Coming Home

"You're angels," they say. "You're saints for doing what you do."

How little they know.

Most of us came into this profession - hospice, if not nursing in general - because we have lost. We have lost someone, or many someones, and have come to truly recognize and accept the inevitability of death. What bugs me at the moment about health care in general is the lack of knowledge amongst MDs about end of life teaching and support. The medical model is based upon curative measures: analyze the symptoms (and lab work where applicable), come up with a diagnosis... treat! Cure! Death is not an option, no matter what the cost - physically, emotionally, financially - for the patient or his/her family. Education in this regard is changing: more medical schools are beginning to incorporate palliative and hospice care into their curricula. Awesome. Speed it up, will you? And require older practitioners to participate in continuing education that includes palliative/hospice care? Thank you. 'Cause chemo/antibiotics/fluids/blood/beta-blockers/insulin/etc don't always work.

Every day I walk into work, and there are fresh flowers delivered from a family directly from someone's funeral, fresh coffee (because the previous shift/CNAs/volunteers are amazing), hugs and gratitude from family members of those who are in our care. Part of me feels unworthy. I am simply a person doing my job, which happens to be incredibly important to me. The other half of me is overcome with gratitude. After 3 years in the ER, being almost continuously verbally and sometimes physically assaulted, after tirades from people waiting in triage for seven hours.... Hugs and flowers and coffee are a most welcome change. There's a piano in the family lounge, for chrissake. Hell, there are *three* family lounges. One with toys and books for the kids. And shelves upon shelves of books and music.

And so, with painted walls, a balcony, fresh coffee, and warmed blankets, they declare us Saints.

But I am no angel. I am no saint.

I - and many of us - came to be here, in hospice, in nursing, because we are accustomed to the front line. We are acclimated to literal shit, to horror, to mayhem, to suffering. We are accustomed to things that some people have never experienced - and we hope never will. And you come to us with your wounded, your half or nearly dead - and we revive, or we let go, according to the patient/your wishes. And maybe we seem detached, cold, unsympathetic at times. It's not that we don't get it. It's that your loved one is not *our* loved one - and that is fortunate for the patient on the bed/table/gurney, because otherwise we could not keep our heads together.

My own grandmother is in a nursing home with Alzheimer's. I care for Alzheimer's patients on a nearly daily basis, and I deliver them comfort care the best way that I can as a hospice nurse. I am told that I do a good job. The patients' families are so appreciative, so kind and complimentary. Grateful.

But my own grandmother? I have not had the balls to visit her in over a year. Because I cannot bear to see the shell of the person I knew her to be. I am ashamed of myself for this. How can I be a hospice nurse and yet not participate directly - as a granddaughter - in her end of life? It's too much. I can't take the nursing hat off and simply be her granddaughter, because it hurts too much. I asked my mother recently - with my nursing hat on - how much my grandmother was eating per day. Three full meals. I broke down in tears and had to leave the dinner table, because it was too much to bear that my grandmother does not know any of us - her family, her children, her grandchildren, all of whom she lived for - and yet is physically strong enough to maintain an appetite, to sustain her blind existence, to continue in this way for however many years to come.

I wished her body to be less capable, faster. I wished her bowels to be less capable of processing food, and for that progression of her disease to lead to less hunger, and for that lack of hunger to lead to less nutrition, and for that lack of nutrition to lead to a swift and painless death. I wished for a fall with a head strike so fierce that it killed her instantly.

Because *I* can't stand it. Because I am selfish. Because I am impatient. Because I - and my family, most notably my mother - are not only bearing the weight of old memories she no longer retains, but we fear our own futures, our own inevitable declines.

So, no. We are not angels. We are no saints. We are doing for your family what perhaps sometimes we cannot do for our own. We are projecting our hopes for our own loved ones onto yours. We are prepping ourselves, shielding ourselves, arming ourselves against what will eventually hit us directly home.