The first time I met Melvin he was sitting at his dining rom table putting together a puzzle.

”Hi Melvin, my name is James.”

He didn’t look up at me or acknowledge my presence.

“He can’t hear you.” His wife explained.

I raised my voice significantly to announce myself. “Hi Melvin, my name is James. how are you doing?”

”James, he can’t hear anything.” She explained. “He’s totally deaf.”

She touched him on the shoulder, and he looked up at us. He smiled at me, and then he smiled at her. He reached up with his hand and caressed her face for a few seconds. He smiled at her, gave her a kiss on the opposite cheek from his hand, and then he returned to his puzzle.

Melvin didn’t start out his life as a deaf man. He just experienced comlete hearing loss as he aged. Over the 2-3 month period of time that I was his nurse, I never heard him say a single word. Every visit was the same. I would perform my assessment, and ask his wife all the questions. He was always engaged in some activity. He would look at me and just smile.

I learned a lot about Melvin from his wife. They had only been married a few years. She told me stories about his travels around the world. He had visited almost every continent. He had been in most of the major cities in Europe. According to his wife, he had even scaled Mount Everest. Most of this had happened before they ever got married. I don’t honestly remember what he actually did for a living. I think he was a college professor or something of the sort.

Most hospice patients end up on some type of symptom management medication as the end of life nears. Usually it’s more than one medication. We have medications for pain, shortness of air, anxiety, hallucinations, nausea and vomiting. Most patients end up on several medications at end of life. Most commonly they end up on something for pain and hallucinations. Melvin sticks out in my mind because he took almost no medications while he was dying.

I remember visiting one day, and he was lying in his hospital bed. His wife was sitting at the head of his bed holding his hand. He was looking up at her with his usual smile. He was cupping her cheek in his hand.

”How has he been acting?” I asked.

“He hasn’t eaten or drank anything since yesterday morning.” She said.

Sitting next to her I asked. ”He doesn’t appear to be in any distress to me. What do you think?”

She looked at him and looked at me.

”He’s never had any chronic pain issues, and he seems to understand what is happening.”

“What is happening?” I asked her.

”He’s dying, and I think he knows it.”

I visited them every day that week. Every visit was exactly the same. She would be sitting at the head of his bed, and he would be holding her face with his hand. He had the same simple smile on his face. Most visits I would see him pull her close and give her a soft kiss on the opposite cheek he was touching. There was never a sound from him. Not a moan, or a groan. No coughing or attempts to speak any words. Just a smile and a kiss.

I remember the day he died. I had received an email from our secretary, Kay. It was a simple email like all of her emails.

“Please call Joanne, she is pretty sure Melvin has passed.”

I replied “Okay” to her email like I always did. After calling Joanne, I drove over to their house. She let me in and lead me to the living room where he was lying. I put my stethascope on his chest and listed for a heartbeat. There was none. I looked at my watch and gave the time of death to her.

While we waited for the funeral home to get there, we talked about the last 24 hours.

“James, it was the strangest thing. Every couple hours he would wake up, look at me, smile, lift his head, give me a kiss on the cheek and lie back down. All night long it was the same. Every couple hours. Wake up. Smile. Kiss on the cheek. Lie back down. Right before I called your office, he did the exact same thing, but this final time, he stopped breathing after the kiss.”

I have never seen anything like it since that day. I have never had a patient who remained that lucid until their final breath. Most patients are unresponsive for days leading up to the end. Not Melvin. He was awake till almost the last minute.

Melvin had a lot of adventures over his lifetime. He had been everywhere, and he had seen everything. When he was close to the end, the only thing that mattered to him was Joanne. He couldn’t communicate with his voice, because he couldn’t hear. What he could do was communicate with his face and hands.

At the end of his life Melvin made sure Joanne knew exactly how he felt about her. A touch and a kiss was all she needed to understand.

James

James worked on-and-off as an LPN for over 20 years. In 2014 he completed a bridge program and became an RN. James became a hospice nurse in January 2015. He lives in the Kansas City area with his wife of over 30 years, 4 daughters and 2 sons in law.