I didn't know him well.

But I am so thankful I knew him at all.  He was in his late seventies and had recently been told he had to have dialysis for kidney failure.  He did go to dialysis for a short time but decided he couldn't live that way.  He wanted to leave the nursing home he was in and go home to die. 

And so he did.  I was there shortly after he got home that first day.  He was sitting in a wheelchair looking out his front window.  Outside the window was a wonderful lake view.  His home was steps from the shore.  It was a tiny home but with a view like that, no one noticed the house anyway.

I sat next to him and noticed that on the table in front of him was a drink he was sipping on.  It was a beer.  I thought then and there, this is why I love being a hospice nurse.  He was doing what he wanted and I couldn't have been happier for him.

The next day he was in bed.  It was a hospital bed in the living room so he could look out the windows all the time.  He never got out of that bed again.  Never had another beer.  Three weeks after he came home, he quietly died in the early morning hours.

Before he died, his sister in law told me that he wanted to be cremated.  Then he would be tossed in the lake.  He had put his wife's ashes in the lake a few years earlier.  It wasn't legal but what can you do, as his nurse I simply nod my head and secretly wish I have such a romantic ending in my life one day. 

He lived in a beautiful place.  I was honored to be there with him even though the time was short.  For some reason, I don't think I will forget him.  Looking out the window, drinking a beer.  It's a wonderful life.  Not a bad death either.

I forgot what I was doing....

Until today when I was driving around between patients.  It was then that I remembered the People of the Little Trees.  I meant to post about them a very long time ago.

It's the beginning of December and despite the short dark and dreary days, there is a noticeable light in the rooms in the nursing home. It starts slowly at the beginning of the month, though some start right after thanksgiving. First one and then another until nearly every single room has a lighted little Christmas tree.  It's usually placed on the nightstand, one of two or three pieces of furniture crammed in the crowded nursing home rooms.  There, piercing the dark long nights, shine the colorfully bright tiny lights of tiny trees.  It's quiet and dark in the hallways and the silence is usually punctuated only by the occasional dinging of a call light or the loud snore of one of the residents. 

Those are the nights that I loved working the most. The night time, the little trees, the tiny lights glowing in a world that in the dark, could be almost anything.  Not until the hall and room lights went on again in the morning would you see the harsh awful reality of the nursing home.  Only then would you know that the snores you heard that almost comforted you in their lulling regularity at night were coming from a man with severe dementia that doesn't know where he is.  At night in the world of the little trees, he was normal, a man snoring while fast asleep in the winter night.

The tiny little trees with their glowing lights stayed on constantly.  No one turned them off or on, they kept their comforting lights on until well after Christmas.  They stayed until the New Year or until a family member came to pick them up, put them in a box and take them away until the next holiday season came around.  Some family members didn't pick them up and the staff was left to put them somewhere out of the way so that the limited space in the room wasn't taken up by something so frivolous. 

During the month of December, the time of the little trees, people were different. Staff were different. They put up with the more limited space taken up by the little trees.  Patients were different. They were quieter at night.  Perhaps the staff and the patients were both comforted by the light, the glow emanating from the tiny trees.  Maybe it was the fact that Christmas brought both of  them lovely memories.  Whatever it was, the people of the tiny trees were different when they had the trees with them.  They were happier. Calmer. More patient and tolerant. Some snored louder.  And their nurse, at least one of them, was delighted each year to be in the land of the little trees, a time when there was comfort in a place that was so often unbearable. 

So.

When I just started the hospice job, I got a patient who was my same age.  MY SAME AGE.  Now I'm not young, but I'm not old and this man was dying.  I could not believe it.  When I looked at him, he didn't look like he was dying and so I convinced myself that it couldn't be true.  Or even if it was, it was going to be a good long time.  It was about three weeks.  From being alert, and just like me to death he was gone in three weeks. 

No one has a promised time on earth.  No one has control over it whether they would like it or not.  As a nurse that's a hard lesson, that you can't prolong a life that isn't meant to be prolonged.  I would have loved to keep this man alive. He was kind, sweet, good natured and beloved by all who knew him.  But God took him away.  I guess it's our selfishness that longs to keep people on earth, because this man was in a lot of pain and perhaps he was tired from fighting his cancer so long.  He had had it for many, many years.  Who am I or anyone to force him to endure because we liked or loved him? 

I had a dream about this man the night I admitted him to hospice.  I dreamt that he put his head in my lap and died.  When I woke up I thought what a silly dream!  He doesn't even know me, why would I be with him at the end?  And in the end, looking back, maybe it was because once he went on hospice he knew he didn't have to keep fighting.  That my admitting him gave him the ability to let go and place his life into other hands (or laps) and he would finally get some rest.  I hope that's what it meant, because if so, what a wonderful gift he gave to me, the trust that putting himself into hospice would mean he could let go peacefully with someone there.

 That is after all what hospice is.

The beginning....sort of.

I became a hospice nurse after I'd completed almost three decades working as an RN.  I had never worked in a home care situation before, I was the nurse you saw in the hospital or the nursing home.  I dutifully called for and obtained doctor's orders for my patients and carried them out with, most of the time, speed and I hope compassion.  I started as a nurse in the mid- eighties, a time of transition for nurses.  Most no longer sported the coveted, yearned for white cap, and it was only a matter of time before not only the cap, but the white uniform disappeared entirely.  With that came a host of other changes, from medicare telling doctors how long to hospitalize their patients to nurses practicing medicine on their own. 

I had always wanted to pursue advanced schooling in nursing, but going to nursing school with three children already made it difficult if not impossible for me to continue on to get my bachelor's or master's degree at first.  Naturally, I kept on having babies, two more, so that when I finally took a breath and looked around and at going back to school, I was *horrors!* already almost fifty!

Still, I needed to do it.  I had to at least get my BSN, and so I plodded through two and a half years of online schooling with the revered University of Michigan.  Not only did I get my degree but I became a Michigan Wolverine for life!  GO BLUE!

Of course, that wasn't enough.  Once you began at U of M, it seemed imperative that you had to go on to grad school.  The more I thought about it, the less I wanted to get an MSN or to become a Nurse Practitioner.  Why?  I'm not really certain.  I think that after living nursing for almost thirty years, some of us need something "different."  My something was going to become Bioethics.

I took a Bioethics class to get my BSN.  I felt like a fool in that class because:
1.  I had no idea what anyone was saying
2.  I had no idea what anyone was saying

My classmates and professor discussed Kant and deontology, the veil of ignorance and myriad other things that I had never in all my years heard of and let me tell you, at first I literally thought I had landed in France.  But during the course, all kinds of interesting things were brought up by the professor.  Was it all right to lie?  What if by telling the truth you hurt someone's feelings?  Should someone end their own life?  Why can't they?  Should a baby or an old man use the only ventilator available in a third world country?  What if the baby is severely retarded and the old man is a respected and well written author?  Oh, it just went on and on and my brain sucked it in like a hummingbird at a feeder.  These questions, the fact that there was no one answer to anything, I swear, my brain felt almost high thinking about so many answers, choices, possibilities. 

So there I went.  Off to get a graduate degree in Bioethics.  Naturally I felt like an idiot again in grad school.  Loyola University in Chicago and it's Bioethics department are a huge repository for some of the brightest minds in the field.  Sadly, mine is not one of them.  Still, I was adequate I suppose, and have continued on until I now have one class left and the M.A.  is mine.

But what does all this matter?  It doesn't really except to say that by the time I started grad school I started to seriously wonder why I was working as a nurse on the floor.  Not that there is anything wrong with that, but how was I going to use this Bioethics degree when my main imperative each day was to pass large quantities of medicines to my patients, to chart, and to admit, discharge, assess and report on them?  I needed something more so when the opportunity to become a hospice case manager presented itself.  I jumped. 

I was so glad I did. 

It all began

with a feeling I had last summer that something was not right.  I should have been happy.  I had a steady job, had completed a year of grad school, was healthy and getting by financially.  I had applied for and gotten the job I had wanted for many months.  Yet something was nagging me in the back of my mind constantly.  It all felt WRONG.

On a late summer day, I suddenly went and filled out an application for a job in hospice nursing.  It was terribly unlike me.  I had worked at my current job for nine years.  I was dependable, responsible and loyal. And yet, the second I let go of the envelope that held my resume and application and let it drop into the abyss of the mail box I knew.  It was the right choice.

Now, I have been in hospice for about nine months.  I LOVE my job.  I feel fortunate every single day that I can meet and be with so many fine and wonderfully delightful people and I get paid to do it.  Today, while reading a book on the monastery life, as I jealously wished I could live in a cell and think of nothing but praise for God and His creations, I realized that I can.  I can write down these things I do every day and LIVE the life of a thankful monastery monk. 

The stories will be true, but of course, all names, places, dates, etc., must necessarily be changed to protect the confidentiality of the patients and family members.  Perhaps no place on earth can you feel the presence of God more than in the presence of the dying.  The transition between this world and the next is palpable and surprisingly, comforting to those of us left behind.