Sending Constance Beyond

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Remember my first patient who really inspired me at this assignment?
Constance, my 3pm appointment, with whom I loved to laugh during the Ellen Show...

She went out late last week to the hospital. She came back Monday with hospice services. Ohhhhhhh.....for all you who work in skilled nursing, sometimes those older folks you just love come home from the hospital ready for their life graduation.

Constance was laying still in her bed, covered only with a white sheet, white as a sheet herself, nasal canula supplying much needed oxygen to help her breathe. My own breath did a sharp intake.

"Oh, Constance!"

I could tell her life force was dwindling. Family had been called in. Most of the day, the room had been filled with family members. Two daughters stood outside the room.

I turned to them. "I just want you to know what a blessing your mom has been. I have enjoyed her so much!" I went on to tell them about what happened when we got together to prepare her arms for splinting.

They smiled broadly. I could tell it brought them some sense of relief from their grieving.  They encouraged me to go tell her goodbye.

I walked into the room. The hospice nurse aide was there at the bedside. I went to the other side of the bed and leaned into her ear.

I told her all the beautiful ways that she had touched my life. I wished her a lovely journey.

As I walked out of her room, I could almost close my eyes and transport myself to a building about 2 hours from here in which I had worked in the past, a building whose people handled death more lovingly, attentively and Christly than any I had ever seen.

The building had a special cart of cold and warm drinks and food. They had beautiful low music playing in the background. When the loved one passed, the body was escorted out of the building with a chaplain, followed by a member of each department, in prayer and honor to the one who had passed.

I will never forget the respect and honor that was paid to those graduates of life. I can only hope that I provide some sense of positivity to those who are preparing for their journey here.

Ben Harper's Acoustic Version

"Waiting On An Angel"

Waiting on an angel

One to carry me home

Hope you come to see me soon

Cause I don' t want to go alone

I don' t want to go alone

Now angel won' t you come by me

Angel hear my plea

Take my hand lift me up

So that I can fly with thee

So that I can fly with thee

And I'm waiting on an angel

And I know it won' t be long

To find myself a resting place

In my angel's arms

In my angel's arms

So speak kind to a stranger

Cause you'll never know

It just might be an angel come

Knockin' at your door

Knockin' at your door

And I'm waiting on an angel

And I know it won't be long

To find myself a resting place

In my angel's arms

In my angel's arms

Waiting on an angel

One to carry me home

Hope you come and see me soon

Cause I don' t want to go alone

I don't want to go alone

Don' t want to go

I don't want to go alone

Lesson of the Day: Live - and Die - Gracefully

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Mabel has lived in our building for years. She is 91; about a year ago, when I came here, she began to lose steam. She went from walking to using a wheelchair. Then she began to have falls when she wasn't aware of the loss of her strength, and she still thought she could take herself to the bathroom.

Mabel had a stroke last month. She came "home" a different woman.

She has tried her best, we see that, but she has lost her will. In the past week, she has quit eating, taking her meds, and getting out of bed.

I have worked with her to see if we can get her to eat. I offer her half teaspoons of pureed food, and small sips of thickened liquid.

(When people have a stroke sometimes, they lose the ability to swallow normal foods. When this happens, the food must either be chopped up or ground into small, soft bites or pureed in a food processor, depending on how much of a problem it is to swallow. Same with liquids - if you start coughing on regular fluids, you go to what is called nectar thick, then progress to honey thick water, milk, juice, whatever you're having....in Mabel's case, she can either take it from the spoon or if the cup is held to her lips. )

My dear Anita, fellow therapist, tells me that Mabel is unable to get up in her wheelchair today. Her face is cloudy and eyes misty. "I hope hospice comes in soon," she says.

Me, too...

We have been tag teaming to see if we can get her out of bed and up in the wheelchair to prevent her from getting pneumonia. "I'll work with her in her room," I assure Anita. I pick up her lunch tray and walk quietly into the room.

Mabel is laying on her back in the bed, head and feet raised slightly, and eyes closed. I speak in a low voice to her - try to be soothing, anyway - and I stir her thickened water.

"Can you take a few bites, Mabel?"

Eyes stay closed. Her head sways slowly back and forth in a certain "no."

She refuses food. She takes a few sips of water.

That is it.  That has been it for over a week.

I put the glass on her tray. Suddenly, her hand shoots out and grabs my arm, runs down my forearm and squeezes my hand so tight.

Ever heard the term "death grip?"

"Mabel, are you afraid?"

And her sweet, old, wrinkled face nods yes.

I sit with her then, knowing how difficult it must be to lay in that bed alone, knowing that she is dying, and having not one person there who has known her in her former BNH (before-nursing-home) life to comfort her, tell her stories about their shared memories or give her TLC.

Wow.

I stay there as long as I can, but it's time to move on to work with other people. I ponder as I walked down the hall back to the rehab department...

I hate to bring this up, but we are all going to be there one day.

I've come to believe that it's not just about living gracefully. It's about dying gracefully, too.

In a Basics of Buddhism class last year, Lama Chuck told our diverse group that Buddhists believe that the state of a person's mind in their final moments is of utmost importance.

It takes a depth of awareness to move through this period by understanding
what your purpose in this world has been, to accept assistance from others when you can't care for yourself, to forgive yourself and others, and come to full acceptance that you are getting ready to close your own circle.

It is our opportunity to practice compassion with each person and each death. Joseph Goldstein writes about compassion that, "It is not the suffering itself that causes our discomfort; rather, it is our aversion to it and our sense of separation from other."

Rather than thrashing in fear and holding onto a lifetime of resentments that have separated us from the ones we truly love, we are challenged, as we close out our time here, to move gracefully and with trust into the transition, the outcome of which none of us can confirm.