This was the first time everyone was up. Usually, the grandson is asleep at ten in the morning. He worked the night shift at a local factory, and his wife spent the daytime with Mary. We usually started the day with simple conversation. Nothing serious really. Just a few minutes of acting normal. Something all of my patients seem to enjoy. They want a friend who is a nurse. Not a nurse who is a friend.

Today was different. I could tell our conversation would move straight to business. Observation is the best tool a hospice nurse possesses. She was a little more short of air than usual. Maybe she was anxious about the subject at hand. Her legs and ankles were as swollen as ever. There was no way she was walking very well these days.

I sat down and simply asked, “What’s up?”
She looked at her grandson and his wife. Then she turned her gaze to me and said, “I’m worried about something.”

“What are you worried about?” I asked her.

“It’s getting close to the holidays. I’m scared that I’m going to ruin everything for them.” She looked at her family and paused for a moment. “I’m afraid I’ll die on Thanksgiving, and the rest of them will be ruined forever.”

“Is it really that bad?” I asked her.

“What?” She responded.

“Is it really that bad? If every Thanksgiving for the rest of their lives they take a few minutes to remember the love they have for you. If every Thanksgiving for the rest of their lives, they take a few minutes to remember how much you loved them. Is that such a terrible thing?”

Her grandson and his wife had smiles on their faces. Mary looked at them and asked, “What?”

Her grandson spoke up. “Grandma, you don’t need that kind of stress right now. We love you very much. We don’t care when you die. We don’t want you to worry about when you die. We are going to think of you every holiday anyway. You have been such an important part of my life for so many years. We just want your final months to be as enjoyable as possible.”

“Listen,” I interjected, “Your grandson and his wife will be just fine no matter when you pass. Enjoy the time you have together, and don’t let the thought of passing on a holiday steal the joy of the moments you have between now and then.”

I finished the rest of my visit. She didn’t like taking medications, so we didn’t change a thing. Our visits were always more social than anything else. That’s what was most important to her.

Before I left that day, I reassured her that everyone would be just fine if she died on Thanksgiving, and that’s exactly what she did.

One of the biggest frustrations working in hospice is the caregiver who will not listen to your advice. They have not yet come to terms with the situation. It is heartbreaking to watch someone pass away and to have all the tools to help them, only to get pushed aside or shut down by someone who just isn’t ready to get on board with the program. There comes a time when all you can do is watch someone suffer. It is gut wrenching. All your pleading and teaching will not change the situation. You can have long talks, leave reading material, educate till your heart is content; but there is no moving or budging their resistance. They refuse medicine saying it will kill their loved one. They force food down a body that can no longer use it, causing greater problems, often for their own selfish reason of making themselves feel better. Even though you, as a hospice nurse, may have gone through hundreds of deaths and end of life scenarios, the expertise and knowledge you have gained is greatly ignored. You know that you could truly ease the suffering before you, but you can only stand by helplessly as the patient struggles to breathe and takes those deep, labored “guppy breaths”, or chokes on soup, being forced down their throat. Somewhere deep within a voice screams “Why won’t you listen to me”?

As my coworker sat down today and unloaded this same frustration, I thought a minute about our Father in heaven. He possesses the tools to make us better. Not just to give comfort at the end of life, but to truly live life abundantly, with His spirit present. He knows what we need, he tries to reach out and tell us. He has left us with plenty of good reading material, and He has the experience and knowledge to share.

After all He came and walked as one of us.

Yet we ignore him. We try to shovel the food of this world’s sin into our body, even as our spirit screams “stop”. It’s dying and can not handle any more. We ignore his excellent advice and continue in our own stubborn ways. He has the medicine to make us comfortable, to allow us to breathe freely, and yet we turn away, continuing to labor. We think we know better. We are afraid to trust; to trust one who does know better. And so we too endure needless suffering.

I wonder if in heaven the Angels have ever heard the cry, maybe coming from a far away corner, but none the less as loud as thunder…..”Why won’t you listen to me”?

Growing up there was nothing my dad could not fix. A mechanical engineer by trade, I watched this man use his hands to create, to dig, to measure, to cut, twist, glue and most importantly provide the security to his family that if something ever fell apart, he would be there to put it back together. Dad came through more times then I can count. His garage full of tools and the big long workbench where he used his hands to carefully put our lives back together was a whole other universe to me. Dad was great with his hands. He still is. I spent many moments in life feeling so indebted to him, knowing that he had done something for me I just didn’t have the skills to do myself. I would have been so lost without him. Even though I’m now over 40, just this week he fixed my faucet that haid been rattling for months. Another mystery solved by the man with the “fix it” hands. Another debt I cannot pay.

You see I fell far from the “fix it” tree. I have never been able to figure out how things go together. What came as second nature to him has been a huge life mystery to me. When a toy or bike or piece of furniture fell out of the box with its many parts, screws, and instructions, I wanted to run the other way. Thankfully dad was there to put it together. I always wished I had his talent. There were times I really wanted to make him proud by pulling off some great feat of engineering genius by fixing something broken before he got home from work; but that never happened. It just got referred to him.

A few weeks ago dad got real sick. He had a large abscess on his neck that required a major surgery. He left the hospital with a good size wound that needed and still needs dressing changes daily. For these past few weeks I have helped him. What an honor to take care of the man who has always taken care of me, even in this small way. Being a hospice nurse, and having dealt with many wounds, a simple dressing change is not a big deal. As he sits in front of me with his head turned slightly down I cleanse his wound and pack it and tape it up. Today I noticed my hands as I tried to delicately scrub without hurting him. They look like his in shape and size. They look old. Somewhere, somehow, they changed from little boy hands, carrying a broken toy to dad to fix, to adult hands. They are still clumsy with a screwdriver but they are good at taking care of him. And others. I was keenly aware today of the different talents the good Lord gives each one of us and how that really makes us need each other.

I was also happy, not that dad had a wound that needed tending to, but that I finally got to help, in just a very small way, the man that has always taken care of me.

With my hands.

A hospice nurse has a lot of information bouncing around in their head.

During my first two months of field work I can use the word “bombarded” to describe what it was like. I was bombarded with a lot of end of life experience. Certainly, end of life is what hospice is all about, but not all patients have a quick decline. When I look at my caseload now, there are only a couple of names I recognize from my first couple of weeks. This means that I have had a lot of experience with patients who are in a steep decline. It has been good for me because it has caused me to learn symptom management early in my hospice career.

It is a cliché, but with great knowledge comes great responsibility. With my increased experience it will be really tempting to walk into a home and try to pour out all the information I can in one sitting. I’m learning very quickly that the information I have in my head caries a lot of weight with it. I have already seen the look on the faces of a few caregivers who were given too much information in one visit. They just stare at me with a blank look on their face. They have been taken to a place where no information given them is being retained. A lot happens in the hours and days leading up to death. A lot of changes can occur with the human body. There are a lot of different things that can happen, but none of those changes are guaranteed. If I’m not careful, I will provide everyone with more scenarios than they can even begin to process. It’s my job to make sure that I don’t try to saddle my patient and their caregiver with too much information at once. It’s my job to give out the information I have in measured doses.

End of life is heavy. The information I carry around in my head is heavy too. My patients, and their loved ones, need a nurse who hasn’t turned his job into a collection of algorithms he applies to treat everything that can happen in someone’s last few hours on earth.

I need to be sure to stay in touch with the human side of what I do, or I will take an event that can be smooth and make it really complicated.

Last Monday I took my first position as a Registered Nurse. I started at NorthCare Hospice and Palliative Care.

I have had a lot of different jobs in my lifetime. Half of them are in the medical field, and the other half are spread across construction, printing, self employment and retail. At no time during the last 24 years did I feel like any of those jobs had any spiritual significance until last week.

Hospice was on my list for a couple of reasons. The first reason was simply the schedule. I’m a family man, and I have no desire for rotating twelve-hour shifts like nurses work in the hospital. The second reason was because I was really interested in work that was more relational in nature. So many nursing jobs are too fast paced. The goal is to get the patient in and out as quickly as possible. Certainly, there is nothing wrong with this type of medical career. Short hospital stays are an essential component to healthcare. I had decided that I just wanted something different.

Over the last few months I have shared my interest in hospice nursing with friends, family and coworkers. I have received a wide variety of responses. People who have no experience with hospice just say that it sounds like emotionally draining work. When I talk to someone who has first-hand experience with hospice they usually get emotional, start crying and share about family or friends who received services from hospice. When I talk to someone who works in hospice they get a smile on their face and simply say, “Hospice is more than a job. It’s a calling.”

After a week of orientation at NorthCare Hospice I understand the designation, “Calling.” Before last Monday I understood hospice to involve helping people die as comfortably as possible. After a week of general orientation I understand that hospice is so much more than that. Hospice doesn’t just focus on keeping patients comfortable, even though that is an important aspect of hospice care. No, hospice isn’t only about death. Hospice is also about life. Hospice is about helping patients function at the highest possible level during their last months of life. Hospice is about empowering people to identify what is most important to them and helping them engage their last days in a way that is the most fulfilling to them.

Hospice is a calling because I will be a pivotal figure in the final chapter of someone’s life. I will manage their overall care. I’m responsible to make sure that my clients are equipped with everything they need to live their final days with dignity. I will be a central figure in the lives of immediate family as well. I will have at my disposal a team of professionals whose only concern is the care and comfort of my client. We will leave no stone unturned to make sure that our clients and their immediate families feel the support they need to manage the most challenging time of their life.

I have had a lot of jobs that I didn’t feel really mattered beyond providing for my family. For the first time in my life I feel like I will be doing something professionally that really makes a difference. For the first time in my life I feel like I will have a job that God has called me to do.