A Strange Little Hospice Story

I'm a hospice nurse. I see nursing home patients and hospital patients sometimes, but mostly I do home care. The nursing I do feels like old-fashioned nursing, when nurses wore black capes and carried their nursing bags around the worst neighborhoods in the city, and everybody respected them, because they would walk into the most fraught and chaotic situations and make things better.

I take care of people who are dying at various speeds and intensities. A good day for my patients is a fabulous and wonderful thing, and on the good days I give them the thumb's-up and stay out of the way. On the bad days, I'm liable to do many different things--give or set up medications, change bedding, give a bedbath or a shower, make tea, move furniture (don't tell the boss, we're not supposed to), help to the bathroom and back again, give hugs, hold hands, adjust the TV, amuse the dog or cat, change lightbulbs, make a phone call, or just talk. I talk a lot. I teach, patients and families, about medications, about caregiving, about symptoms, about what we call "the decline", and about death. I do nursey stuff too--blood pressures and wound care and all of that--and engage in the social chitchat all of us need to feel comfortable and comforted.

I listen. I hear a lot of stories--amazing stories--but I am not, by nature, a story collector, or much of a story listener. Even as a kid, I got bored being read to and learned how to read early so I could tell the stories to myself. I work with chaplains and social workers, and they see my patients too--usually not as often as I do, but often--and they collect the stories far better than I can.

My patients sometimes tell me things they can't tell anyone else. I've been the one they have said "I know I'm dying," to and cried, while I sit there and listen. I find myself witnessing a lot of pain, and a lot of letting go, and it keeps me clear in my own life about what is important and what is nonsense, but not for a minute do I go into my work to meet some need of my own. Many of my patients never get close to me at all; sometimes I get closer to a family member than the patient, and sometimes I'm just the nurse, and that's okay. I'm there for them, not for me, and I'm not trying to be anything more than what they want or need me to be.

Sometimes I find myself trying harder than usual, though. Jean from the islands was in his nineties but didn't look it, and he had a smile that was the best I've ever seen. When I would visit him and he was angry about being sick, or simply feeling like shit, and I couldn't get a smile, I'd joke and tease and cajole until I got one. The few times I couldn't I would leave his house feeling a little like shit, too, which wasn't fair to Jean at all but I couldn't seem to help it.

When I started being his nurse we would sit together in his yard out in the sun and talk. His accent was thick and difficult to navigate, but he didn't mind repeating, and when I would say, "Jean, I have no idea what you just said," he would smile and shake his head and repeat it. He worked manual labor his whole life, and his arms were still etched with muscle, although thinner by the week. He had rode his bike everywhere until he got too sick, about six months before I met him. He had a deep belief in God. His issue with the business of dying had much less to do with leaving this world than with his body skipping out on him. By Christmastime he had been bedbound for weeks, and the boredom of being weak and exhausted would make him irritable. Often I would visit and he would be sleeping, so I would not wake him--I would quietly assess his breathing, his color, the appearance of comfort versus discomfort, and talk to his granddaughter about what had been going on and what they might need.

A week before he died he was the brightest I had seen him since the days we sat in the sunshine--he told stories, he laughed, he knew where he was. I sat beside his bed for much longer than I usually gave a visit, because I suspected this was the last time, and I was right. The next day he went to sleep, and he didn't really wake up after that. He died right before midnight on New Year's Eve, in a characteristic decision to live the year out to it's fullest.

I don't go to funerals much, but I went to Jean's. I didn't get to the wake, so before the service, I paid my respects while the casket was still open. He was dressed in a dapper gray suit, looking not at all like himself, but then I noticed--to my great joy--that he was smiling. I had never in my life seen a body smiling serenely in a casket, but he was--the corners of his mouth were distinctly upturned.

A few days later I was in the office, and saw the chaplain I work with, and I mentioned going to Jean's funeral. She had been to the wake. "It's amazing," I said, "but did you notice how he was smiling? I've never seen a person smiling in a casket before."

She gave me a very odd look. "He wasn't smiling," she said.

"What? Yes, he was. It was so clear. His mouth was turned up. You couldn't miss it!"

She shook her head. "No, kiddo, he was not smiling. You saw him smile?"

Now I was doubting myself, but in my mind's eye, I could see him. I could feel him, too--I had felt the happy, boyish, joyful energy of his smile all around his casket as I stood there looking and saying my own version of a prayer for him. "Yeah, I saw him smile. He was smiling."

"That must have been for you, kiddo," she said.

You know? I think it was.