for Jim and I.  It's a long story with returning children and invited guests...but now, after Howie graduated in 2015 from high school, Jim and I are alone.

While I dug in the dirt, I thought of that...being alone...being done.  Now I know, most folks reading this will assure me that they will come back and probably live in my basement, to which I will be sorry.  I had one bounce back and after the shock of it all, I enjoyed it alot!

But, I digress.  I am thinking about the ends and beginnings...seasons of life.  As you all know, I care for the dying and see the seasons of life and end of life on a daily basis. 

The last few weeks have been a microcosm of life and death...sadness and celebration that is life.

Two Saturdays ago, I went to a funeral.  It wasn't the death of a patient of mine but of a dear friend.  It was the death of Uncle John.  Jim had a dear friend that passed away, after what they think was a diabetic problem.  He was 55 years old and one of Jim's greatest friends.  He was the guy that helped Jim when his mother passed away. After his mother's funeral,  Jim was sad, lost and needed a friend...and the phone rang and it was Uncle John.  He was at our wedding, around for our kids and just a crazy, wonderful Uncle figure to our kids.  I remember Christie playing with his hair, sitting on his lap, because he had grown a pony tail when she was 3.  He was a wonderful friend and uncle and now he is gone.

After the funeral, I drove to the airport to fly to Spokane to attend a wedding of a daughter of a dear friend.  I sat on the plane and thought about what a mess life is.  How one minute you're so sad you can't see straight and then next, you can be on top of the world with happiness.

The wedding was beautiful and the bride and groom were so obviously in love and I prayed that when the ups and downs of life come...they stay that way.  

I flew home Monday morning to a full schedule and work to be done.  

I have quite a few patients that are living well knowing that they are dying.  I stand in awe of them and the strength and love they give to their family while they are in this place.

 Fridays are my days to see all of my hospice patients or as my husband says, "tuck them in" for the weekend.  Yesterday was no different.

As I went from house to house, I felt confident that I was doing all I could do to make them comfortable and ready to enjoy the time with family.

I have one patient that is close.  She is not here on earth but is not gone either.  I always tell families that the patient is doing the work and when it is time, they will go.  I compare dying to birthing and how there is work to be done by a body to bring a life into this world and when someone is dying, there is work to be done to leave.

I walked in and the house was quiet.  This family has done everything right and cared for this patient well.  She is just not done with her work and so she is still here.  She isn't responsive but she is comfortable and quiet.  

I bent down to ask her the questions and she didn't respond.  I took her vital signs and touched her hands and feet and they were warm. Then, out of nowhere, I asked the family if I could give her a bath.  They responded that she had one yesterday but if I wanted to,  it was okay with them.

I gathered all the things for a bed bath, making sure that the water was nice and warm and the soap smelled good.   I began with her face and gently washed around her eyes and mouth with care.  I thought about all the kisses that were given with that mouth and how there may be more before she is gone.  I moved slowly to her arms and legs and  I washed and dried every finger on her hands, knowing her family will be sitting with her holding that hand until the end..  Then I moved to her  body, washing and then drying her gently all the while telling her that she was doing a wonderful job doing her work to leave this earth.  Then I rolled her over and washed her back, dried it and applied a lovely smelling lotion.  I thought about how long she has been lying there doing her work and how it must feel great to have her back rubbed.  While she was on her side, I asked the family for clean sheets.  I took the old sheets off and put cool, clean sheets on the bed.  I rolled her over, dressed her, brushed her teeth and rinsed with mouthwash and put new pillow cases on the pillows.  I took the covers, and pulled them up over her chest, held her hand and told her she was ready now.  I watched as her face relaxed and she fell quietly back to sleep and hopefully to a place of deep comfort.

I sat on the couch and talked to the family.  I reviewed the plan of care, encouraged them and told them she would leave when it was her time and I couldn't tell them when.  I just told them it would be over soon and that they were doing an amazing job.

I got in my car and backed out of the driveway.  It was around 4:00 on Friday and she really didn't need a bath.  But, I needed to give her one...I needed to provide more comfort for her and in turn for myself.  

You see, this job is hard and all the nurses have days when they think they can't do one more thing or their heart will break.  I think the last few weeks were like that for me.   Between awesome beginnings for my kids that took them to faraway places, the unexpected death of a wonderful friend,  patients that I have fallen in love with that struggle with life and death and the changes of growing older, I needed to offer comfort and enjoy the comfort I gave.  It was a holy time for me and for that I am thankful.

Why am I telling you about a bed bath that I gave a patient at the end of the day on Friday?  Because most of the time, the little things are so much more than that.  Because time goes by and I wish I would have spent more time doing things like that.  Because 27 years of marriage and raising kids and making a life has gone by in the blink of an eye.  Because you get a phone call of Friday night that makes you wish you would have called and checked in, or stopped by or treasured the last time because it was the last time but you didn't know it.  That's why...

Life is short and it is long...it is amazing and amazingly difficult and the little things matter.  You know why?  Because the little things are the big things...

We'll tawk tomorrow,
I love you all,

Monday, May 9, 2016

"Because I'm the Motha" (in a NY accent)

In my house, we tend to repeat things well beyond the time it is useful.   The problem is, we laugh about those repeated things again and again, so they become funny.  Two out of three of my children appreciate that and one does not.  He did leave for college and has a new appreciation for home and and has been mocking my NY accent, so he is coming around.

Since yesterday was Mother's day, this post is about kids growing up and leaving.  My last child left for college last September, but I had the good fortune of having my daughter move home.  Now those of you who I talked to every day, probably won't see it that way and I must admit, I rode her hard and I was out of line.  That child was sure of her dreams and goals and I had no patience as she was "masters prepared engineer" and needed to get a job in an engineering firm and start her life.  The link below will lead you to her blog and if you take a minute to understand her...you will agree, I was out of line.  


At the time, I was doing what I thought was right because that's what I did.  I got a job right out of college, looked for a husband that would be an awesome father and wanted to start my life.  I didn't put a whole lot of thought into caring for people...I mean, I was a nurse and wasn't that enough?  I thought so.

March 4th, 1992, my daughter came into the world after I thought I knew exactly the right way to live my life and how I would raise her.  Funny thing is, she raised me.  She was a miracle to behold and like I have said in other musings, she changed me...my life plan...and who I wanted to be.  I wanted to be someone that this kid looked up to and I wanted to make sure that she knew she could do anything she wanted and that she was loved.  Jim and I would eat dinner with her in her "bouncy" seat and marvel at the miracle that our genes had created.  Not because she was the perfect child (although we thought she was) but because we had this human being to raise. 

As time went on, I decided that there was nothing more important to me than being a mother.  I had my second child on a Friday the 13th in May with my dear college friend and Jim coaching me on.  I brought him home and the first thing my oldest did was ask to "pet" him.  True to form, she became his mentor, the person who told him what to do and how to do it and his biggest fan.   While I was exhausted with two little ones, I was over the moon that I had the privilege of being their mother.

The last one came out of nowhere.  My mother passed away in February of 1996, I was 31 years old and next thing I knew, another one was on the way. ( I guess you call that being comforted!)  Because he was a "surprise" if there is really such a thing, I didn't get ready for a baby until a week or two before he was due.  Maybe, I thought, if I didn't get ready, I wouldn't have 3 kids under 5.  

Thanksgiving came and went and old Howie, didn't show.  I even had my father in law and sister in law staying with us to watch the other two because it was getting close.  He came on a Sunday morning after church in a hurry and was a strapping 10 pound dude.  He completed our family and I stayed home with him while Jim took the two other little ones to cut down our christmas tree.  In my mind, there was nothing better than three little ones at christmas time.

But, now, 20 years later, there is.  To watch my oldest live her life volunteering for the Peace Corps in Peru and dreaming big...not big with stuff but big with helping people is a dream come true for me. 

For my middle guy teaching in an inner city school trying to help 6th graders with math and coaching baseball...just hanging with the fellas hoping to make a difference by loving kids makes me loud and proud.

For the "surprise" child, he watched quietly and took in the life decisions the other two made and began to make his own.  This summer, this guy will spend it in service for the whole summer in Juarez, Mexico building houses.


So I send them off...All with plans that are so different than mine. They have plans to serve, to love and to try to make the world a better place with kindness and service. They humble me and force me to be a better person.

Yesterday was Mother's day and I spent it with my boys.  We hiked and talked about when they were little.  They remember the things I did right and all the things I did wrong.  But, they still made time to hang out with their "motha".  I cannot tell you how lucky I feel.  
As we sat at the brewery, (I picked that for dinner because I'm the Motha), and watched them banter about memories and listen to them gush about how proud they are of their sister...I could not have asked for a nicer mother's day.  You see,  they have taught me more than I can convey and they have given more joy than any one person deserves.  And most of all, when I ask them to do something and they ask me why...and I reply, "Because I'm the Motha" they laugh and do what I ask!

We'll tawk tomorrow,
I love you all,

Saturday, April 30, 2016

When it's time to leave...

I'm sitting here this morning drinking my coffee, looking out the window.  It's cold and dreary with another round of spring snow.  The sky is gray and low and honestly, the whole scene matches how my heart is feeling.

I have spent the week talking about leaving.   Leaving town, leaving this earth, leaving families and friends, leaving pets.  It's been exhausting and sad and I often wonder why life has to be this hard.

I have a few patients that I have fallen in love with after having no intention of doing that.  When the new year came, I had a talk with myself about becoming more "professional" and keeping my "boundaries" intact at all costs.  Stop falling in love and just nurse...

After this week, I can tell you I have failed miserably and it is coming time to pay the piper.  I have a few patients that are getting close to leaving this earth.  They are prepared to go and are just sad.  I am just sad right along with them...

One of my folks came to me with a to do list that had to be completed.  It was not my idea of a to do list of someone who  was dying but of someone who was getting ready to move out of a house.  Twice a week, I would call and plan a visit and I would get the report, " I got most of my room cleaned out and organized, took a load to the dump and a load to donate.  It has been a fantastic day."  Often I would hang up and laugh and tell myself that I need to talk to her because this is no way to die...She needs to slow down, hang with family and get ready.  But on my weekly visits, she was full of joy and talked like a teenager at how she was getting organized.  We didn't talk directly about her dying or getting ready to leave, but it was an unspoken conversation that would be had at another time.

Well, "another time" has come.   She is organized and if you were to do a moving timeline, the movers are ready to come and get her stuff.  She knows that it's now time for family.  Her family arrives on Monday for a visit.  We didn't talk about that on her "to-do" list because I suspect that would come when it was getting really close to leave.  After catching up,  I did my "nurse" stuff and began to talk about what I found...and she agreed.  She looked at me with her sparkling blue eyes...and said, "I know it's growing but I'm still hoping for a miracle" and after the lump cleared my throat, I responded, "Me, too."   We sat for a time in silence, holding hands with tears running down our faces...knowing she is leaving soon and that the time has come.

I finished my visit wishing her a great weekend and to call me because I was going to be around and bent down to hug her.  She kissed me on the cheek and told me she loved me.  I responded in kind.   Then I walked out the door, wiped my eyes and stuffed all the sadness deep down in the bottom of my heart and drove to the next patient.

The next visit was very different but similar.    I knocked on the door and walked in with my usual, "hello, it's Terry, the nurse" when I could feel the sadness of the house envelope me. The kitchen was empty and the caregiver came out and informed me that it had been a sad morning.  I walked into the  room to find my patient holding hands with his wife, looking at her with his mouth open sobbing.  Occasionally he would take a breath and let out a moan.  She turned to me and told me he has been doing this more in the last few days and he is just very sad.  

He has been ill for a very long time and was told 9 months ago that he would be gone in 3 to 6 months.  He blew by those dates and continued to sit at the table and have meals, be read to by his wife, visited by his sons and grandchildren and did life.  We didn't talk much about his leaving because he was doing so well. But, in the last few weeks, something has changed.  He knows his time is closer and he is just sad.   

When I took her place to check on him and asked him what was wrong...pain somewhere, etc...he sobbed his wife's name.  Then I told him that I know he loves her and that she will be okay and we will take care of her...he sobbed even harder.

His wife and I left him and sat at the kitchen table, trying to figure out how to get through this time.  She wondered if there was anything more she could do to help.   I explained that he is doing "the work" of leaving and some people just become very sad. I told her the thing to do is sit with him in it...cry with him, love him and let him get there.  While it's really hard and heart breaking, being in it with him is the only thing left to do once the physical stuff is taken care of.  We talked about how she can't change the situation but she can be with him in it, either in silence or with conversation.  

I sat for a while at the table wondering if I had told her the right thing...is there some other way to take all this pain away?  I came to the conclusion there is not.  I told her that he was so lucky to have her and that she was doing everything right and that he just doesn't want to leave her.  Although it is becoming his time and she is prepared, he just wants to stay.  She teared up because she is so tired...tired of wondering when the time will come, staying up nights holding hands and reading and feeding and thinking...all the things that are loving and right and holy and comforting to do when your husband is dying.

I pulled out on the street and thought of myself and my daughter leaving.  Granted, she's in Peru and she signed up to serve in the Peace Corps, but honestly, even leaving for a little while makes your heart ache.

Life is so hard...and so amazing...and then so heartbreaking again. You get a diagnosis, you care for a loved one, you sign a paper that closes out the marriage that you planned on lasting forever, you take a child to college,  or God forbid, you bury one...

For my patients, they know it is time for them to leave.  They both know that  they are going to a "better" place.  They know it's a place  where they are not hurting anymore, or feeling nausea all the time unless they take a pill...but sometimes even knowing that and knowing it's time, they  don't want to leave.   That's the hard part and the part that sits in the  heart and stirs the soul forever.  

So leaving is hard...because usually we love the people that leave. But love is a gift...and the experiences that come with love are the gifts...the things that keep us afloat in this life. 

So the wish for today:
May we love so hard that when it's time to leave...however that is, we recognize the blessing that we experienced and use those memories to heal our broken hearts.

We'll tawk tomorrow,
I love you all, 

Sunday, March 27, 2016

The wall...and I'm not talking Pink Floyd

As we left the US, things seemed as they always do...
Then, when you look to the right, you see the wall separating the US and Mexico...the wall that separates us.

As I turned from the wall to the neighborhood that we were driving in, it was obvious that what separates us is much more...

We have more and they have less.  I guess that is a simple statement and honestly when you pick it apart, it is not simple at all.  We have more stuff, more money, more food, more conveniences, more doors and windows to shield us from the cold.  We have more medical care, more cars that run and more electricity.  So, yes...we have more.  They have less...of all the things I mentioned.

But, do they really have less?  Sometimes I wonder.

Every year, I head across the border to build a house.  But, in my mind, I head across for other reasons...all having to do with what I want.  This year, I went because I wanted to hang with  my college boy and I knew that if I was there, he would have to talk to  me.  I had no plans of connecting with families or seeing anything I haven't seen before.  You see, I have been doing this since 1999 and know it all...

On Sunday, Jim and Howie and I went an scouted the site.  It was in Anapra and is built on a land fill...a dump.  The roads are cut through mounds of garbage and the smell is pungent.  If you look down, you can see garbage...diapers and feminine napkins, tiles, glass and things that were thrown out.  They have lost the sharp edges from people walking on the objects although if you listen when you walk...you can hear the crunch.

The site was right next to the home that some of the family lived already.  They wanted it built close, so they could add on and be together.    As we walked up, you could see they were not sure if it was true.  These three gringos were coming to figure out how to give us a house?  Jim smiled and used his limited spanish to assure them that indeed tomorrow morning, more gringos were coming to work.  

I always wonder what the big deal is when we build an 11 x 14 house with two rooms, two windows and one door.  But on Sunday, when I walked into the home they live in now...a 9 x 11 ish frame with a curtain dividing the house in half with two beds pushed together for 5 of the family members to sleep.  On the other side from the beds was a stove and two plastic chairs to be the kitchen and living room...no windows and a curtain for a door.  So yes, it is a big deal.

On Monday, we showed up...all 21 of us, to build.  We had a 80ish dynamo and a 7 year old on our team.  We were all there for our own reasons to build a house for a family.  That was really all we knew.  As the day went on, the family came over and spent time with us...not thanking us but wanting to help build the home that was to be theirs.  They weren't looking to have it built and then look it over and move in...they wanted to help create it with us.   As much as my rock hard heart didn't want to soften, to watch this family become more and more excited each day with this place to call home...it began to melt.

We framed walls, framed the roof, poured the concrete and smoothed it, drilled holes in the studs for the light and the ceiling fan, put chicken wire on the outside and insulated...the place was taking shape.

Then, Jesus, the father asked our group if we could go and visit his son and pray with him.  I didn't think anything of it because I was busy but as the day wore on, we decided we could break and go.  We piled in the vans and drove 15 blocks to a rented house where they live now while they wait.  He told us that his son was ill and in bed and that he was depressed.  

We arrived to find a 22 year old boy on his side with his eyes closed in a small room.  On a table next to the bed was his "things", his dressings and things I am used to.  We stood around and I kneeled next to him and began to ask about his condition.  His mother told me that he was unable to walk anymore and was losing function in his left arm....and then she pulled back the covers and showed me his bedsores from being in bed for 6 months.  She told me that she can't go out much because he is unable to be left alone and he needs her.  She started to cry.  I looked away and began to get angry...I felt so helpless.

I went into nurse mode, and asked a million questions about how she is caring for the sores, how she is keeping him off of the pressure points, about the plan of care for her boy.  As she answered I realized where I was.  I was in Juarez, Mexico where you don't get nurses to change dressings three days a week with fancy dressings and creams...you don't get cushions and wheel chairs to change the pressure on spots.  In Juarez, you get to care for your boy as best you can with gatorade to put on dressings and pack in wounds because it says it has vitamins and minerals.

I slowed down and began to ask her son about pain and movement and things like that.  He told me he has pain but can't afford the medication...ibuprofen...to help with it.  

I was humbled by his mother who was like any of us...a mother who loved her boy deeply and wanted to do whatever it took to try to make him well and out of pain.  I was humbled by the surroundings and the lack of medical care and information available to her to care for her boy.

On Wednesday night, we finished the house.  It was beautiful and we were all excited.  I couldn't get this boy off of my mind and went to the big grocery store to see what I could make for makeshift wound care to heal this boy.  I found dressings, antibiotic ointment and things to help this boy's skin.

On Thursday, we had a huge party and gave the home to the family.  It was a great day and the family was so happy.  Then, we all went up to see the boy again and I got to give the mom all the presents I bought her so she could help her boy heal.  We sat and I taught her everything I know about wound care and skin care and diet and healing.  We gave them a cooler with cold cuts for protien and we held hands while we talked.  Mothers who want the best for our boys do that.  I told her she was doing a fantastic job caring for her boy and to keep doing what she was doing.

When it was time to leave, she cried and thanked us for caring about her boy.  I told her that we are mothers and we love our boys no matter who we are and where we are from...we are the same.  
We are mothers and fathers and family that loves deeply and wants only the best for our loves.  We are the same yet we are different.  In the US, we have dressings and help and medical care that is available if we need it...even when it is not the best.  We have something.  

But, at the end of the day, the family we built for was humble, thankful and joyful.  They cried when we handed the keys over and they cried when we talked of their boy...but through the tears, you could feel the joy of life.  The joy of having family around and the joy of being honored by caring for each other...

So I ask...who has more?  Are there things we can learn from each other?  While we toil away making money and buying the latest of this and that and worrying, they seem to accept what is and love each other.  Isn't life really all about the people we love?  I think because they live a hard life in so many ways, the joy they get from each other is apparent in all they do.  So I ask again, who has more?  Who deserves more?  Just questions to ponder as we go....

Back to the wall...this is the tall wall that is to keep the mexicans from coming into the US.  It goes on for miles and there are cameras and flood lights on our side and border patrol trucks at the ready... 

What do I know about walls?  If my boy needed care that I could not get here, or I had a home made of cardboard and pallets and was freezing, and tried everything I could do to change that in Mexico without luck...I would not rule out getting past that wall to a life where I was able to care for my family.  

That is what I learned on this trip...we are the same yet different, sad yet joyful and we all want to care for our loves...

We'll tawk tomorrow,
 I love you all,

Friday, March 11, 2016

Momma told me there'd be days like this.

Today was one of those days...the sky was so blue and it was warm and calm and smelled of spring.  Everywhere I looked, I could see hope.  I know it sounds so opposite after all the disgusting politics that are going on but today was just lovely.  When I turned the corner from my house, I saw a mamma dear and her babies hanging out waiting for me to go by.  I know it seems a little early, but life was that good.

I got to my first patients home and it was cool out and I shivered at I walked to his front door.  I did all the things I do, the IV's, dressings, empty the garbage, fix them breakfast...the things that my patients expect from me and then sat down to talk.  For some reason, today didn't feel so rushed.  I left his house, wishing him a great weekend and headed to patient number two.

This patient, I have had for a very long time.  She is old, frail and has the sweetest smile.  Today, though, things seemed different.  She was concerned, looking off into space and almost seemed like she was in pain.  Her caregiver was concerned and wondered what was going on.  I looked her over and really couldn't find anything obvious to think about or try to fix so I gently stroked her arm and watched her.  She was thinking, and it was obvious she had something on her mind.  Slowly and quietly (believe it or not) I asked her some questions...do you hurt anywhere? What can I do to help you?  You seem unsettled...what's going on?   Knowing her as I do, it was obvious she is unsettled but it didn't seem she was in pain.   Sometimes, I told the caregiver, there is work to be done that we don't understand and we just have to make sure we are supporting the patient in that work...just keep her comfortable, love her up and we will watch her.  Then I told her I was going to be around all weekend and to call me if she needed me.  I sat in the car in the driveway and wondered if she was heading out of this world...

My third, fourth and fifth visits were lovely.  Nice homes, nice people and a joy to care for.

My sixth and last visit of the day was around 3 pm.  I arrived to find my patient doing well and enjoying the day.  I did all the "assessment" things I need to do and sat in the recliner.  She sat in her chair and we began to talk.  We talked about her family, her grown kids, grand kids and how wonderful and smart they are.  We talked about her life when she was raising them and how different they were from each other.  We talked and talked and talked.  Before I knew it, I had been there an hour and 15 minutes.  I decided it was time to finish up, so I walked over to her medication planner and she and I talked through the medications and why she took them and when.  

Finally, we walked through the kitchen and stopped at the refrigerator to look at what she had on it.  It was filled with pictures of her life, when she was a young mother, her husband, her dogs.  She went from picture to picture and talked lovingly about the folks in them.  She told me of the grand kids, the daughters in laws, the great grandkids and when they had come to visit.  It was a 45 minute snippet of a life well lived and loved.  Finally, I asked her about the picture in the middle, one of her husband who is gone, smiling a huge smile right into the camera.  I looked over at her while she was talking about him and she had a big smile on her face.  She ran her hand over the pictures on the door of the refrigerator and then she turned to me and said, " I like these pictures here because whenever I go by, I look at them and remember what I good life I've lived".

She  walked me to the door and I bent down to give her a hug and I felt a sweet kiss on my cheek and heard a quiet " I love you" in my ear as I pulled away.  I told her I loved her too and I would see her next week...

There are days in my life that I rush through and when I get in bed, I can't remember what I've done.  I have regrets about those times as many of them were when I had three little kids and needed to get them through the day.  Now, I am trying to slow down and remember how my heart felt, what something smelled like and the colors in the room.  

I'm so glad I took the time today to slow down, listen and feel that kiss on the cheek and whisper I love you...because my heart felt like it was going to burst, the cheek felt soft against mine and all I could see was the bright light of love.

It was a beautiful day...and I have to try to make all my days like this...

We'll tawk tomorrow,
I love you all,

Saturday, March 5, 2016

If you don't laugh...you'll cry...

It's been that kind of week.  Honestly, every week seems to be that kind of week when you do Hospice nursing...so I guess this week has been no different except it was.

I like to make light of things that are intense...crack jokes, make fun of myself, and usually talk about how much wine I am going to drink when it's all over.  If I look at the team I work with, that is a way that we get through the days that are so difficult for families and for us...we laugh it off...and sometimes we all go out and drink wine too. 

When  you work with the dying, and do hospice care, you are on a team. (Thank God).  The team meets every two weeks to talk about the patients and the care they need and what we can do to make their time and their family's time with them better...sweeter and more profound.  The meetings have the nurses, the doctors, the chaplain, the social workers, the volunteers and who ever else is needed to make time better.  The meeting is mixed with questions, laughter, support and new ideas for the person's care.  It is something that I look forward to especially if I have a patient that I need help managing either symptom wise or emotion wise.  The thing that is not generally seen at this meeting is tears.  It is usually all business with an exchange of ideas as if we are fixing symptoms on a broken vehicle or dealing with a recipe that we haven't followed directions but need to change some of the ingredients to make it taste better.  We just don't cry a whole lot.  Now, we tell jokes...we laugh, but otherwise we are serious and down to business.

Last Thursdays meeting went along in the same fashion that we always do.  We started with the patients that have passed away and we talked about how peaceful the passing was and how the family is doing and then we asked our social workers to contact them for grief work and moved on.  It was very quick and solemn.  After that we moved on to the patients that we are caring for and the symptoms and things that we want to address.  We include the family and if they need support, we add that.  It was a really helpful meeting and we were done in record time so we could go and put out new ideas into action.

Just as we were breaking up, a nurse came in that was obviously upset.  She has been taking care of a patient for a long time and the end is near.  As she began to talk about the things she needed help with, she broke down in tears...and we all quieted down and stopped moving.  All at once, she was peppered with,"what can I do to help, should we do this, or should we do that?" to which this nurse just kept saying "yes, I need help."

You see, when you care for someone in their home, you become special to them even if you try not to and you try not to have them become special to you.  But, from the moment you knock on the door, sit in the chair by the bed, make a cup of coffee or food in their kitchen...you become family.  So how,does a nurse who needs to keep boundaries of some sort do that when you become family to folks week after week? 

The quick answer to that is...you don't.  You put your heart right in the middle of the situation and you do everything you can do to care for them like family.  Yep, that's what you do.  You know why?  Because when you let someone into that time of life when you are hanging by a thread and cannot deal with one more stranger,  we walk in.  When we walk in, we don't tell you that you are going to beat this cancer and live forever, although I wish we did.  No, what we tell you is what we can do for you at home...where you haven't been much because of symptoms or because  you have been doing chemo and it has been beating you down..in other words, you have had no control.  When we walk in, we give you your control back...you wanna sleep?  OK.  You want to take more pain medication because you still hurt?  We figure out what you need to take to get your pain controlled.  And your family is wondering how to help you?  We can give them ideas around that too so you and they can have the best time you can with what you are facing...

When we get you all organized and comfortable at home, we leave you with your family knowing we are a phone call away any time...day or night.  So yeah, we turn into family, them to us and us to them.

I don't know why we were a little surprised at the tears and frustration at the end of the meeting.  We have all felt that way more than we can even let on and I know many times in the meeting when I am caring for someone who I don't need help with but know I will miss, I swallow hard and say, "There fine, He's good...Just go to the next one" and raise my head high to keep the tears from sneaking out and down my cheeks.  For me, it's not because I am too tough to cry or because I can't...it's just sometimes I get afraid that when the tears start, I may not be able to stop them.

Thankfully, our team rallied around this awesome nurse and figured out what we needed to do to help her patient and to help her know that sometimes we do everything in our power to help and it doesn't work.  Kind of like life...we think we are on the right path and things go south...

So thank God for families...our own, our work families and I am thankful for my patient families as well.  The folks that have the courage to love people out of this world when they would rather be doing anything else.  

So...see...that's why I say, if you don't laugh, you'll cry.

We'll tawk tomorrow,
I love you all,

Sunday, February 28, 2016

What's better...to know you are dying or to just drop?

I always get this question from families at one time or another and honestly, I don't know how to answer it.  I believe there are things about both ways that can be appealing.  

Last week, I had a patient that had been battling a terminal disease for almost three years.   He knew that there wasn't a cure and he knew that eventually it was going to be his time.  He would have a round of chemo, get knocked down and then get back up.  He would do the things he loved, hang out with his family and cherish the time.  At least, to hear it from the folks he left behind, that is what he did.

His last hospitalization did not go well and he had finally heard those words, "there is nothing more we can do."  He immediately told his wife to take him home...do not stop at go, do not collect that $200, I want to be in my chair at home now."   Being the amazing woman that she was, and that her family knew her to be, she took him home.  When I met them, it was apparent that he was failing and didn't have time for small talk with me.  He wanted his family close and my job was to make sure they had the tools to care for him at home with love and comfort.  

So that's what I did.  Thursday night, we got him home and in his chair with his family, his pain medication and his cigarettes.  The kids (young adults with families of their own) stayed the night to help care for him and keep him safe and happy.  It was a long night for the whole gang.  

In the morning, everyone who needed to come to tell him good bye and farewell showed up.  The house was full of folks with food and drink and music.  They told stories of the patient and how much he meant to them.  It was good but also bittersweet.

Then, as some folks were filtering out and others in, the grand kids showed up.  They slowly walked in and got on the hospital bed next to Grandpa's chair.  They had faces of confusion as they watched their "papa" dose off.  I looked over to see my patients son sitting at his father's feet, talking to the kids in a quiet voice, explaining that papa was sick and has been for a long time and now it was time for him to go.  They all looked at their grandfather waiting to see what he would do and he woke up, looked at them, and broke into a big smile.  It was one of the sweetest times I have ever seen of a family and the love they shared.  The little ones beamed as they watched "Papa" smile at them and the older ones just took a breath in and relaxed.  Then, one by one, they gave him a little kiss on the cheek and the designated family member to care for the children took them home.

My patient's son was in tears as was the room.  That was an intimate piece of time that was just exactly what was supposed to happen for "Papa" and for the kids.  The chills ran down my spine and I knew I had just witnessed something profound.  When I began to explain the signs that signify that death is coming, I asked the kids to make sure they had told their dad everything they wanted him to hear.  One by one, they told me of the special times they had with him after the diagnosis and the connection and peace they had with him leaving them.  They told  him daily how much they loved and appreciated him.  They said that they knew time was limited and didn't let anything be taken for granted when it came to letting Dad know they loved him.  The kids were at peace.  He passed quietly and comfortably in the night with his kids and wife around him as he left.

They called me in the morning and when I got there, the house was peaceful and organized...they had finished strong and just how "Papa" would have wanted it.  They were sad and relieved and holding each other close as they went through the day.  They were an amazing family.

So was that good?  Would you rather that then just being here one day and gone the next.  Still hard to say really....

But, when you think about it...limited time gives you is perspective.   I think it makes you take stock of what you have and what you don't...of how you want to be remembered, and of how much you want others to know how much you love them.  You can also take comfort in knowing how much they love you.  

For instance, a few weeks ago, a patient's friend went skiing and had a heart attack on the ski slopes.  He was an older gentleman and was with his family.  I asked my friend about this question and she responded that she was sure that they had all their "accounts in order".  Interesting way to put it but I understood what she meant.  They were all together, celebrating Valentines day with the whole family and spending time together.  Hopefully, they knew how much they  loved each other and there wasn't much left unsaid... 

The reality is that day to day life isn't so easy...to let by gone's by by gone's or to let things go that really bother you go.  But, I think, it has to be a priority to tell the folks you love everyday that it is true.  Even more important, is to tell the folks you still love them after a fight or a misunderstanding because that kind of thing can haunt you the rest of your life.  I know...I have made some mistakes in that area and am convicted as I watch families love each other so completely at the end...

I believe the question isn't, is it better to know you are dying -  but do all the people in your life that you cherish know how much they mean to you?  That is the question to think about and make a change if they don't.  As you and I  know, life is both long and short...long when you are suffering and short when you know the end is near.  

I would argue that for some of us, knowing the end is near will change us...to make amends and love hard and savor the love, the kisses and the closeness of those we love.  The thing is, we never know...really...when the end is near, so why not try to do that more?  To savor that kiss from our love, that time with our kids, our friends and our people... knowing it will be a memory some day and hopefully, a memory that we cherish and take comfort in.  

Because, really, that is all we can do in this crazy world...love each other better, right?

We'll tawk tomorrow,
I love you all,