Beyond the heartbreak and pain of dying, there is also a rare kind of beauty. There is the flash of impossibly cornflower-blue eyes as a patient gazes into the sunlight, the tenderness of longtime partners holding hands while laying side-by-side in a hospital bed, or a row of perfectly framed photos of children who all have the same dimple in their chins as their father. Still, there is the undeniable but raw sadness that comes with the body as it unravels.
When I was a new hospice social worker, I realized that all day, every day, I would meet people at their end, often at their worst, all of them dying. An older, seasoned nurse on my team said, "We have to live richly and fully for them, in their honor." I have never forgotten that. When I lived in India, I watched children chew on thick stalks of sugarcane, trying to extract as much sweetness as possible from the woody fiber. Working in hospice is like that. We look for sweetness and then magnify it, enjoy it even more, relish it completely. Perhaps because I see so much dissolution and so many endings, when outside of work, I love to create. Like balancing a salty curry with a couple of teaspoons of sugar, it evens out the raggedness of living a life engaged with death. I raise a jungle of houseplants, feed wild birds, bake bread. I knit chunky shawls, watching the even stitches line up in my hands, forming something soft and lush, and almost alive.
My youngest patient right now is 48 and the oldest is 106. Most of them will be gone in the next 6 months. But for all of them, "today" is the platform we focus on. Today the sun is out, today we can drink a cup of hot coffee, today the pain is managed well enough to take a nap unbothered. This "nowness" is the gift of hospice work. My patients have taught me the acceptance of the next minute, and resting in it fully is the key to living.
Every morning I triage my patients, noting who is actively dying and needs to be seen that day. Sometimes I have an intuition that whispers urgently to me, "Go see this one, go now, don't stop just get there fast" and I do. And without fail, that is exactly the person who needed me to be there at that precise time. This morning I write a letter to the State Department for the family of a Marine who needs to come home to say goodbye to his mother. I call an airline to arrange transport of a body home to Guyana. Families call with questions about where to donate wigs, or where to donate a body to science, and how to apply for medical leave.
I am finally out the door, and drive through a summer storm to get to my first patient of the day in a nursing home. He is reclining in a geri-chair, eyes closed, tucked under an Irish wool lap robe, too weak to open his eyes. I hold his hand and play Danny Boy on my iPhone, and sing along, then FaceTime his daughter who lives an hour away. He has stopped eating. Perhaps he will be gone by the end of the week. I give him a gentle hug. I carefully ask his daughter about the funeral home she will use.
Every day is a daisy chain of calls, letters to be written, funeral plans to explore, family tensions to ease, hands to be held, hearts to console. One of my patients likes to tell racy jokes and we laugh together. With others, simply sitting quietly watching the rain is a powerful visit. In hospice, there is no room for small talk.
Back in the car, I pop in my AirPods, and join a conference call, then drive to the hospital. I am meeting a young mother with three small children. She has stomach cancer that has metastasized to her lungs, and liver, and bones. Yesterday, I got the kids into her bed, and they curled around her legs like kittens. Today I brought three stuffed rabbits and some cord and beads to string. The oncology unit is sleek and dim, but her room is always full of lively Ecuadorian chatter, snacks, tias smoothing her hair, and getting cups of ice. I knock on the door and push it open. The room is silent, bright, immaculate, and the bed is freshly made, and empty. The empty bed. A stark image that means one thing. She passed in the night. I close the door, press my back to it and have a silent cry.