Paperback
-
PICK UP IN STORECheck Availability at Nearby Stores
Available within 2 business hours
Related collections and offers
Overview
All of Janet's forty-six personal stories are true, fascinating, heart-felt, and thought-provoking. Through her authentic examples, readers gain understanding, hope, and a sense of peace about what is, after all, an inevitable experience for us all. And with that sense of peace, comes joy.
This book is endorsed by the President of Hospice of America and will be used as a training manual by that organization.
Product Details
| ISBN-13: | 9780835609401 |
|---|---|
| Publisher: | Quest Books |
| Publication date: | 10/01/2015 |
| Pages: | 232 |
| Sales rank: | 576,506 |
| Product dimensions: | 5.50(w) x 8.50(h) x 0.80(d) |
About the Author
Read an Excerpt
Peaceful Passages
A Hospice Nurse's Stories of Dying Well
By Janet Wehr
Theosophical Publishing House
Copyright © 2015 Janet WehrAll rights reserved.
ISBN: 978-0-8356-0940-1
CHAPTER 1
The First One
The 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 like 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 what is known as 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 I did not recognize 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 done 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 for working 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 amongst 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.
CHAPTER 2Hospice 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 have been laid out the night before to save time if a call comes. 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, whom 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 them while they grieve. I call the doctor 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: 2:30 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.
CHAPTER 3For Comfort's Sake
Not surprisingly, laypersons who are caring for ill family members at home often presume that the medications that are used at the end of life cause death. The prevailing reason for this belief is that very sick people often do die while using these medications. But it is of utmost importance to clarify that the real cause of death for such people is the disease process itself, not the medications that promote comfort at the end of life. Morphine is one of these medications, and it is given routinely in hospitals, in other clinical settings, and at home, with no concern whatsoever to causing death. It is the same in hospice care, and I'll say it again: comfort medications don't cause death; illnesses cause death.
A few years ago, Ada, a woman who was of a religious faith that did not allow its members to seek medical help or to take medications, was added to my caseload of patients.
Ada's husband, Charlie, had made the initial contact with hospice, and I met with him before I met with Ada. Within minutes of introducing myself, I saw him crumble into a heap of despair while he told me his wife's story. Ada was sixty-three years old and had end-stage breast cancer. Because of her religious beliefs, she had not seen a physician for this or any previous health conditions, nor had she taken any medication to help with pain. Months ago, she had closed herself off in an upstairs bedroom, and since then she had rarely seen visitors except for Charlie. The reason was this: her left breast was being devoured by the cancer that was growing there, and the smell was horrific. She isolated herself from other people, including her children, so as not to embarrass herself or offend others with this problem. This was bad enough, Charlie cried, but his wife was in so much pain that he just couldn't stand to watch her suffer anymore. He told me tearfully but with conviction that he was ready to break his vow to his church for both him and Ada and wanted to begin giving Ada medication to ease her pain.
I empathized with Charlie, but I knew that if Ada was of sound mind and able to make her own decisions, it would be she who had to make this choice.
When I got to the upstairs room where Ada had chosen to hide herself, I found something that made my heart break, and it wasn't the smell that I found so overwhelming it made me feel dizzy. Ada was sitting in a chair, hunched over a small table, with her upper body balanced on her elbows, which was the one and only position she found she could tolerate due to the severity of her pain. Charlie, who had followed me upstairs to his wife's room, told me that at night he put a pillow down on the table so that she could rest her head. He said that she had been unable to lie down or sit back in the chair for weeks. Every movement, every breath, every attempt at sleep was an ordeal of pain.
I began to tell Ada that there were things I could do to help her. When I told her I could get a hospital bed that we could adjust for her comfort, she stared. When I told her that I could get dressings to eliminate the odor of her cancer, I had her full attention. When I told her I wouldn't rest until I knew she could rest, she started to weep. "All I want is to be able to lie in a soft bed. All I want is to take a breath and not have it hurt. All I want to do is to go to sleep."
Charlie moved closer to his wife then and told her in a quiet voice that he had changed his mind about a few things, and one of them was their religious conviction not to take medications that could help them. "You aren't against science, are you?" he asked gently. "God gave us science, and science made these things available. Maybe we've been ungrateful not to use what God has provided." Ada didn't have to think about it very long. She nodded silently at Charlie, then whispered to me, "I'll do whatever will help me." "Thank you, God. Thank you, Charlie," I prayed silently.
It is a well-known fact among hospice nurses that pain or anxiety can keep a patient in a lingering pattern during their dying. A person can become so focused on the physical feelings they are experiencing with their body that they can't relax enough to let go and allow death to occur. My belief is that when medications are given and interventions are performed to promote comfort and relaxation, the mind and the heart of a person can enter into the necessary quiet place that will allow them to connect with their spirit. It's as if the physical body can finally exhale and say to the soul, "I'm done. You take over for me now."
Within two hours, a hospital bed was set up in Ada's room with the best, softest mattress that was available. Medications for pain, anxiety, and the other end-of-life symptoms were on the dresser with instructions for their use. I cleaned and dressed Ada's left breast wound with a dressing that contained a charcoal filter to eliminate odor. I asked her if she would take a dose of pain medication before we attempted to transfer her to the new bed, and she agreed.
After waiting fifteen minutes for Ada to relax and for the medication to take effect, Charlie and I lifted her delicate, little body out of the chair she had sat in for so long and laid her gently on the bed. We covered her with a soft, yellow flannel sheet and stood back. It was the first time in several weeks that Ada had been able to lie down and rest her sick body. She sank into the bed's softness, and I heard her sigh. Although her eyes were closed, her face broke into a sweet, heavenly smile, and she said almost inaudibly, "Now I have everything I want."
Once Ada was comfortable, she never spoke or moved a muscle all night. She died just before sunrise the next morning, having found the peaceful place she needed so that her spirit could soar and she could leave her body behind.
CHAPTER 4Not Yet
As hospice workers, we are well aware that hearing is the last of the senses to shut down during the dying process, and there is growing evidence that patients can hear right up until the time that death claims them. They often lack the energy or the focus to converse in the way they used to, but they continue to be aware of who is present and other small details of daily life. We urge family members and friends to talk to their loved one and especially to share what is in their hearts, even though the patient appears to be nonresponsive or in a comatose state. We know that the time dying persons spend in apparent sleep is time they are actually processing what they need to do to accomplish passing from this world. It isn't unusual for a patient who hasn't verbally responded or been alert in many days suddenly to contribute a comment to a conversation going on around them or to rouse, if only briefly, to make a statement, ask a question, or connect in some other, important way. We teach families to talk to the dying person and to share information with them, such as the day, the date, and plans for who might be visiting. Even if the person seems to be unaware of what is going on in their environment, we encourage their families to talk to them as if they were listening, because they are. If doing so can contribute to a peaceful passing, it is well worth the effort, even though the family might feel it's in vain at times.
Sometimes the dying person is waiting for one more element of closure to conclude their business before making their final passage. One male patient survived several days longer than the expected seven to fourteen days for someone in a comatose state who had thus not received food or fluids during that time. The body's organs suffer from dehydration after only a few days; yet this man was almost sixteen days into the process, and we did not see any of the obvious changes associated with imminent death. I understood the reason after I spoke to his wife. She told me that their son lived in China and that the only flight he had been able to book would not arrive for another twenty-four hours. She had held the phone up to her husband's ear so that their son could reassure his dad. "I'm coming, Dad. I love you. I'll be there on Friday at 8:00 p.m." Sure enough, our patient was still lingering on Friday at 8:00 p.m. He had the closure with his son that he had waited for and died at 9:00 p.m., having checked the final item off his "to do" list before he left.
(Continues...)
Excerpted from Peaceful Passages by Janet Wehr. Copyright © 2015 Janet Wehr. Excerpted by permission of Theosophical Publishing House.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Contents
Acknowledgments,Introduction: Why Hospice? Or, How the Peaceful Passages Book,
Came to Be,
Part One: Understanding Death,
1. The First One,
2. Hospice On Call,
3. For Comfort's Sake,
4. Not Yet,
5. Dying with Dignity,
6. I'm Coming, Dad,
7. One Last Wish,
8. Hospice 101,
9. A Water Bug's Tale,
Part Two: Ways of Saying Goodbye,
10. A Baby Angel,
11. Gone from My Sight,
12. The Look of Love,
13. A Sky Full of Crows,
14. Promises,
15. Till Death Do Us Part,
16. Upstairs,
Part Three: Heartwarming Relationships,
17. Home Sweet Home,
18. Now Hear This!,
19. Now I See You,
20. Rose Jeanine,
21. Birds of a Feather,
22. That's a Lotta',
23. Male Bonding, in Spirit,
24. Shared Death Experience,
Part Four: Mysterious and Spiritual Experiences,
25. Penny from Heaven,
26. Two People, One Dream,
27. Carpenter Angels,
28. Barrett's Song,
29. Two by Two,
30. By Special Invitation,
31. Remote Connection,
32. Laughing Jesus,
33. Reaping What You Sow,
34. A Sister's Farewell,
Part Five: Tough Customers,
35. Star Struck,
36. Letty, My British Import,
37. Late-Night Goodbye,
38. The Next Stop,
Part Six: Comic Relief,
39. Too Much Information,
40. Hospice and Hamsters,
41. A New Intervention,
42. Did They Really Say That?,
43. Brave Dave,
Part Seven: Cultural Differences,
44. An Indian Princess,
45. Hospice and S.W.A.T.,
46. Caves and Cockroaches,
47. Fatimah's Gift,
Part Eight: Closing Thoughts,
A Friend for Me,
My Personal Journey,