Peaceful Passages: Glimpses into the Life of a Hospice Nurse

Printed in the Fall 2016  issue of Quest magazine. 
Citation: Wehr, Janet, "Peaceful Passages:Glimpses into the Life of a Hospice Nurse" Quest 104.4 (Fall 2016): pg. 118-119

By Janet Wehr

The First One

Janet WehrThe call came at 2:15 a.m. It was my first on-call summons since I had become a hospice nurse a month earlier. I dressed quickly, running a comb through my sleep-flattened hair, feeling more than a little as firemen do as they jump into their boots and slide down the pole when the alarm sounds. I reviewed the patient’s name and address and the message the triage nurse had given me on the phone: “Madeline D. is close to dying. Her family is expecting you as soon as you can get there.” On the way, I carefully remembered what I had been taught to do when I arrived. My heart would tell me what to say.

Taking a deep breath, I knocked on the door of the small but cozy apartment. Madeline’s granddaughter, Christine, answered, and it was obvious that she had been crying. Christine’s husband, Jack, was there to support her. I took a moment to comfort them, then went into the bedroom. Madeline lay in a hospital bed under a pink comforter. She was very old and frail, shrunken to just a wisp of a person. Her knees were drawn up to her chest as if she were going back into the womb. Her fingernails and toenails were a pale shade of blue, the color of the inside of a seashell, showing that her weakened heart could no longer perfuse even this child-sized body. Her breathing was raspy with the death rattle, and there were long gaps between breaths. I knew that she was only a few hours, maybe minutes, from dying.

I began gently to discuss with Christine and Jack the physiology of what they were witnessing in Madeline’s condition—the signs and symptoms of dying. They listened carefully, relaxed in knowing that what was happening was the normal process of a body letting go of life. Christine related to me that, only two days earlier, Madeline had shared that she was tired, she was old, she had had a rich life, and now she wanted to rest. She had said this calmly, quietly, and with complete satisfaction and conviction in her voice.

Unexpectedly a man then burst through the door into the apartment. It was apparent that he was angry and wanted to take charge. He was introduced as Christine’s brother, Robert, who was a prominent surgeon at our hospital. Robert stormed past us and went into the room where Madeline lay so close to dying. He visually assessed her for no more than a few seconds, then moved briskly to the phone and dialed 911. When he had ordered an ambulance, he turned to me and yelled, “What do you think you’re doing? My grandmother is dying! She needs emergency treatment NOW!”

I’m a good “diffuser” in most situations, and I calmly began to explain why this was not an emergency. “Your grandmother is ninety-nine years old,” I said. “Her doctor explained to your family that there was no treatment for her age-related illness and decline. She can’t see, she can’t hear, and now she can’t swallow. Perhaps she doesn’t want to stay any longer.”

Robert simply glared at me, tapping his foot with impatience, waiting for the paramedics to arrive.

And they did. When Robert opened the door to let them in and introduced himself in a loud, authoritative tone as “Doctor,” all the king’s men jumped into action and whisked Madeline out of the house and into the waiting ambulance, leaving Christine, Jack, and me with our mouths hanging open.

What had just happened here? None of the training I had received as a hospice nurse had prepared me for this. I felt that I had let Madeline down and prayed that she would not die in a speeding vehicle or in the emergency room among strangers. I prayed that the emergency room personnel would not intubate her or perform CPR. I wanted what Jack and Christine wanted, which was for her to be in her own bed, in her own home, with people who loved her and understood her desire to leave. I packed up my nursing bag and left Madeline’s home, feeling as if I had failed her.

I was called back to Madeline’s home the very next day, to hear from Christine what I already knew: the emergency room staff had taken one look at Madeline the night before and told the “Doctor” that his grandmother wasn’t sick, she was dying, and that they felt they should send her back home. Madeline held on until she was back under her fluffy down comforter, in her little pink bedroom, and quietly slipped away.

Hospice on Call

When the pager goes off, it’s 2:00 a.m., and I reluctantly leave my dreams and my soft bed and jump into action. I go to where my clothes had been laid out the night before to save time if a call came. I dress quickly, barely bothering with my hair, because I am needed somewhere.

Someone has died.

I leave home in the dark, following directions from the hospice information sheet. Even though I’ve been to this home many times in the daylight, I surely don’t want to get lost at this hour.

I pull up in front of the house. I center myself for a minute so that I can be the calm in the storm that is probably waiting inside.

A man with a tear-stained face greets me wordlessly at the door and walks me to the back bedroom. Then he disappears around a corner, not wanting me to see him cry.

There, in the hospital bed, is the person who has died. A tiny attractive grandmother. No heartbeat, no breaths. Pupils fixed and eyes at half-mast. I wonder about who she was, what things she had done during her life, who she loved, and who loved her.

I tell a young woman, who introduces herself as the patient’s daughter, that her mother has died. Two teenaged granddaughters standing at the door burst into tears as they hear the word they expect but have been dreading.

I turn off the oxygen and remove the oxygen tubing from the grandmother’s nose. I whisper condolences and tell the family to take as much time as they need. I explain that there are official phone calls that need to be made to the coroner, the doctor, and the funeral home, and I excuse myself to make the calls while they grieve. I call the doctor and to report that his patient has died. The physician has cared for this patient a long time, and I can sense sadness as he asks me to give his condolences.

I call the coroner and the funeral director, both of whom I know now on a first-name basis—these people who work during the wee hours of the morning, just as I do. I tell them the official time of death I pronounced: 2:00 a.m.

I offer to bathe the patient and dress her before the funeral director arrives to take her away. The daughter leaves to gather the necessary items, and I sense her relief at being able to perform one last, loving task for her mother. I bathe the body, tenderly and respectfully, while the rest of the family waits in the next room. This woman has been sick a long time. She is withered and wasted away. She still has blue ink marks on her chest and abdomen where the radiologists aimed the radiation treatments that were meant to help her. I dress her in the clothes provided by her daughter: clean undergarments; a soft blue sweater; black velour pants; cozy socks. I comb through her hair and take a moment to spread lotion on her face so that she will smell good when they kiss her goodbye.

The doorbell rings, and there is a white van in the driveway: the funeral director is here. I encourage the family to say their goodbyes and explain that it might be easier if they wait in the other room while we transfer the body. They decide to stay.

I help the director transfer the woman’s body to a gurney and watch as the bag is zipped up over her face. This is always difficult—the finality of it—although I’ve witnessed it hundreds of times.

I pack up stray medical supplies, strip the bed, and tidy the room. I dispose of medications in the bag of kitty litter that I keep in my nursing bag just for this purpose. I turn off the light and close the door behind me.

The family is grateful for my guidance and support during this difficult time. After my numerous visits over the past several weeks, they say they will never forget me. Despite the fact that I will repeat this scenario over and over again, little do they realize that they, and their loved one, are likewise etched in my heart forever. My watch says 4:00 a.m. I leave the home, get into my car, and turn the key. The pager goes off.

' Someone has died.

Janet Wehr, R.N., has devoted most of her nursing career to hospice care. A Qualified Therapeutic Touch Practitioner, she is a member of the Therapeutic Touch International Association and the American Holistic Nurses Association. She is also on the board of directors for the Saret Charitable Fund of DuPage County, Illinois. These stories are excerpted from her book Peaceful Passages: A Hospice Nurse’s Stories of Dying Well, published in 2015 by Quest Books. Reprinted with permission.

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