A Hospice Story

garden gate 2

Rural San Diego County, California is about as close to heaven as I can imagine. I drove long distances between my patient’s homes on mountain roads lined with all sorts of flowering bushes and trees. It was sunny and 70 almost year round. I was driving through a lemon grove on the top of a small mountain with the scent of citrus wafting through my windows when I said to myself “I can’t believe they pay me to do this.” As I came to the end of the last line of lemon trees I realized I was at the very top of the mountain and at my patient’s wide brick driveway. As I was driving up to the gorgeous stucco home a tanned, blonde lady in her 40’s came bouncing down the steps in white shorts and a pink halter top. She stood beside my door as I scrambled to park, unbuckle my seatbelt and gather all the forms and tools I knew I would need. I was yet to realize that this was my new patient.

 

Sandra was unlike any person I had ever met, even more unlike any hospice patient I had ever cared for. She greeted me as if I were a long lost best friend. She showed me around her beautiful home and was especially proud of the pool with the manmade waterfall and stone bridge that crossed over it. Finally, we sank into her white leather sofa and joined by her husband she got right to it. “What’s it like?”, “Will it hurt?” “Will I know when I’m dying” “Will I be in a coma?” “Will I have to wear diapers?” Now, I am used to talking about all these things however, I am usually the one that struggles with when, and how to present this information to my patients. We spent several hours answering each other’s questions. I learned she had a tube in her stomach because she had difficulty swallowing, she had liver cancer of unknown origin which had spread to several other sites and had caused restriction of her esophagus, she could only tolerate liquids and ice cream, and she was not experiencing pain. I filled out the mountains of forms, collected all her history and reviewed her medications and set up our next appointment. She walked me through the arched front door and through her meticulously landscaped courtyard to the wrought iron gate. She waved goodbye and I drove back through the lemon grove and on to my appointed rounds.

 

When I saw Sandra a few days later she complained of moderate pain in her right side. She described it as a dull knife tearing through a tough steak. I knew that she was probably feeling the highly sensitive liver capsule stretch as the tumor grew. We started a pain regimen that would soon become the most extensive that I had ever managed. Sandra continued to be mobile, and cheerful. Sometimes we would visit in the living room, sometimes by the pool, sometimes in her bedroom and sometimes she would hold court in her bathroom at her makeup mirror as she continued to apply mascara, even when she had failed to remove it the day before, but she ALWAYS walked me to the gate at the end of our visit.

 

Sandra had fantasized several times about what her last Christmas would be like. It was only a few months away. Sandra realized before I did that she had probably already had her last Christmas. She set her sites instead on planning a vow renewal ceremony with her husband on the stone bridge overlooking the pool. It was scheduled for a month away. I was making daily visits to assess her pain, change her meds, eventually giving morphine, and then Dilaudid via a pump. The medical director came once every week to help me figure out what to do next. Still, leaning on her IV pole, against my loud and insistent orders, Sandra continued to walk me to the gate.

 

Sandra ended up on Continuous Care for a record-breaking 39 days. She refused to go to the hospital and honestly, I don’t think she would have received any better results in that setting. Her Continuous Care nurse walked her up the stone bridge for her vow renewal ceremony; she fell asleep twice during the short service. Having reached her target date, Sandra removed the mascara, tied her hair on top of her head and spent most of her remaining days in bed. Still, with the help of the Continuous Care nurse she insisted on walking me to the gate. My attempts to stop her had become a running joke. “Dammit, Sandy, you are NOT going to walk me to the gate. I’m the nurse and you have to do what I say!” She loved proving to me that I had no control over her whatsoever and when we finally, slowly reached the gate and I turned to point my finger with a mock scolding she put her hands on both my shoulders and squared herself and said “you know, you are right, I’m NOT walking you to the gate. You have been walking ME to the gate since the day I met you and it has been a beautiful journey.”

 

The next day, Sandra was unresponsive. She continued to live another week and remained on Continuous Care. I was present when she took her last breath. I will never forget her.

 

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Comments

  1. beautiful. She was blessed to have you as a nurse!

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