Some of the most heart-rending situations I found myself in as a hospice nurse happened when I was working in Admissions. We were the ones who would be sent out first, to evaluate whether a patient was appropriate for hospice, and if so, get them signed onto the program. Because we were the first ones out there, we sometimes encountered some very crazy and sad situations. Occasionally, someone would sign up for the program so late that the admissions nurse would be the first and the last hospice nurse they would see.
Whenever I’ve told someone that I worked in hospice, people react in very sweet ways, “Oh, you guys are angels” or “I don’t know how you do it.” I haven’t found hospice nursing to be very difficult emotionally most of the time. Usually our patients are old, have lived full lives, and are ready to go home. When they do pass away, it is sad for the family, but they are also relieved that their loved one is now free in heaven. So I would rarely get choked up in my work. I don’t remember ever crying. I think that it would be unprofessional to do so because it would make the family or patient focus on you instead of on themselves. And you are there to help them, not for yourself.
There were things that pierced my heart all the time. But only one time I remember almost crying: I went to admit a man who was living with a friend in a trailer in a poor area of town. He was in his late 40s or early 50s, and he had very advanced cancer. His roommate was unable to care for him anymore; his roommate hadn’t really signed on to be a caregiver, and my patient had no one else who could do it. I was blessed that the hospice also sent a social worker to help me; that would happen occasionally if there was a red flag about the admission. Possibly this man’s younger age or caregiving situation triggered the social worker.
I talked with his roommate and the man’s power of attorney for awhile. The power of attorney signed the papers for him to go on hospice. Then while the social worker talked with the roommate and power of attorney, I went up into the trailer to see the patient. There was garbage everywhere. He reeked of urine. It was clear that he had not moved for some time, and that his roommate never cleaned him up. It may have been like this for days. He was unable to speak or move, though I was could not tell if it was because of his cancer or because he was in incredible pain. He was awake. He had some pain medicine there, and immediately I gave him some. It was clear that he was not going to live more than another day or two.
I called our hospice doctor and got him admitted to our inpatient unit for pain out of control. The doctor asked me if he would die in the ambulance, but I said I didn’t think so. His breathing was still regular.
I changed him and gave him a clean pair of adult briefs from my car stock and a clean pair of pants. Just moving him a little caused a lot of pain. With the doctor’s orders, I was able to give him more pain medicine.
Then the social worker came in and called his family. They did not live close by, in another state somewhere. I think they had been estranged, that my patient was someone who had substance abuse problems and had not been in regular contact with his family. The social worker explained to my patient’s parents that he was in the last stages of his cancer, that he would not live very long, that we were moving him to our hospice facility to care for him, and that he could not speak.
Then the social worker held the phone up to his ear while his mother got on the phone. I heard, “I love you, my sweet boy,” I heard forgiveness and love, and a mommy in her 70s now who loved her son just as much as when he was a baby. I could imagine her stroking his hair as a little boy. I almost lost it. But I didn’t. I got on my computer and started charting, so I could hang on during that conversation. It didn’t last very long, but my patient heard his mother and father say goodbye to him for the last time. He had tears. I was grateful for this social worker, because I never would have thought to call his family. She gave them a wonderful gift.
This man is one of those I think of when I hear the words that Jesus spoke, “as you did it to one of the least of these my brothers, you did it to me.” My patient made it to our hospice facility. The nurses and aides cleaned him up, gave him a proper bath, and relieved his pain. He was treated with dignity. He died the next day.