I am often asked why I chose to work in hospice and palliative care. There isn’t one answer to this question other than to say it was a calling. There is such a spiritual side to hospice; it’s so much more than giving IV medications and changing bandages. I don’t consider myself an expert in end of life care, and I know I’m not the best hospice nurse in the world, but I find caring for those facing the end of their time to be extremely rewarding. I know it’s a totally selfish reason, but the people I have met in this journey have given me purpose, inspiration, insight, love, and hope. I have seen pain and bliss, anxiety and peace, loneliness and friendship. I have seen things that are difficult to explain.
The first time I thought about becoming a hospice nurse did not involve a patient transitioning to hospice. A recently employed RN coordinator at a skilled nursing facility, I was still adjusting to the change from acute care on a busy post-surgical unit to long-term care. My office was across the hall from assisted living rooms where the frail, elderly residents sat at their doors waiting for someone – anyone – to visit.
I realized that many of the wonderful residents of this facility did not have family nearby, including a lovely 99 year old lady who we’ll call Anne. Born in England in 1896, the 75 years living in the U.S. has faded her British accent so just a trace remained. She was elegant, polite, kind, and amazingly fit for nearly a century of wear and tear. We started with simple greetings in the hallway, then like a moth I was drawn to the light in her gentle soul and started visiting her as much as possible. At times we would eat lunch together in her room or I’d bring her homemade cookies. We became close, maybe because my grandmother passed the year before, maybe because we were kindred spirits.
Anne may have been the most independent resident in the assisted living rooms. The nursing home was square with a courtyard in the middle, and I remember she walked the inside circle after every meal, pushing that walker with the pink basket as fast as she could go. I was not aware at the time, but now I recognize much of her routine is common among centenarians. She ate mostly vegetables; she always had an afternoon nap and went to bed early. She maintained friendships with many other residents and staff, and she always saw the glass half full. Anne was always a positive ray of sunshine in the dismal surroundings of a nursing home.
As her 100th birthday approached, her family contacted the facility to arrange a space for a celebration. Family came from New York, Tennessee, Colorado, and Hawaii where she spent most of her married life as a Navy wife. She moved to the mainland when her husband retired, and she joked that most people in Indiana want to retire in Hawaii yet she did the opposite and ended up in Indiana. Her husband died decades before and was buried in Indianapolis next to their oldest son; she remained there because it had become her home. To her five children, 17 grandchildren, and many great-grandchildren, Indiana had become the central meeting point for family reunions, including her 100th birthday party.
I remember family showed up a week before the celebration, trickling in for visits as they arrived. Anne was the happiest I’d ever seen her. No more waiting at the door for visitors – they waited at her door to have one-on-one time with this amazing family matriarch. She pulled volumes of photo albums from the top of her closet and went through photos from England, Italy, Hawaii, and from every vacation she had taken with her husband. She reminisced with family right up to the afternoon she blew out 100 candles (she had a little help). After the cake was devoured and the guest had left, Anne went to her room to eat her dinner like it was any other day. I stopped by before going home to see how she was doing.
“I’ve had the best time today.” She remarked. “Seeing my family together again warms my heart.”
“That’s great, Anne,” I replied. “You will have so many new pictures that you’ll need another album. You can share them with your family next year on your 101st birthday.”
“Oh no,” she said matter-of-factly. “That will be the last time my family gets together like we did today.”
“I will have the film developed when I go to the store tonight. They have a instant photo booth.” I planned to surprise her with a new photo album.
“I have lived 100 years and I think that is enough for me. I’m ready to go home now. I’m ready to be with the Lord.” She seemed at peace, staring into the distance. I didn’t think much of that comment because most older people talk like their next birthday isn’t a given, and I suppose it isn’t for any of us. Besides, she was exhausted. She might have been spry for 100 years old, but she missed her nap and all the visitors during the week had been a little overwhelming at times.
“You get some rest tonight.” That’s all I said before I left.
The next morning I noticed she wasn’t in her room watching the national news headlines during breakfast, which was part of her daily routine. I stepped in and saw her bed was not made and her dentures were still in the cup on her night stand. I immediately checked with the nurse’s station to see what was going on.
“I don’t know, she just died,” the night nurse said as she was leaving. “She was fine at 4:00 a.m. bed checks, then at 6:00 o’clock she was gone. Died peacefully in her sleep.”
“She went as gracefully as I’ve ever seen anyone die,” commented another nurse.
“That’s crazy!” It’s all I could think, because it was absolutely bonkers that this perfectly healthy woman died on her 100th birthday, or technically the day after. Sure, she was a centenarian, but there were no medical issues that would have caused her to die suddenly.
“Oh Sweetie,” the older nurse commented. “After you’ve been around a while, you will see a lot of crazy things.”
Looking back I believe Anne had simply decided to die. I can’t explain how someone could do that – to control their body or have it cooperate with their decision, but I certainly understand why Anne would have if she could have. She told me herself she was ready to go. I heard her but I did not listen, something I vowed to change going forward.
This is when I realized the magnitude of the nurse’s presence with those facing end of life. I was one of the last people to speak with Anne. I also witnessed how death can be a moving, miraculous event. Most of Anne’s family was still in town, and those who could, stayed for the service. Those who had to leave were grateful they had the chance to see her once more. What an honor to have known her, to spend time with her in her final days. It was Anne who showed me how natural and beautiful the end of a life can be, and it was Anne who inspired me to walk the path to hospice nursing.