What It's Like to Be a Hospice Nurse

Snapshots of life at home.
June 19 2013 5:30 AM

Approaching Death

A nurse goes from the ER to a hospice, and changes the way she thinks about life and its end.

(Continued from Page 1)

I had been involved in emergency medicine for 14 years—first as an emergency medical technician, then as a paramedic, and finally as a nurse. The crackling energy and hot, white lights of the ER seemed like a perfect fit for my frenetic nature. I’d always had enormous reserves of energy; reading was the only thing that ever slowed my racing thoughts, and my mother would hand me a book the way another might hand her child a lollipop. So, there I was, a center stage participant in a vital dance, and the result was a matter of life and death. I felt completely at ease. When I speed-walked down the halls, I often heard the joke, “Where’s the fire?” There were never charts waiting on the desk when I was working, and my inability to sit still, or to even slow down, lessened the workload for everyone as I zipped through the incidentals, the standard protocols, the well-worn paths of action. Everyone around me thought I was doing a great job.

But nonstop motion is not always as productive as it seems—the best emergency workers, in fact, move slowly, carefully. I eventually realized I was missing something. I felt like I was floating through someone else’s life, as if I wasn’t actually feeling compassion. I felt like a fraud.

I went to nursing school partly because I liked being the one whom people looked to and leaned on in times of crisis. Like many people I met in emergency medicine, I had the proverbial need to be needed. I took pride in caring for my patients, but my urgency to be in the next moment prevented me from really seeing them. My co-workers liked to work with me, of course, and my employers thought I was excelling. But what about the patients? I didn’t know how to find my buried compassion, nor did I know what to do next. But I knew the time had come to move on.

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The ability to change specialties is one of the best aspects of nursing. I assumed, because I had seen so much, because my critical care skills were the envy of some physicians, and because I knew exactly how to react in the direst of situations, that I was qualified to do anything. I had seen things most people would never see, having been at the center of a pounding, bloody battle where we won as often as we lost. I needed something completely different. Of course, any other type of nursing would be, if not a step down, at least less challenging. I walked around a job fair, aimless and uncertain, until I found myself standing in front of a hospice booth.

I had been, in my childhood, a distant witness to several deaths. When my great-grandfather died, I watched my mom cry and was sad he would never finish teaching me to play pinochle. I was heartbroken for my friend when her mother died, and I cried and cried when a car hit my golden retriever. But I was never afraid. This is not to say that I was evolved or anything. When I was 13 years old and square in the middle of that most awkward, terrifying slice of adolescence, I actually looked forward to death. Perhaps it was a brief, pathological, adolescent-induced depression that made me wish for it. As I matured, however, the feeling that death was a lovely way out stayed with me. Nothing could ever get me really down, or be too serious, because I would eventually die. It may sound like a strange consolation, but I had become quite comfortable with my old friend, Death.

Maybe hospice would be the fit I was searching for. During my first month of the new job, I agreed to work the weekend on-call shift. Two 12-hour days of nonstop calls took me from one end of the spectrum to the other: reinsert a urinary catheter, teach a family what CPR really entails, hold a child’s hand as his mother takes her final breaths. I constantly switched gears, depending on where a particular patient or family happened to fall on the timeline of life and death. Caring for the dying, as well as their families, I hardly noticed that I had somehow chosen the one shift in hospice that fit my old profile.

Over one weekend, I ordered antibiotics for a 98-year-old woman who lived alone and refused help with anything, comforted a woman who had to place her elderly husband in a nursing home against his will, and started an IV on a young woman who insisted she was not ready to die, though every system in her body was decaying from cancer. I spent two hours talking a wildly delirious patient into allowing his wife to give him his meds; I ran back to the office for supplies, twice; and I spent several hours with family members as they waited for the mortuary to pick up their matriarch.

It was five o’clock on a crisp, chilly Sunday evening when my pager beeped again: “Six-week-old patient in crisis.”

Six weeks?

A tiny flaw in the genetic makeup of a developing human can result in a life just incomplete enough—after nine months of gestating, 16 hours of birthing, and a few hours of bonding—to be afflicted with multiple congenital anomalies. “Take him home,” the doctors said, “and hospice will help you keep him comfortable. We are probably talking about weeks.”

The baby would suffer from longer and longer periods of status epilepticus, and drugs would become less and less effective. His tiny frame would flail in violent, disorganized muscle contractions 10, 15, 20 times a day. The hospice team—a nurse, a social worker, a chaplain, and a CNA—visited the parents every day to comfort them, to teach them to care for him, and to support their grieving process. The family had gotten to know this team, but I was the nurse on call that day.

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