THE JOB OF A HOSPICE NURSE When the beeper went off you were dreaming about running away from your kid's ball game and your job and your home. On your way you review all the steps of pronouncement - you look for the hospice death packet and think about what you will do and say. They meet you at the door, quietly leading you to the room. Everyone is silent, the lights are dim, and they are waiting, expectantly. On the hospital bed lies a skeleton - a shell of a person - pasty in color, motionless. There is no heartbeat, no peripheral pulse, no respiration; the eyes are open and fixed. You wonder who this person was, what she was like when she was young, what kind of suffering she endured. You tell the family that the patient has died. The young girl begins to cry; her brother holds her, their mother - the patient's daughter - sits stoically next to the bed; hands folded in her lap. You stop the CADD pump and gently remove the sub-q catheter. You turn off the oxygen concentrator and remove the nasal cannula. You excuse yourself to make the phone calls. The family sits next to their now gone grandmother - touching her hands, crying, reassuring each other that they have done the best for her. The daughter, the spine (pillar?) of strength is not crying but gently talking to her children. You notify the doctor - he is sad, says he's known her for 30 years probably will go to the funeral. You notify the minister who says he'll be right there. The funeral director will arrive in 30 minutes. The daughter witnesses for you as you pour morphine and Percocet tablets into the toilet and flush. Paperwork. The daughter tells you her mother suffered from cancer for 20 years off and on –but that the last 3 months were fast and painful until the hospice nurses got the pain under control with the CADD pump. You calculate what the cancer must have occluded, eroded, robbed, to cause such pain. There is cachexia. There are pedal contractures. The abdomen is grossly enlarged. You tell the daughter the good things you see - how beautifully the skin has been kept, not a hint of breakdown; how nice the hair looks, such an obvious sign of the love and devotion her mother has received. The two young children leave the room and you and the daughter bathe the mother one last time, change the linens, and make her comfortable. You talk to each other and to the body. The daughter begins to cry - you hold her, like the child she is at this moment - the child who no longer has a mother. The doorbell rings, the funeral director has arrived. You encourage the daughter and her family to come into the dining room and have a cup of tea. You go back to the bedroom to assist with the transfer of the body into the funeral bag. Such finality when the zipper goes over the face – you want to keep the family delicately away from the sight of this. It is painful enough for you. The minister arrives. The family gathers in the living room. They thank you for being there and for giving up your sleep in their hour of need. You pack the loose medical supplies, strip the bed, break it down, gather the trash, turn out the bedroom light, and close the door. The equipment company will come in the morning for the larger supplies. You say good-bye and leave. Outside, alone in your car, you cry. A few months later at a mutual friend's wedding, you see the daughter. When she sees you she smiles with sadness in her eyes. You smile back. She knows. You know. She knows you know. That is all. That is enough.
I ran across this picture somewhere on the net and it felt so personal...so real...so much like a Hospice nurse. I also found the note following the picture. I am not sure of the author but it truly represents the duty that a nurse has to carry out and the personal sadness felt when a life leaves...even when that life belonged to someone you did not know.