This is a short story that I developed after spending a week doing hospice training at Hendrick Medical Center. I spent some time on the inpatient unit, witnessing all that went on with dying patients. I dealt with social workers, nurses, doctors and many other health professionals. I saw a lot of weird things during my time, and my experiences directly assisted me in the writing of this story.
An Average Day, One in a Million
Dreams interrupted by the buzz of an alarm I have heard so often I am almost used to it. Sheets pulled aside, feet hit the cold floor. What day was it again? It was a Monday, which meant a day for new client paperwork. I drag myself out from my bed and prepare for the day. I put on my tie; still can never figure out a full Windsor knot. The car rumbles to life as the garage door rises, showing me the first true sunlight all morning, reflected in my rearview mirror. As I drive along, I hear another talk show that takes callers dealing with personal life problems. The therapist on the end receiving calls rushes through the process, not giving enough time for healing. Whitewash. That’s all this world wants anymore. A quick fix, an external fix that they do not have to take responsibility for. Traffic is light, as it should be at 7:00. The hospital is only 5 miles from my house, but the beehive that is the parking lot, even for employees is a maze. After a quick check that my doors are locked, I walk into the side entrance, sliding my ID card. The door lets me pass, and I am immediately assaulted by a crowd of hustling doctors, nurses, social workers, volunteers, and even a few patients being wheeled around.
Once inside the sanctuary of my office, I close the door to dim out the noise from the hall. My assistant has already placed the paperwork on my desk for new patients; she’s the best. I turn on the computer, and begin to sort through hospital announcement e-mails, weight watchers groups starting up, and even notices of continuing education opportunities. Gloria, my assistant, walks in and leans upon the doorpost that connects our offices. She asks about my family, my new niece, and how my seminar last week went. I could not have hired a better assistant. She is a retired nurse who wished to do more than volunteer, so I said I would love to have her aid me in my ever-expanding practice within the hospital.
Gloria and I had worked together now for 6 years or so. Initially, I was just some psychologist that checked on patients, but now I was an authority, respected, in the matters of death and end of life. Gloria and I had become even busier as time went on, once we were recognized for our abilities and resources. Gloria picked up where my expertise ended. She knew more about how to keep a patient comfortable during my prodding and poking, so we made a great team. Her husband had died a few years back; oddly enough he was my first patient. Gloria and I had formed a special friendship, and it was not uncommon for Gloria to keep me in check. She reminds me to stay alive as an individual, to not work so late so I can have time for myself, and even scolds me for my power lunches consisting of pixie sticks and sprite.
Today’s stack of new files was more impressive than the last, and not in a good way. I hate taking so much time away from patients to look through generic admittance forms. I am bound by ethics to review everything the intake form discusses, looking for abuse, neglect, suicidal tendencies, medications, and family histories. I received a few nasty ones today. Nasty in that the patients were in really bad shape; what we in the hospital call “the imminents”. These patients had maybe a few days left to live. These were automatically made a priority because of the proximity to death. A few of them could not even fill out the forms themselves; usually the family member with medical power of attorney would fill it out as best as possible. This was a job full of uncertainties. I had helped so many families cope with the anticipatory grief that befell them, but I also was the expert on mental well being before the end of life. How many times I had created charts for dying patients, helping them cope with their pain, keeping the nurses attentive, and confronting eager doctors that ordered too many tests, lessening the quality of life near the end.
Reviewing the stack of folders on my desk, I began to wonder how this day would go along. Friday had been easy. I had a day full of patients that were having “good days”. Being able to sit down, look doom in the face, and have it smile and talk to you was so very encouraging. Mondays were always difficult. Having to meet new people all the time, and to be viewed as having surefire answers to everything was always difficult. I found that I kept very close friends in the hospital to avoid becoming spread thin in sometimes thankless situations. When a family member dies, the family may need you for a while, and then they disappear, just to be replaced by another family over and over again. The most enjoyable patients were the ones in hospice. Once we stepped in, treated them like human beings, and less like projects, relationships could form. Having a patient solid for 6 months also allowed families to get to know you. Case in point, Gloria. Her husband was in our Hospice inpatient unit for about two months. We normally wouldn’t hold someone that long in that unit at one time, but his condition was very unpredictable. Clock now showed 10:30, time to visit a few patients before lunch.
Lunch was a sacred part of the day. Lunch became almost spiritual for all in the hospital. Patients could fill a need themselves, regain some control, and receive comfort. Doctors, nurses, and other staff would meet with friends, and it was like a Christmas armistice came across the hospital. We all became equal; we all became human. War was ceased on disease for the moment, and stress went into hiding. Families could imagine the patient like old times, eating lunch brought back that connection to the real world. Narcotics, antibiotics, SSRI’s, IV’s, and even surgery wasn’t the universal medicine, lunch and Sabbath were. Everybody took a dose at the same time every day, but it could never last the entire time.
I was scheduled to meet with Mr. Jones, an elderly man with a wife, 3 kids, 7 grandchildren, and 2 great-grandchildren. In his form, which he was able to fill out himself, he indicated he had terminal prostate cancer. Throughout his form, he indicated that he had experienced depression, but nothing out of the normal for someone who was worried about dying. His wife, on the other hand, was a complete wreck. In a generation where women stayed home, and had little formal education, she was looking to be dependant on her children once her husband stopped working. She needed him, but not just for monetary needs, she needed the foundation she had always known. A shift like this was rarely kind to a woman of this age. I recommended she be evaluated for depression; I knew if it weren’t today, she would be diagnosed later. Mr. Jones was asleep when I entered his room. I had gently knocked to request permission, something I had instituted in hospital protocol to bolster the patients’ belief that they retained a measure of control and dignity, and was granted entry. Martha, his wife, was sitting in a standard chair that every room in the hospital had, holding her husband’s hand, watching him breathe as if it was their first morning waking up together, side by side. She couldn’t hide a quick scowl towards my direction when I approached. I had gotten used to frightened and confused people giving me looks. A lady of manners and sophistication, she attempted to be cordial towards me, but it wasn’t working. I let her know that I was there if she needed anything, and to give Gloria a call when her husband woke up. Long good-byes were never common, I excused myself and left as quietly as possible; he wasn’t going to wake up, I had seen it too many times to know better.
After a time of rest, enjoying leftover meatloaf, I was ready for a full afternoon of visiting patients, and consoling families. The next on my list was a patient that had been with us for about three weeks, and they had no family, save their daughter, a lonely woman herself. It never fully became normal to me to see a daughter or son of a dying patient that was 65 to 70 years of age. Sometimes, if the patient was still able to walk, I would get confused as to which individual was the one in my charge. The patient was in her bed, eyes closed, mouth open, chest heaving infrequently. The daughter was there, gently wetting her mother’s lips with a wet washcloth. There was something eerily calming about a person in a bed, completely still, no tubes and machines beeping all the time. I had never heard this woman say her own name, let alone her voice. Her daughter looked at me, past the point of anger, and flashed a smile that, if I hadn’t been paying attention, I would have missed completely. The daughter, Sharon, rose to her feet, and gently walked over to me. She asked me to tell her the truth about how long her mother had. I had asked other medical personnel their prognoses, and it wasn’t good. I whispered that she had maybe 2 days. She nodded quickly, almost trying to shake the spirit of sadness from her head. She asked if there was anything more we could do, I simply shook my head. Tears were never easy to stop. She had to just accept the inevitable. I told her about the grief support groups I supervised, and told her to embrace her feelings, leaving appropriately soon afterwards.
The imminents were taken care of for the day, thank goodness. Now I was on to the new patients. The thing about new patients was that they were like gambling, the reactions were unpredictable, and usually not in your favor. I was about to walk in to another room, but I heard loud exclaims and a hullaballoo. My knocks were not heard, but I entered the room. The patient was in his bed, laughing, with intermittent coughing, with a very large crowd surrounding him. This was the sight I always loved to see. Having families surround the dying loved one really made my job and life easier. I walked to his bedside, introduced myself, and told him I would come by tomorrow morning after he was rested to do an intake assessment. You could tell he didn’t want anything to interrupt this moment in time where he was happy. As I excused myself, bumping into the odd relative, I began to think.
Death has more of a pattern than life itself. The predictable ones were the family members. Once the novelty of a relative dying wore off, fewer and fewer would show up to be there for him. I always held the faith, but I chose to stay in reality to make sure that nothing could surprise me. Next was another new patient, but wires had been crossed. He was being wheeled into his room just as I arrived; this wasn’t a good time.
This day was the easiest in a long time. I was scheduled to meet a patient that had been in the unit for a week, to evaluate his acclimation to his new surroundings, and assess his levels of anxiety and depression. Mr. Williams was still very much able to speak, and even could take a short stroll down the hall at non-peak hours. I spent an hour with him, asking him questions, not to just assess him, but to get to know him a bit more. We finished our time together, and I began to leave. He turned to me, called my name, and thanked me for my attentiveness. I told him it was just what I did, and I would be available for a chat anytime.
The orange glow of the sun glinted down the west hallway, signaling the closing of a day. Gloria was on the phone, reminding the hospice volunteers of their patients they were to make contact with sooner rather than later. I walked to my desk, and slumped into the chair I hardly ever got to sit in. Insurance paperwork was such a pain. Every assessment, every appointment was at least an hour longer than the actual session due to the prep work before and documentation afterwards. I had to update the psych profile for the charts that each of my patients had. Mr. Williams was reaching dangerous levels of depression; I would have to do a more specific assessment as soon as possible. Gloria appeared in the doorway as she did earlier that morning, purse on her shoulder, keys in her hand as she turned off her light. She wished me a blessed evening, and reminded me to not stay too late. I promised her, but I knew I would stay a little longer to visit more patients that I knew needed some attention. I left at 7:00 that night, drove in relatively little traffic, and picked up Chinese food from a local place. I loved walking into places where people knew my name, and what I ordered. God bless fried rice.
The keys jingled as I turned the lock in my door leading from my garage to the rest of my house. I adjusted the thermostat; winter was on its way. That meant more patients, and more opportunities. I turned on the TV after I baked a few filets of tilapia, and the top story was covering the legalization of PAS. The media always would pick interviews that would make them interesting, and skew the truth. News wasn’t news anymore; it was closer to Ripley’s Believe it or Not. A kid gets left in a hot car and dies, that isn’t news, which is a tragedy. Is anyone going to learn from crazy news anchors squawking about it? Frustrated, I turned off my television, and began making my way to bed. I always thought on a particular phrase of a children’s song that dealt with the Black Death: If I die before I wake, I pray the Lord my soul to take. I never liked the idea of growing old and ill, especially when I knew how things worked. It will all be okay, though. I have a little while still left yet.
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