GRIEVING

Eighty-two year old, “Eleanor” had been estranged from her son, “Richard”, for years. Richard became addicted to alcohol and drugs as a young man. Eleanor shares that she and Richard have not spoken in years. She says that when she suffered her stroke a few years ago, she never heard from her son. She has disappointments and regrets over their relationship. She takes some blame for the breakdown saying that maybe she could have done some things differently.

Her son had been in a nursing home as he could no longer care for himself. Richard’s friend, “Peter”, was willing to step in and help as needed. Richard’s health took a sudden turn recently to where he spent most of his days sleeping and eating very little. That is when the hospice referral was made.

When I went out on my first visit to meet Richard, I found him in a deep sleep. I gently jiggled his shoulder, but he did not awaken. On my second visit yesterday, I found Richard unresponsive and in a coma. One knew his death was imminent.

Richard died a little after midnight this morning. The hospice nurse reported that Peter was going to call Eleanor and inform her of her son’s death. I called Eleanor later this morning to offer condolences. It was then when I discovered that Peter had not called her. She was not surprised by the news as did know her son was in a nursing home and not doing well.

Eleanor shared that her daughter, “Danielle”, died seventeen years ago from cancer. Eleanor is very close to her three granddaughters, Danielle’s children. Eleanor has a strong faith which helps her cope with the belief that her son is now at peace. She spoke of regrets and sadness that he got into drugs. Eleanor will move forward with the help of her Christian faith and her three granddaughters. I wish her well.

GRIEVING

　
Life has not been easy for her.
She has suffered so many losses;
more than any mother
should ever have to endure.

She’ll readily admit to those around,
“Loss is different when it’s a child,”
First her daughter from cancer,
now her son from poor choices.

I thought she was told about her son.
I thought she already knew.
I called her to offer condolences
finding I was the one to let her know.

She was not at all surprised.
She knew that this call would come one day.
She regretted the choices he had made.
She so wished it didn’t have to end this way.

She has been grieving her son for years.
Grieving the death of their relationship.
Grieving what he could have become;
his potential, his future.

She will mourn him a while longer.
She will grieve as any mother would.
But she also feels some relief
hoping now he has found his peace.

A mother’s love.
A mother’s heartache.
A mother and her son,
       for quite a while,
              have both been grieving

ALONE

Sixty-one year old “Rob” suffers from renal cancer. Rob was diagnosed a month ago while in the hospital for a short stay. Two weeks ago, he was placed into a Skilled Nursing Facility. It was then that Rob was referred to hospice. Rob’s ex-wife, “Elaine”, had been involved and supportive and helped with the placement. Initially she informed the nursing home staff that she was the contact person.

When the hospice staff called Elaine to set up the initial visit, she adamantly told hospice not to call her as she was not involved. The nursing home staff was unable to get any additional information from Rob as he was getting confused and could not help.

A few days later, I did a visit to the nursing home to meet with Rob and attempt to find out who would be legally making decisions for him. Family can make decisions without legal paperwork, but it is always best when you can talk to someone with whom the patient has delegated that role. Unfortunately, Rob was in a deep sleep and I could not awaken him. To no avail, I read through Rob’s nursing home chart in order to attempt to locate another family member or friend.

The social worker from the nursing home called me today requesting that I attend a care conference this afternoon for Rob. Fortunately, I was able to shift my schedule around and attend. The nursing home staff still had Elaine as a contact person. They had called Elaine about the care conference and she agreed to be on speaker phone for the meeting. When the social worker called her during the conference, she told him that she was not involved and did not want to take any responsibility for Rob.

The social worker said that, in these type of cases, they call the Public Administrator who will take over once the patient dies. The patient will get cremated through the state.

It just seems so sad to have one’s life end so alone. How many people will be aware or even will care that he has passed? I know I care and it breaks my heart as I feel so sad for him. I guess we choose our life and have to take some responsibility for the outcome. Maybe it is a blessing that he isn’t aware of his current situation. It could be that he is not sad at all. I would like to believe he is going to a better place and will never be alone again. God only knows.

ALONE

　
It breaks my heart to see him.
Lying there with no one around.
A handsome man struggling to breathe.
In a nursing home; alone.

His mother is elderly and frail.
She’d like to help, but cannot.
She struggles with their strained relationship.
She’ll sadly share, “He got into dope”.

His ex-wife refuses to help.
She doesn’t want to be involved.
She needs to distance herself from him.
There is no one else to call.

He’s hardly eating anything at all.
He no longer is able to talk.
He spends most days in a deep sleep.
Likely not aware of what is going on.

He doesn’t have much time left.
The county will then take over.
They’ll do what needs to be done.
Cremation and burial;
        alone.

EMOTIONS

I received an urgent phone call at 5:50 this morning from a dear friend, Camille, asking me for help. After six weeks of a very stressful hospital course, her husband, Howard, just wanted to go home. After two surgeries, he became septic. The infection was impacting his system to where his organs were shutting down. The only option was dialysis, which was not a viable choice for him. There was also a high risk that he would require life supports.

After talking things over with his doctors and family, Howard decided that he just wanted to go home. I had not been aware of these recent events and was shocked by the phone call this morning, but so grateful that she called. She had questions regarding the process for getting her husband home on hospice.

Howard was in a hospital two blocks from my work. Surprisingly, I had no scheduled visits this morning and was available to help her in any way she needed. Typically my schedule would be full, but I feel a higher power was involved in giving me time to be available to my friends.

I called Camille when I got to work and offered to come over if she needed, as I had all morning available for her and her family. She sounded so relieved when she said yes. She wanted me to be there when the discharge planner talked with them.

I had not met any of her family before as they all live out of the area. They all so graciously accepted me into their world. I was there when the discharge planner explained the process. I clarified things and gave thoughts of what they might expect once they got Howard home.

I spoke with Camille this evening. She said that Howard just got home. Her reaction humbled me as she thanked me for getting him home. From my perspective, I was only a small part of getting Howard home as I was just sharing what I knew. I had the easy part as I was just being a friend. The gift of giving and receiving are both given out of love. I thank them as much as they thanked me for allowing me in at such an intimate time of their lives. I am honored, humbled and in awe.

Camille taught me that it doesn’t matter how big or small, it is the act of giving to another that is huge, especially when it is given all in the name of love.


EMOTIONS
　

It is hard to put into words,
the emotions that I feel.
I am honored; humbled, in awe.
A mixture of feelings profound.

He foremost on their minds.
Wanting help in just getting him home.
Not knowing where to start;
not knowing what to do.

I needed to be there for them,
but also for me.
The strong desire to fix things;
wanting to take away their pain.

I couldn’t speed up the process.
I couldn’t make staff appear.
I could only give thoughts of what might be
once he did get home.

They asked so little of me.
Their appreciation abound.
Humbled by their reaction.
In awe of who they are.

Emotions

THE CHANCE

Today I had the opportunity to say goodbye to a patient I had known only three months. I did weekly visits as it was important for her to be able to process her emotions. This was a new diagnosis of cancer and her decline was swift.

Visiting today, I found her to be actively dying. She had not eaten for over a week. She was lying in her hospital bed with labored breathing. Her eyes were open, but she wasn’t seeing, although she appeared, at times, to understand what was being said to her. Even though she and I had only met three months ago, we instantly bonded. Immediately we both knew we were kindred spirits. I mentioned to the patient how we were kindred spirits and I heard her weakly reply, “We are.”

Many patients will let go once they know their family is going to be okay. Some patients may have unfinished business or they may be waiting for a special birthday or anniversary date. There are multiple reasons why someone lets go at any particular time. I just know that it is always the perfect time for them. I felt honored to have been able to say my goodbyes to her today.

Addendum: Her daughter flew in from out of state two days later. The following morning, the patient died peacefully with her three children by her side. It was the perfect time for her.


THE CHANCE

　
Thank you for giving me the chance;
the chance to say goodbye.
Thank you for allowing me to tell you
the impact you made on so many of us.

It was hard to find the fitting words;
words that clearly could express my heart.
I hope you heard the love, the honor and the respect;
that I was attempting to convey.

I know you didn’t want this to happen,
but I know your faith is strong.
You biggest worry has always been your children.
You want to know that they’ll be okay.

I promised you I would make sure of that
in the best way that I knew how.
Phone calls, follow-up, comfort.
The support will be available to all of them.

So when the time is right for you;
when all your work has been done,
let go, fly high and soar
when you have the perfect chance.

CROSSING OVER

Sixty-four year old “Timothy” came onto hospice two days ago. He suffered from renal cancer that had spread throughout his body. Timothy lived with “Kitty”, his wife of forty-four years. Kitty and Timothy had two adult children; forty-two year old “Valerie” and thirty-eight year old “James.”

The family was beset with health problems. Kitty had a lupus type of disease that attacked her muscles while James suffered from Schizophrenia and drug addiction. James lived nearby in a facility for the mentally ill. Valerie was married and lived nearby as well. She was the caretaker for all of her family members.

Timothy was gravely ill when admitted to hospice. The family gathered around to support each other and Timothy. James would not go near his father and kept pacing the floor. Kitty thought it best that Valerie drive James home.

Timothy died at 8:30 that night, hours after being admitted to hospice. The family kept trying to contact James and could not reach him on his cell phone. Valerie’s husband drove over to James’s apartment the next afternoon and, it was then, he called the paramedics. The paramedics believed it was an accidental overdose of drugs; telling the family that James had made an “amateur mistake”. The paramedics calculated that James died thirty minutes before his father’s death the night before.

Valerie and Kitty believe that James was with his father when Timothy crossed over. James had always needed help from his family and felt bad that he could not help them in return. The family truly believe that James was there to help his father cross over and that they crossed over together. It gives Kitty and Valerie peace knowing that they both are together in a better place and that James was finally able to help his father in return.


CROSSING OVER
　

He always depended upon his dad,
and his dad was always there.
Especially through the hard times
of his mental illness and drug abuse.

His dad got sick a few years ago.
Thinks were okay for a while.
But in the end, the cancer took over
causing so much heartache and pain.

He was there when his dad lay dying.
He couldn‘t sit still; he paced the floor.
It hurt to see his dad this way
so he had his sister drive him home.

He must have taken too many drugs.
He just wanted to ease the horrendous pain.
The next day they found him in his bed.
Drug paraphernalia lying around.

They calculated the time as best they could.
Figuring he died shortly before his father passed.
Family believes he helped his dad cross over.
Reaching out to him and holding his hand.

It gives mom comfort to know
that her husband and son are together in peace.
Her son finally able to help his dad,
like his dad had always done for him.

Two losses moments apart.
How does a family cope?
She believes in God and the power of love.
Crossing over together, father and son.

A LITTLE SAD

As a hospice social worker, I meet so many amazing and wonderful people. Every now and then, I connect with someone on a much deeper level. Usually it is someone with whom I can relate to so easily for a multitude of reasons.

After they have died, normally I will be sad for a while, but realize that they are in a better place and are no longer suffering. I then am able to focus on the things I so admired and loved about them. I have been hit doubly hard this week as there are two patients that I have strongly connected with. “Fred” died two days ago and “Rita” has likely only a week or two to live.

Fred was in a slow decline, but then took a sudden turn, and in one day, with his family at his bedside, he was gone. Rita is having weekly changes and declining to where now she is sleeping most of her days and eating very little. I visit Rita weekly and see a dramatic decline with each visit. It hit me today that she likely won’t live for much longer.

For me, Rita’s decline, being so close to Fred’s unexpected death, has hit me doubly hard. I became sad after visiting Rita this morning and I cannot shake the feeling. I realize that my sadness is the grief I feel knowing that Rita’s time and mine is coming to an end. In addition, I know that Fred and my time is now over. What remains is the memories of knowing each of them.

What also is impacting me I know, is that yesterday was the fifteen year anniversary of a dear friend’s death to breast cancer. I have been thinking of my friend, Kate, a lot this past week and hoping that she is aware of how she so strongly impacted my life. I believe the sadness I feel, is the result of these three amazing people that I have been so blessed to have been able to meet and share part of our journeys together.

A LITTLE SAD
　

I am feeling a little sad tonight.
It has hit me hard somehow.
Usually I can shake it off
and remember them with love.

Some cases can be harder than others.
Some patients touch me deep in my heart.
That vulnerable place of love and pain.
An honor to have had them cross my path.

He died so suddenly.
We were all surprised.
A blessing for him,
but I needed more time.

She’s going quickly.
She doesn’t want to linger.
She’s ready to die,
but I’m finding it hard for her to go.

Two special people who have graced this earth.
Two people who have touched so many souls.
We all are better to have known them,
if only it was just for a short time.

So I guess I’ll be sad for a little while longer.
For a while I will have a heavy heart.
In its time the sadness will go;
replaced by the memory of two special souls.

HIS OFFICE

Eighty-four year old “Ogden” suffered from lymphoma. He was diagnosed four years ago. Ogden had been doing quite well, although was slowly losing some of his energy. He used to walk a mile each morning to buy the daily newspaper or take care of his half acre property. Activities he no longer has been able to manage.

I first met Ogden about twenty months ago when his wife came onto hospice. Coincidently months before then, I met Ogden’s daughter, “Annie” when she was the primary caretaker for her aunt, her mother’s sister, who was on hospice. A few months after her aunt died, Ogden’s wife, Rita” came onto hospice. Rita suffered from Alzheimer’s Disease. Ogden hired a full time caretaker to attend to his wife’s needs. Annie, again, was the primary contact and support person.

Ogden and Annie loved Rita. Rita was bed bound and so confused, but always had a smile. She didn’t understand what was happening, but was so easy going and receptive to any help that was offered. I would always meet with Ogden and we would talk in his office. A very large desk sat in the middle of the room. His desk chair swiveled conveniently right near his computer. Also his chair was conveniently situated to watch the stock market channel, his favorite station. He was very content and said that he rarely went into any other room of his home.

Rita died ten months ago peacefully in her home. I knew Ogden was heartbroken, but he also understood that Rita was in a better place and no longer suffering. Due to his spiritual beliefs, Ogden believed he and Rita would be together again one day.

Three months ago, Ogden and my life crossed again when he was admitted to hospice. I was happy to see him, but a bit sad as he was so much thinner and weaker than the last time we saw each other. Ogden still had his amazing smile and, again, welcomed the hospice staff so warmly into his home.

With each visit, Ogden and I would meet in his office. He would always sit at his desk and I would sit on the side of his hospital bed a few feet away. Ogden spoke of Rita frequently and their sixty years of marriage. His decline was slow and he knew he would be with her soon. I visited Ogden five days ago and, as usual, he was sitting in his desk chair. When I said goodbye, I had no idea that it would be the last time I would see him.

I heard this morning that Ogden died yesterday with his family at his side. I feel sad, although I know he is now with Rita. I will miss him as he was always a joy to be around. Some folks cross our path for a reason. Ogden will always have a place in my heart.

　

HIS OFFICE

　
He was always in his office.
It had everything he needed.
His computer, his bed, his TV.
Everything within arms reach.

He was most comfortable there.
While his wife was sick;
when he too became ill.
It was his sanctuary.

I have known him for almost two years.
I don’t think we talked any other place.
He was always in his office,
welcoming me with his wide grin.

His wife’s been gone almost a year.
He talks about her all of the time.
How much he misses her.
How he knows he’ll be with her soon.

We talked in his office just last week.
He in his desk chair; me nearby.
Talking about his wife and children.
Sharing stories of his life.

Now he is gone.
The end came quite suddenly.
He dying where he was most comfortable.
I know where he chose to be.
          His office.　

DID SHE?

Fifty-one year old “Marcia” was diagnosed with stomach cancer two months ago. Her daughter, “Terry” had been after her mother to go to a doctor for weeks. Marcia had always been stubborn and refused to go. When it got to the point that Marcia had to stop during her workday to sit down a lot, she relented to her daughter and saw her doctor. It was then that she was diagnosed with the cancer. Her cancer had already spread to her liver and there was no treatment.

Marcia moved in with her daughter and son-in-law, “Jason”, two weeks ago when she knew she could no longer manage living alone. Terry and Jason both worked, but Terry planned on taking leave when her mother could no longer be left alone. Everyone thought it would be in a month or so, but Marcia’s decline came on rapidly.

Marcia came onto hospice ten days ago. I saw her last week and she was up and about, although eating very little and appeared frail. I did a return visit today and met Terry for the first time. Terry said that mom fell three days ago. It was then Terry put in for her leave and has been home helping her mom.

When I saw Marcia, I was amazed at the changes in her. She was confused, looking, but not really seeing. She was lying in the hospital bed trying to get comfortable. She had a difficult time following instructions and was slow to respond to any questions presented to her.

Terry and I spoke in the kitchen around the corner from where Marcia was resting. I spoke about the end of life process and what to expect. I shared that often patients won’t let go until they know their family is okay. I encouraged Terry to give her mom permission to go if she could. I added that it is okay if you can‘t, but your mom will always be your mom and she wants to make sure you are okay. She will let go at the perfect time for her. Terry started to cry and fell into my arms. We both stood in the kitchen hugging each other.

I called for a chaplain as the patient appeared to want a visit. The chaplain said she could come in one hour. Thirty minutes later, I left the home encouraging Terry to call hospice for anything she needs. Within the thirty minutes of me leaving and the chaplain arriving, Terry died.

I truly believe that patients do let go when the time is perfect for them and when they know their loved ones are going to be okay. Marcia may have wanted to depart with just her daughter present like it had been those first eighteen years of Terry’s life. She may also had known that the chaplain would be there shortly to give Terry the comfort she needed. I guess there are some things that have no clear answers.


DID SHE?

　
Did she hear us talking?
Did she even know that I was there?
Was she protecting her daughter?
Why did she pick that time to go?

So many unanswered questions.
Likely we will never know why.
Sick for only two short months.
A swift decline in a few days time.

She raised her daughter alone.
For years just the two of them.
Her brothers are nearby and loving.
Her son-in-law is as special as they come.

Seeing her today was such a change.
Up and about no problem last week.
Now bed bound, confused, not eating.
No longer able to swallow.

I prepared her daughter as best I could.
It might be minutes, hours or days.
Talked about her saying goodbye.
Follow your heart and the words will come.

I don’t know if she spoke with her mother.
I don’t know if she found the right words.
But moments after I left the home,
her mother chose to let go.

Did she know her daughter was alone?
Did she time it just for the two of them?
Some may say it was coincidental or chance.
But then,
          did she?

TOOTHPICKS

“Jake” suffered from pancreatic cancer. He was diagnosed only two months ago. He went downhill quickly, especially so in the past few weeks. He died peacefully with his wife, “Grace” by his side. Grace and Jake were always teasing each other. They both would laugh so easily at themselves. It was always so uplifting visiting their home as they both would quickly put their guests at ease with their kindness and humor.

Jake died four days ago and Grace asked if I could visit as she needed the support. I was worried about how she would do after Jake died as the two of them were soul mates. They did everything together. They acted like newlyweds with each other which was wonderful.

After I walked in today, Grace immediately started telling me stories about Jake and their life together. They had so many fun times just being together. Her stories weren’t about exotic trips or adventures, but everyday life around their home and neighborhood. She would light up just reminiscing about it all.

Grace then shared the story about finding the toothpick. She says that it gives her peace knowing that Jake made it to the other side and is doing okay. She has strong Christian beliefs where Jake did not. Grace worried a bit about Jake being a non-believer, but now is convinced that he is doing quite well and is waiting for her when her time comes.

She was receptive to meeting with a bereavement counselor next week for support. Because of this and the toothpick, I am pretty sure Grace will be able to process her grief and be able to move on in time. Thoughts of Jake will sadden her, but I believe, will also leave her with a smile.


TOOTHPICKS
　

He always had a handful of toothpicks.
He would chew on them leaving a small kink.
His supply would run out quickly
as he would drop them all over the house.

It became their private joke.
He leaving toothpicks lying all around.
Losing them and asking her to bring him a few.
She would always respond, “How many more?”

She would pick them up when he dropped them.
The floor, the end table, in the back room.
She would laugh and reprimand him for being so messy,
knowing she will always continue to find more.

He has been gone for only a few days.
She misses not having him around.
He was her soul mate; the love of her life.
She so wants to know if he is doing okay.

They picked up the hospital bed leaving a void.
The living room looks empty without him there.
She moved back the chairs, the end tables, the lamps.
She vacuumed the carpet, all spic and span.

She came back later and walked into the room.
Then noticed something on the living room rug.
A toothpick with his distinctive kink.
He was letting her know that he was okay.

She has peace believing he is in a better place.
No more pain; no more suffering.
All validated by a familiar sign.
A small, kinked, powerful
          toothpick.

COPING SKILLS

Fifty-eight year old “Lori” was diagnosed with liver cancer over three years ago. The cancer has now spread to her lungs. Fluid has been building in her stomach which necessitates a need to have it drained several times each week. The tumor is pushing onto her stomach which makes eating a challenge. She gets full very quickly. If she eats too much, she becomes nauseas She also has swelling in her legs and feet which make it difficult for her to walk.

Through all of these health challenges, Lori does not fret. She wants to know the truth about her disease progression. She accepts her fate without fears or concerns. She will say, “It is what it is.” She is coping amazingly as her challenges are great.

Lori has been separated from her husband, “Leo” for years. About six months ago, he moved back into the home as Lori needed his financial support for monthly expenses. Lori and Leo have three adult daughters. One of their daughters resides in the home. The other two daughters live nearby. Lori’s three daughters are devoted to her and rely on her to settle the differences they each have with their father. Leo is an alcoholic and binge drinks on the weekends. Lori says that he gets obnoxious and his behavior can be out of control. Quite often Leo doesn’t pay his portion of the bills as he has gambled it away at a local casino.

It amazes me how Lori has accepted her dying but struggles over family dynamics, which have been ongoing for years. Typically one will have a certain level of coping for life’s challenges as they come. Her coping is so dramatically paradoxical. Her worries are with her family not getting along with each other. I know her dying will impact her family tremendously, but that gives her no concern. She is at peace and has accepted her dying.

Fortunately Hospice has a tremendous bereavement support follow-up that is available. I hope the family takes full advantage of this benefit.


COPING SKILLS
　

She wants to know how long she has.
She wants to know the truth.
She was initially told six months,
but then, that was a year and a half ago.

Recently she asked her doctor again.
He said likely no more than two months.
She is seeing weekly changes in her body.
She knows she is going downhill.

She believes what he has told her.
She knows this is to be.
She is calm, she understands.
She accepts her fate with grace.

Her struggles are with her family members.
They don’t get along at all.
This has been going on for years.
She knows nothing will ever change.

She stresses over the arguments.
She cries each time a door slams.
It is difficult for her to cope with it,
knowing there is nothing she can do.

She’ll calmly talk about the afterlife.
She’ll talk straight forward about not being around.
But then she’ll cry so easily over her family.
For her, the hardest thing of all.

SO EASILY

Seventy-seven year old “Barbara” came onto hospice with a recent diagnosis of pancreatic cancer. She had a short trial of chemotherapy which was not successful as her tumor continued to grow.

Barbara has been widowed for eight years. She speaks so lovingly of her late husband while sharing stories of their life together. Barbara has strong Catholic beliefs and knows that she will be with him again soon. Barbara has three adult children. Her daughter just returned home to another state after a ten day visit. She plans on returning soon to be available to her mother. Another son lives out of the country, but is routinely staying connected via the telephone. Barbara’s youngest son lives with her in the family home. He works full time, but is planning on using his family leave when needed.

On my first visit to the home, Barbara met me at the front door and warmly welcomed me into her home. She was so warm and genuine that one instantly is taken with her. She is so engaging that the moment I met her, it was like we had known each other for years. We had an instant connection as we both had similar beliefs about life and death. I know that if we had met in another situation, we most definitely would have become fast friends.

My relationship with Barbara and her family is, and always will be, the hospice social worker. I could never become friends with a patient or their family members, as I would always be “mom’s social worker”. My role would not allow me to free up to be me as I would always have my social worker hat on to help them when an eventual need would arise.

I have met so many amazing people during my work with hospice. I appreciate the time I have with them and feel grateful that our paths have crossed, even if only for a little while. Cancer is such a random disease and so easily, I or any of my colleagues, could hear the same diagnosis from our own doctors. It makes one grateful for their health and to recognize each day as a blessing.

I feel honored to have met Barbara and look forward to our time together, as long as it is. She is a gift to all for as long as she is here.


SO EASILY
　

The moment I crossed the threshold,
I felt welcomed and invited in.
Her words were so heartfelt; so warm
as she greeted me by her front door.

I instantly knew we would get along fine.
I knew we were on the same page.
She was so easy to talk to; to listen to.
She spoke with the love from her heart.

She was straightforward and frank.
She got right to the point of how things are.
Her struggle with a horrid disease.
Her sadness of what is to come.

She is such an independent soul.
She’s used to being on her own.
She was the one always helping others.
It’s so hard now to ask for help.

I see myself in her actions.
I hear myself in her words.
I understand her struggles; her fears.
So easily, it could have been me.

If only the situation were different.
If only we had met some other way.
Strong chemistry; strong connection.
Most likely we would have been friends;
          so easily.
 

SHE SEES

Forty-five year old “Marge” was recently diagnosed with a rare leukemia. She stated that only ten people in the United States have this type of cancer. She underwent chemotherapy without success. Marge is aware that there is no more treatment and has come onto hospice.  Marge has been blind since birth.  When she was a toddler she could see shadows and light.  As an adult she only sees darkness. 

Marge lives with her significant other, “Jeff”. Jeff also is blind, but is as capable as Marge. They have been together six years living in Marge’s small duplex apartment. Jeff and Marge walk around their home with ease. I was amazed at how they interacted with each other and with guests. They both listen attentively to your voice and give you eye contact.

Neither see themselves as handicapped. They rely on their computer which has a scanner and can be voice activated. It takes Marge about ninety minutes to go through their daily mail which they have accepted as a fact of life. Neither complains about their situation. They will sit together and hold hands, grateful to have each other.

They have family around, but the two of them are more self sufficient than many sighted people. With Marge’s new cancer diagnosis, Jeff’s biggest concern is Marge’s dignity. Marge worried about being in pain. I reassured both of them that hospice is all about comfort care and our nurses, along with the doctors, do an amazing job of keeping patients pain free. I assured Jeff that patient care and comfort is the primary focus of hospice, with Marge directing the hospice team on how she wants to do things. I reassured them that the hospice staff is very respectful to all of our patients. We tend to treat people how we would like to be treated ourselves: with dignity, care and compassion.


SHE SEES
　

She’s been blind since birth,
but doesn’t see it as a handicap.
She lives her life to the fullest.
She does what she needs to do.

She will greet you at the door.
She lifts her hand to shake yours.
She welcomes you into her modest home,
directing you to sit down on her couch.

She is aware of your position on the couch.
She gives you eye contact and listens.
She hears, she smells, she feels.
Using her senses to their full potential.

She doesn’t see your body language;
gestures we routinely use to communicate.
She doesn’t see your facial expressions;
subtle signals that enhance our words.

What she does see is so much more valuable.
She sees your heart; she sees your soul.
Our true character exposed openly in front of her.
She sees us as we truly are.
          She sees perfectly.

RICHES

Ninety-three year old “Helen” has multitude health problems. She was referred to hospice as her kidneys are now failing. She is bed bound and sleeps most all of the day.

Helen lives with her daughter, “Tina” and Tina’s partner, “Jocelyn”. Jocelyn is the primary caregiver for Helen and Tina. Tina has had recent hip replacement surgery and needs both of her knees replaced as well. Because of her health issues, Tina has many limitations.

Jocelyn is devoted to Helen and Tina. She handles the responsibility placed on her in stride. Tina will talk about how much they rely on Jocelyn and how difficult it can be at times. Jocelyn upon hearing this, will just shrug it off and change the subject. Jocelyn’s kindness and compassion is true.

I met the family for the first time today. I was walking toward their front porch and heard laughter inside. Jocelyn opened the door and, with a very large, warm smile, welcomed me into their tiny home. They live in a small two bedroom home that Tina’s father built over sixty years ago. It is small and cramped with limited space.

I walked into the bedroom where Tina was sitting next to her mother in the hospital bed. Tina was holding her mother’s hand. She said it helps her mother sleep. They immediately started to joke and tease. Helen was in a deep sleep and didn’t stir when the laughter got loud.

Tina shared that she is the last of four children her mother bore. In addition, her mother has outlived two husbands. I asked Tina how her mother copes with so many losses. She said her mother just continued to keep walking. The family has such a strong faith that sustains them through tough times and throughout their lives. They state strongly that “It is all in God’s hands.”

I was so impressed at the devotion and love this family shared with each other and the warmth they gave to me. Many define riches by the possessions they have acquired. This family knows that they have the most important riches of all; faith, love and family. They are to be admired.


RICHES
　

They had me laughing
right from the start.
Teasing, joking, giggling.
Everyone was fair game.

Their life has been a struggle.
Challenges at every turn.
Losses abound,
but their smiles never fade.

She’s lived nine decades.
Three of her four children are already gone.
Tremendous losses for any mother.
She has always just taken one more step.

Now she lies bed bound.
Her daughter faithfully by her side.
Holding her mother’s hand when she can’t sleep;
is all she is physically able to do.

She has many health problems herself
which limit her ability to help.
But she will continue to smile.
She will continue to focus on the love.

They don’t complain about their tiny home.
They don’t complain about financial hardships.
They don’t worry about the latest fad.
Luxuries many others do take for granted.

They see their invaluable riches.
Riches of love, faith, humor, family commitment.
A bounty of priceless gems.
Riches not seen by the eye,
       but riches
              conveyed from the heart.

"YEAH"

Eighty-eight year old “Lucy” suffers from Alzheimer’s Disease. She resides in the Memory Care Unit of a large senior complex. Her husband, “George” lives in the same complex, although in the assisted living section. George recently fell and injured his hip. He spent a few days in the hospital to return back home needing to use a wheelchair.

George and Lucy have eight children and numerous grandchildren and great grandchildren. The family is amazing and so devoted to their parents. Family is rallying around as Lucy has had a sudden decline. She is unresponsive and her death is imminent.

I went out to do a visit to check in and give support to the family. While I was in Lucy’s room, a staff member wheeled George in to visit his wife. George typically doesn’t say much, but you can see the love in his eyes for his wife of seventy years. His daughter started to tell the story about her parents. Her mother was six and her father was three years older, when they met each other living in the same neighborhood.

She shared that ten years later when her father was in the service, her mother “went after him” as she knew he was the one for her. George filled in the story when prompted by his daughter. As the story progressed, George started talking more about that first official date.

He said they went out to dinner and then to a movie. I asked him what movie they saw and he remembered that it was called “The Four Feathers”. He added that it was a British war movie. His daughter was surprised that he remembered the name of the movie they saw.

I know that George will be sad for a while, but he has eighty-two years of amazing memories to hold on to of he and Lucy’s life together. Hopefully that, with the tremendous support from his family, will help him get through the tough days ahead.
 
“YEAH”

　
They wheeled him in to see her.
You could see the sadness in his face.
He was losing his wife of seventy years.
Not ready to say goodbye.

He spoke about how they met.
She was six, he was nine.
Neighborhood pals from the start.
Not aware of what their future would be.

Years later he joined the service
in the midst of World War II.
She knew he was the one for her,
so she went to claim her man.

They went out to dinner.
They went to see a show.
Their first official date.
His wallet now bare.

He couldn’t afford transportation.
His money had all been spent.
So he walked the seven miles home.
Thoughts of her, I’m sure, on his mind.

I asked him if it was worth the walk.
You could see him thinking back in time.
A beautiful, genuine smile crossed his face,
as he slowly replied
       “Y-e-a-h”.

MEANT TO BE

Sixty-nine year old “Jim” was diagnosed a few weeks ago with pancreatic cancer. The cancer has already spread with no treatment options available for him. Jim lives with “Gina”, his significant other of seven months.

Gina and Jim met in high school while teenagers. They were best friends and enjoyed each other’s company. After graduation, both went their separate ways. Both married and divorced. Jim has three children; while Gina has one daughter. Jim’s children live nearby and are very close to their father and like Gina a lot.

Jim came onto hospice last week. I went out to meet the couple and to explain my role on the hospice team. The first thing I noticed was Jim’s engaging smile and Gina’s devotion to him. They are so cute together as they kiss and hold hands. Their love is pure and true. It was during this visit when they shared how they met, became separated for decades and met up again through Facebook.

Gina worries so much about Jim and cherishes each moment they have. Part of my role as a hospice social worker, is to give the caregiver support. I encourage caregivers to remember to take care of themselves as, rather frequently, they will put their needs on the back burner as the patient’s needs are quite often more urgent. I spoke about respite support that is available through hospice. Gina would have none of this. She cherishes each moment with Jim and plans on being by his side throughout. This is what sustains her.

Gina started to cry softly when speaking about life after Jim is gone. She has good supports from her daughter and friends, but likely won’t reach out. She shared that her friends call her, while she doesn’t pick up the phone ever to call them. For Gina, rediscovering her love and then having it snatched away it extremely painful for her. She is grieving her life today and her future without Jim. I plan on visiting weekly; more to give Gina support with her grieving. Fortunately, hospice has an extensive bereavement follow up support that Gina, hopefully, will take advantage of.

 
MEANT TO BE
　

They were meant to be together.
It was written in the stars.
Meeting in high school so long ago.
Best friends right from the start.

They each went their separate ways.
Marriage; children; divorce.
Both struggling with unhealthy relationships.
Not having someone to make them whole.

By sheer chance they met up again.
The spark between them instantly ignited.
Best friends; soul mates.
Seven months ago, he moved in.

At last, the two of them side by side.
Days full of heavenly bliss.
Making up for the time they had lost.
So obvious they were meant to be together.

A new diagnosis of cancer.
Prognosis poor.
Trying to grasp each new day.
Savoring what soon will be gone.

She feels it is so unfair.
To lose him while they’ve just begun.
She’s not ready to let him go.
“We were meant to be.”

BEDROOM LAMPS

Eighty-two year old “Walt” has been on hospice for six months. He suffers from cardiac disease. Walt has eight children, with dozens of grandchildren and great grandchildren. Many of his family live nearby. Walt was widowed three years ago. He and his wife had been living with their eldest daughter, “Mary”. Mary has been the caretaker for both of her elderly parents.

Walt started to dramatically decline recently having more bad days than good days. A week ago, Mary called 911 as Walt was struggling to breathe. The doctors said that he had only a week or so to live. Mary wanted to grant her father his wish to die at home.

Walt died early this morning right after midnight after being home five days. Twenty-seven of his family members were present. Walt had no fears about dying as he talked so lovingly of his wife of over fifty years. He knew he would be with her again.

Months ago, Mary shared her story about the bedroom lamps with me. I had a pre-scheduled visit with Mary and Walt this morning. Once I heard that Walt had died, I called Mary to offer condolences. She asked that I still come out as she needed to talk with me. It was during the visit this morning, that she shared the continuing story about her bedroom lamps.

It gives Mary peace as she truly believes it was her mother letting her know that her dad was okay and made it safely across. Whether it’s true or not, Mary believes it to be true, which is all that matters.


BEDROOM LAMPS

Her mother died three years ago.
She had been sick for a short while.
Hours later, her bedroom lamp, unaided, turned on.
She knew then her mother was okay.

She has a lamp on each bedroom end table.
You just have to tap them and they turn on.
No one was in her bedroom when again they lit.
Two more times within two days.

It gives her peace to know she’s around.
To know her mother is doing fine.
It reassures her that there is an afterlife.
That they’ll all be together again one day.

Her father died just after midnight this morning.
All family had gathered around.
They went to bed to get some rest,
waking up early; so much to do.

They gathered in the kitchen over coffee.
At peace knowing their parents were together again.
She walked past her bedroom and saw the light on.
It was then she knew, her father was okay.

She felt her mother was letting her know
that he made it safety to the other side.
She believes her mother is communicating to her
generating energy to create a heavenly glow
       using ordinary
              bedroom lamps.

MELTDOWN

Sixty-eight year old “Joyce” suffers from lung cancer that has spread to her kidneys. She has been living with her daughter, “Cathy” since her divorce years ago. Also living in the home is Cathy’s husband and teenage son.

Cathy’s husband has been out of work for more than two years. He is in construction and does side jobs, but the money isn’t consistent. Cathy has been attempting to get services from the county, but keeps getting denied. Cathy says that somehow the bills do get paid, although always late.

Cathy is devoted to her mother. Joyce suffers from depression and needs constant reassurance that things will work out. Joyce has a strong faith and gets comfort from reading the bible. She has no fears about dying due to that strong belief system.

Cathy has a large, extended family who reach out to her. She is the caregiver for all. She has a huge heart and cannot refuse anyone, even if she has nothing left to give. She shared during my visit today, that she had a meltdown two weeks ago. She said she was tired of being “The Good Girl”. She grabbed one of her husband’s whiskey bottles and started to drink. She added that she typically doesn’t drink. She then got into her car and drove down a country road. She ran into a tree which totaled her car. Fortunately she was not injured. She ended up in jail with a DUI on her record.

She has no regrets or remorse as she said the incident set her straight. Hopefully she has learned that she needs to reach out to others for support. I shared with her how asking for help is a gift she can give to her family and friends. The tremendous feeling of helping others benefits all. Old habits are hard to break. Sometimes it takes a bad experience to teach us challenging lessons in life. I hope Cathy has learned what she needs to learn.
 
 
MELTDOWN

　
She is the family caregiver.
Everyone constantly asks her for help.
She has always been there for others,
never once letting anyone down.

Her life has been difficult at best.
Tough times are familiar and frequent.
Cash is always in short supply
to pay what is long overdue.

Now that her mother is ill,
her energy is running on low.
She’s not used to asking for what she needs,
so her patience remains in short supply.

She had a meltdown the other day.
Behavior unfamiliar to her.
She was tired of being “The Good Girl”.
She got drunk and got in her car.

She drove her car into a tree.
Fortunately no injuries were sustained.
She landed in jail with a DUI.
She has no regrets or remorse at all.

She said it put her back on track,
although her energy will likely drain again.
Hopefully she’s learned to reach out
when she again becomes stressed
        to avoid another
                      meltdown.

CANDLE FLAME

Eighty-five year old “Samuel” suffers from end-stage Parkinson’s Disease. The disease has left him confused, chair-bound and dependent. He was diagnosed almost twenty years ago and has had a long, slow decline. His wife of sixty-years, “Bette” is a very young seventy-eight year old.

Bette could no longer care for Samuel at home, and so three years ago she placed him in a board and care home. He gets excellent care which relieves her of being his caregiver, to being his devoted wife. She visits him daily which he appears to enjoy. His face lights up when he sees her. He will smile and reach for her hand.

Samuel chokes easily on fluids. He has had many bouts of aspiration pneumonia because of that inability to swallow correctly. With each episode, Bette has the facility call 911 so that Samuel can get IV antibiotics. He is weaker after each episode. Bette is aware that she has the option on not doing any treatment. The medical staff tell her that it is not a difficult way to die. Hospice would make sure he is comfortable and not in any pain. Samuel no longer speaks and cannot communicate his wishes. Bette and Samuel had never shared their wishes with each other which gives her struggle now.

Bette had not yet been ready to make the choice of doing nothing as she felt Samuel had some quality of life. Currently she is struggling with what to do as he has had such a decline these past few weeks. When I met with her today she shared the candle analogy to his illness.

Bette has many hobbies and activities in her life. She is a hiker and, either alone or with her hiking group, manages to fit in her exercise on a daily basis. She has a wonderful family and many friends which occupy her time. She is very open when discussing her grief over losing her husband of sixty years.

I know she will make the right decision at the right time for her and Samuel. With her tremendous support system, she will be okay, no matter when and if she needs to choose treatment vs. no treatment.


CANDLE FLAME
　

They’ve been married almost 60 years.
He’s been sick for a third of that time.
Where prior he was such a vital, active man;
now, he’s just a shell of who he once was.

She believes he still has some quality of life
as he easily smiles when she walks into the room.
He’ll reach for her hand with joy on his face.
He’s confused, but it seems that he knows who she is.

Recently he’s been sleeping a whole lot more.
He is losing weight and getting weaker.
It’s hard to know what he is thinking
as he hasn’t spoken for quite a while.

She wants to do the right thing.
She wants to follow his wishes,
but they never spoke about these things.
She’s not sure what he would want her to do.

He chokes easily when drinking water.
He’s had pneumonia many times.
She rushes him to the hospital for treatment.
With each episode, he declines a bit more.

She knows a time will come to say no more.
She wants to do what’s right.
“His candle is going down.
The flame continues to lower.”

She’ll watch as his candle flame flickers.
She’ll watch as his flame loses it’s glow.
Her love will guide her; she will know
when it’s time to let his flame naturally
       burn out.

IN THE END

Sixty-eight year old “Christy” was diagnosed with pancreatic cancer six months ago. She came onto hospice shortly afterwards. Christy lives with her significant other of twenty years, “Bob”. Bob has his own health issues, but is able to care for Christy at this time because she is still up and about. She tires easily and takes several naps each day. Bob helps with meals and household chores.

I went out to do a visit today and our initial discussion was related to Bob’s health issues and his limitations. It was then, I asked about their long term care plan for Christy. I have concerns about Bob being able to care for Christy when she starts to decline and needing more help.

Christy said they do not have a plan. She has no family, but has a large network of friends. Unfortunately, many of her friends live out of state or, due to busy schedules, are not available. Her friends are there for her emotionally, but the hands-on care will fall onto Bob. Christy said that she has fears of becoming dependent. She told Bob and I that she would do whatever she needs to do to avoid becoming dependent.

I asked her if she knew where that fear came from. She then shared the story about her grandmother and the many shut-ins they visited when she was a child. Those visits have left vivid memories with Christy. We talked at length about the end-of-life process and options available. She would have nothing to do with it.

I believe that if someone wants to commit suicide, there isn’t much anyone can do to prevent them from following through with that choice. I asked Bob what his thoughts were about Christy’s plan. He shared that he wanted her to talk with him first. She was quick to add that she didn’t want him to be involved as she feared he would be arrested for aiding in a suicide.

Christy asked me about other patients and their dying experience. I shared the truth being that, quite often, patients find peace in their final weeks, days and hours. I have made a referral for our psych nurse to make a visit to assess Christy. Our hospice nurse will monitor her medicine and, if needed, her pills can be locked up in a lock box. But in the end, I believe, if Christy is steadfast about her decision, there isn’t much anyone can do to prevent her from taking her life. I wish her peace.


IN THE END

She comes from a small village
where everyone lent a hand.
She has memories being with her grandmother
visiting those dependent in their homes.

She remembers clearly those long ago times.
Mixed emotions arise from those memories.
Having seen things she will never forget;
dependency, struggles, vulnerability.

She has fears of becoming dependent herself.
She would never want to be that way.
“I will do what I have to do,
to avoid ever going through something like that”.

She talks of taking her life before dependency comes.
She has many pills within easy reach.
She is not stressed, but rather at peace.
It is a natural option for her to choose.

In the end, no one can stop her, I suppose.
In the end, it really is her choice to make.
Whether a wise decision or not,
she likely will do what she needs to do.

She has always lived her life her way.
I suspect she will die her way as well.
Somehow I know it will be what it will be.
One way or another,
      it will end.

LATE BLOOMER

Ninety-two year old, “”Katie” retired seven years old at the age of eighty-five. She went back to school after her children were grown. She was in her early fifties and wanted to study psychology. She received her PhD and went on to have a clinical practice for thirty years.

Katie has always been an independent, free spirit. She has been widowed for over thirty years and is used to being responsible for her own accomplishments. Katie moved into a board and care home three years ago. She could no longer live alone as her memory was fading.

Katie has four adult children, of which two live nearby. They are very involved in her care and are devoted to her. I met with Katie and her daughter, “Janet” today to open them to our hospice program. Katie was lying in her hospital bed in her room. She was sleepy as her daughter had just woken her up. Katie was easy to smile.

Janet and I went into the living room to talk about our hospice program and how we are available to support the family as they need. It was then that Janet told me about her mother’s accomplishments. She was very proud of what her mother had done.

Meeting Katie for the first time and seeing her confusion, it is hard to imagine that she was working only seven years ago. She is an excellent example of someone living their life in a way that suits them. She is a role model for all of us.


LATE BLOOMER

　
She has had a long life.
She’s made it ninety-two years.
Unfortunately she is now totally dependent
after years of amazing accomplishments.

She went back to school in her fifties
after her four children were fully grown.
She didn’t stop until her PhD.
Clinical Psychology, an impressive goal.

She counseled clients for thirty years;
long after most of us would choose to be through.
Seven years ago, she took her retirement.
At age eighty-five, it was time to step down.

Confusion is now her constant companion.
She has few memories of her impressive past.
Her children remind her and brag to their peers.
They all are so proud of what she has done.

She has touched many along her way.
More than she’ll ever know.
Although her time may be short;
her legacy will always remain.
A role model,
        a mentor.
              It’s never too late.

CELL PHONE

Sixty-six year old “Gene” suffered from esophageal cancer. He was diagnosed three years ago, but had been doing well until recently when he started to decline. Gene lived with his wife, “Susanne” of twenty-five years. They both had children from previous marriages, but her sons thought of Gene as their dad.

He was on hospice for only three weeks as his decline was rapid. It got to the point to where he was bed bound and spent his days in the hospital bed in the living room. Susanne would sleep on the couch nearby in case he would wake up during the night. He struggled with some pain issues and, for several nights, he would wake up Susanne throughout the night.

Fortunately, the pain issues lasted for only a few days to where he became more restful. Susanne thought the turning point was when the hospice nurse put in a catheter. She felt that a lot of his pain was discomfort from not being able to urinate on his own.

Gene died early one Monday morning. Susanne had just gotten up to use the bathroom and heard him make a noise. She quickly went to the bedside and saw that he had stopped breathing. Her sister was with her and was able to give her the support she needed.

My role as the hospice social worker includes bereavement. I do follow up telephone calls and visits as needed. I did a home visit today with Susanne to give her support. It was during today’s visit that Susanne told me about Gene’s cell phone antics. She says it gives her peace knowing that he is, without question, on the other side.

As a side note: it was amazing to me as Gene was born the same day and year that I was born. I seldom meet anyone with whom I share a birthday; let alone one who was born in the same year. It gave the two of us a wonderful connection.

CELL PHONE

　
He was sick for a little while.
He had some struggles along the way.
She was nearby when he took his last breath;
giving thanks for a peaceful end.

She found his cell phone the next day.
The battery had completely died.
She put his phone in the back bedroom.
He would never need it again.

Later she heard someone texting on his phone.
She wondered how would that be?
His battery wasn’t charged; it shouldn’t be working.
She wondered if it was him.

It happened again the very next day.
She knew what she had heard.
She started to believe that it really was him
sending her a message via his cell phone.

A few days later, his cell phone rang.
She was convinced now that it was him.
Communicating to her so that she would know
he was on the line with his final goodbye.
Spiritual technology; giving her peace;
       using an earthly
              cell phone.

REGGIE

I first met Reggie, a Dalmatian/collie mix dog, about two years ago when her master, “Angie”, came onto hospice. Angie suffered from lung cancer and over the course of those two years, had a very slow decline. Angie lived with her partner “Sarah”. The two had been a couple for almost forty years.

Reggie would always greet me at the front door with excitement. She would bounce around, her tail briskly wagging wanting to nuzzle you. Reggie would then run to the living room where Angie was sitting in her recliner.

With each visit, she would greet me with the same enthusiasm and joy. Once we all sat down, Reggie would go and lie near Angie. Toward the end of Angie’s life, she spent her days in a hospital bed in the living room. Reggie would lie as close as she could to the bed to be near Angie.

A few weeks ago, Reggie was diagnosed with pancreatitis. The initial treatment seemed to work, but Reggie continued to decline. The vet kept Reggie at the animal hospital for a few days only to inform Sarah that there was nothing that could be done. During this time, Angie had stopped eating and spent her days asleep. Sarah did not tell Angie about Reggie.

One Monday morning, Sarah had two friends stay with Angie while she drove to the hospital. Sarah was at Reggie’s side when she died. Sarah is grieving the loss of a lifetime partner with the added grief of her faithful friend. It gives Sarah comfort knowing that somehow Angie must have known that Reggie was waiting for her. She sees them together side by side and, with a few tears, can bring herself to smile.

REGGIE

　
I loved that dog Reggie.
Part Dalmatian, part collie.
One hazel eye, the other pearl.
She was the cutest thing.

Reggie was the first to the door
whenever she heard a knock.
Tail wagging, nuzzling you.
One could almost see her smile.

Reggie would lie by her master.
She was faithful to the core.
Somehow she seemed to know
her master’s time was short.

Reggie got sick quite suddenly.
There was nothing the vet could do.
Her master didn’t know,
but it was time to let her go.

Reggie’s life ended one early afternoon
while her master was in a deep sleep.
Simultaneously, her master awoke and reached up.
“Reggie, Reggie” coming from her lips.

Reggie must have been waiting for her.
She must have known her pup was there.
As three hours later, she too, let go.
Reggie and her
       again
              side by side.

MAMA'S BOY

Sixty-six year old “Brenda” just came onto hospice as she has been in declining health for months. She has multiple medical problems to where now, she is unable to walk and needs assistance when transferring to her wheelchair or bed. Brenda’s husband had been caring for her until six months ago when he died after a sudden illness.

Since that time, Brenda’s eldest son, “Matt” has been staying with her. He is not working and is available to be with his mother to attend to her needs. At first glance, he looks like a tough, rough around the edges kind of guy. He is tall and husky with a powerful voice. His demeanor softens immediately when he looks at his mom.

He has been in prison twice for robbery. Both times it was after the death of someone with whom he was very close. He says he has learned his lesson, but when I asked him about how he thinks he will do when his mother is gone, he replied, “I don’t even want to think about it.” Fortunately, hospice has a very extensive bereavement follow-up for support. Hopefully he will be receptive to the help we have available for him.

I was surprised when he shared that he has been called a “Mama’s Boy”. He is anything, but that. He has many supportive friends nearby with whom he treats like family. During my visit, many were coming and going and checking in on both of them. They have a large network of support.

Looks are deceiving and it is always best not to judge someone by the way they appear. You may be surprised, more often than not, once you get to know them.


MAMA’S BOY
　

She was eighteen when he was born.
They’ve always been so close.
She watched over him as he grew to a man.
Now it is his turn to attend to her.

She been sick for many months.
She needs a lot of help.
He lovingly attends to her every need,
like he promised he always would.

They’ve had many struggles along the way.
Their lives have been difficult at times.
His two terms in state prison;
felony charges he can never forget.

His heart of gold is hidden somewhat
by his rugged physique and demeanor.
His body scarred by vicious assaults;
his forceful voice demanding attention.

He’s been called a “Mama’s Boy,”
because his love for her is devout.
The two of them have a special bond;
but he is as masculine as they come.

He may appear intimidating to some.
He may be rough around the edges.
Let them call him a “Mama’s Boy”,
but he is a very compassionate son
giving his mother what all of us need;
a tremendous heart bursting with love.

EATING OUT

“Caroline”, sixty-seven, has been on hospice for almost two years. She suffers from lung cancer. Caroline was retired from her job as a concierge for a large hotel downtown. She was very sociable and had strong relationships with all of the staff at the surrounding restaurants.

The managers of the restaurants would offer Caroline free meals hoping that she would send hotel guests their way. Caroline loved to eat out and would gladly take them up on their offer. She lived downtown near many of her favorite dining places and frequented them on her own time as well.

When Caroline came onto hospice, she used a walker to ambulate. She was slow, but several times each week, was determined to walk the short distance to her favorite places near her home for lunch. Caroline was declining, but her strong will kept her going. It got to a point where she could no longer stay in her own home. Her home had many stairs which she could no longer maneuver.

She moved into an independent senior complex nearby. In addition to the independent living section, the facility had an assisted living center and nursing home wing. Caroline’s two children wanted her to be in a place to where she could have access to increased care as needed.

This past week, the children and I have been working on the paperwork to get their mother into the assisted living center. Caroline hated the idea, but knew it was going to be a reality soon.

Yesterday, her son spent the day with her. She was pretty weak, but then early afternoon perked up and said she wanted to go to the nursery to get a few plants. Off they went to buy a few plants for her apartment. Returning home near dinner time, her son fixed her a vodka on the rocks, her favorite drink. He was feeling a bit nervous as he knew that the hospice nurse was coming the next day to talk with her about moving to the Assisted Living Section.

This morning about 8:30 AM, the hospice home health aide found Caroline dead in her bed. It was sudden, but then it was perfect for Caroline. She died her way; dining out until the end and able to stay in her independent living apartment. The hospice nurse came out and said her body was still warm. Death had to have been pretty recent.

Thirty minutes before, Caroline’s daughter was driving her son, Caroline’s grandson, to kindergarten. It was during that drive to school when her grandson talked about what he saw. Both of Caroline’s children have comfort knowing their mother died the way she wanted. They are not surprised to know that she continues to eat out and is making friends.


EATING OUT

He called his great-grandma “GG”.
She’s been gone for about a year.
His grandmother goes by “Nana”.
He knows she’s been sick for a while.

Nana had to move to a different home.
A place where they had more care.
She was still able to eat lunch out.
Her favorite thing to do.

He knows she’s been getting weaker,
because she sleeps a whole lot more.
But she’ll still find the energy to enjoy a meal
at her favorite restaurants nearby.

Driving to kindergarten this morning .
he told his mom what he was seeing.
“I see GG with Nana.
They are sitting together having lunch”.

His mom asked where they were sitting.
“There are no tables in heaven.
They are sitting on the lawn.
Nana is making lots of friends there.”

A few moments later, the aide found his Nana.
She must have died in her sleep.
It was a shock as the day before she went shopping;
she had a cocktail before dinner.

Children’s connection to the other side is strong.
The are open to receive what may come.
A beautiful scene of GG and Nana
doing what they both loved to do;
          Eating out.

HI RAY

The hospice nurse and I went out together to open a new case to hospice. “Linda”, fifty-six suffers from breast cancer that has spread to her bones and liver. She was working until six weeks ago. She has had a rapid decline since that time.

Linda lives with her husband, “Norm”. They have been married thirty-six years. Norm, seventy-one, is fifteen years older than Linda, but looks so much younger than his years. He has a youthful spirit and is very active, healthy and so full of life.

Norm reminded me so much of my friend Ray. Ray died eighteen months ago of cancer. Ray was seventy-one when he died. Ray was also fifteen years older than his wife, Judy. Norm looked, talked and joked like Ray. He was a spitting image of Ray.

I felt Ray’s presence in the room. I don’t know how much of that feeling was Norm’s likeness to Ray, but I knew Ray was nearby. I felt it in my heart. It gives one comfort to know that loved ones do come by now and then.

After the visit, I called Judy to share the story. She said that earlier that day, she was driving behind a Jeep Cherokee with a sticker in the window that said, “Ray’s”. Coincidently, Ray’s last three vehicles were all Jeep Cherokees. Judy said that she too has felt Ray’s presence all day .

Be it coincidence or not, it gives one comfort to feel the presence of a loved one. It gives reassurance that we all will meet up again one day.

HI RAY
　

Hi Ray.
I felt your spirit today.
Showing us your presence.
Watching over us here.

He looked like you.
He joked like you.
His voice was your voice.
He had you down pat.

Happy to see you again.
Happy to know you come around.
Checking to see that we are okay.
We need you in our corner.

Tears have come as there is sadness too.
Awareness of the pain of losing you.
Missing those special times.
Moments that are forever gone.

Ray, come again soon.
Let us know you are nearby.
A sign that you are doing well
and that we will see you again one day.

          Hi Ray.

SOCIAL WORK

“Joyce”, seventy, has been on hospice for about three weeks. She suffers from lung cancer and is slowly declining and needing more and more help. Joyce lives with her daughter, “Candy” and Candy’s husband and teenage son. I have been visiting weekly as this family has a lot going on and need support.

Candy’s husband has been unemployed for over three years to where his unemployment checks have stopped. His background is doing dry wall work. He gets odd jobs that pay very little. The family has not paid their mortgage or utility bills for over two months. Needless to say, finances are a stressor. In addition, the burden of Joyce’s illness has put a huge strain on the family emotionally.

Candy easily has opened up with her emotions to me. She expressed a lot of anger toward God as her burdens are overwhelming. She feels that it isn’t fair. Her heart is full of love toward her family and mankind. Anger toward God is her only avenue of release for those emotions. During my visits, I have been assisting her with processing this anger. A large part of my role is to validate her feelings while guiding her to her own resolution.

I called Candy today to schedule a visit for tomorrow. She turned to her mother, who was nearby saying, “It is Marilou, the social one.” I laughed and said “Hence, that is why I am called the Social Worker.” She laughed and said that it was easy to talk with me.

I keep my style casual and low key as it offers an environment of safety and support. Observing my style, many do not see the therapeutic interaction that goes on between me and families. It seems to work well for them and me this way.

SOCIAL WORK

My style is very casual.
I try to keep things low key.
It allows many to open up
in a safe and honest way.

They may think I am just talking.
I am listening to what they need to share.
They don’t realize it’s the work that I do,
as I guide them along their way.

She sees me as a guest; not a counselor
saying I was the most social one.
It doesn’t matter much how she perceives my role
as long as she gets the support she so dearly needs.

I want her to feel comfortable.
I want her to feel safe and not judged.
I want her to know how much I do care
so she’ll never ever feel alone.

My job is not just social.
My job is not just work.
I am directed by my families
intertwining social constantly
with the work.

SIXTH FLOOR

Sixty-eight year old “Carolyn” suffers from lung cancer. Carolyn has been divorced for years, but her two adult children live locally and are very devoted to her. The love the three of them share is so endearing. Carolyn is very social and gregarious. She owned a beautifully decorated colonial home downtown. Her home was three stories and it became difficult for Carolyn to maneuver the stairs.

Carolyn’s two children knew she needed more help and spent time encouraging their mother to move into an independent living retirement community nearby. The independent living section offered meals in the dining room. After many weeks of persuasion, Carolyn reluctantly agreed. She is now struggling with walking, although can slowly ambulate using her walker. She is losing weight and is very weak. Carolyn has days when she cannot get out of bed. Then amazingly the next day, she perks up enough to make it downstairs to the dining room in the facility.

Carolyn is now having more bad days than good days. Her son was visiting yesterday when Carolyn could not get out of bed. She was so weak, she told her son, “I am dying.” That was the first time she mentioned dying to anyone. She is such a strong, determined woman who uses denial to cope. Denial allows one to process reality at their own pace.

The family called me out today to talk about placement in the nursing home section of the retirement community on the sixth floor. They had a lot of questions about finances and how it all would get arranged. Carolyn missed most of the meeting as the hospice home health aide was assisting her in the shower. When she came out, I summarized our conversation, but reinforced that she was the one in control and it would be her decision.

She is at a place where she knows it is something that must be done. Carolyn has been holding on for a long time. She will probably move up to the sixth floor, but not without putting up a fuss. I admire her strength and her determination. She knows the family just wants her to be safe and get the proper care. No doubt she will continue to do things her way and I would be disappointed if she didn’t. Somehow I wouldn’t be surprised if she chose to let go the day before she was to move to the sixth floor.

Addendum: Carolyn died two weeks later; the morning the hospice nurse was coming to tell her that it was time to move to the nursing home section of the facility. The family asked that the hospice nurse inform Carolyn of the need to move, as they felt she would be more receptive than if one of them spoke with her about it. She lived and died her way. Way to go Carolyn!!

SIXTH FLOOR

　
She fights hard to keep on going.
She is determined in her cause.
She hoped this time would never come,
but knew it probably would, one day.

Her inner strength; her determination;
her independence; her forceful soul.
Qualities that make her who she is.
Qualities she holds dear.

She likes living on the third floor.
She is independent, although they prepare her meals.
She resisted moving here from her own home
but has settled in to make it hers.

Now it is time to move again.
To the sixth floor where she’ll get more care.
On her bad days, she knows it’s best,
but then she needs a little more time.

Plans are being made for when it is time.
They are preparing for what likely will be.
She’ll fight it as long as she can,
then will likely end her days
where she never hoped to be.
       On the sixth floor.

TODAY

“Ursula”, seventy-four, was diagnosed with cancer two months ago. By the time the cancer was discovered, it was too late for treatment as it had spread throughout her body. Less than a week after the diagnosis, she came onto hospice.

Ursula was so full of life and had such a dynamic personality. She had a quirky sense of humor that had me laughing right from the start. She was still working and one of the first things she did was file her retirement papers. She had a difficult time with this as she loved her job. She worked for the state and her job involved numbers and details; something she excelled at. She loved to be able to figure out the process in order to successfully complete a project

Ursula lived with her daughter and son-in-law, “Erica” and “Mac”. Erica and Mac were so devoted to Ursula. Erica worked as a nurse, so while she was at work, Mac cared for Ursula. Fortunately, Mac’s job allowed him to work out of the home if needed.

Ursula declined quickly while keeping her upbeat personality. This past week though, the decline was so rapid to where she could no longer get out of bed. Erica took a leave from work to stay with her mother.

I was shocked by how she looked when I went out to do a routine visit yesterday. Ursula was so thin and had lost a lot of weight. She had constant nausea and had stopped eating two days before. She was tired of the struggle of living like this. She was ready to go.

When I asked her if there was anything I could do for her, she replied, “Tell me that today is the day I will die.” She was so used to having control and sorting out what the next step would be. She didn’t like not being able to figure out what to do.

I told her that no can answer that question as no one really knows. I added that it would happen when it is the perfect time for it to happen. I said that letting go may allow the process to flow to where it is suppose to flow. Why she was still here, I didn’t know.

I always like to think that earth is our school. We are teachers at times and students at other times. We all have lessons to teach and to learn. Once we have ended our lessons and taught what we need to teach, then maybe that is our time. There is no logical or clear answer for any of us I suppose.

TODAY
　

She wanted me to tell her
that today was the day she would die.
She wanted me to say her suffering would end
before tomorrow comes.

She stopped eating two days ago.
She was weak and could no longer get up.
She was nauseous with no end in sight.
She had had enough.

She wanted to understand the process
so she would know what she needed to do.
She wanted a guarantee that today was the day.
Something no one could ever promise or know.

I told her it will happen in its own time.
The moment will be perfect for her.
She must trust and release control.
Letting go may allow things to flow.

She must have listened to my words.
She must have thought things through
as before the clock struck twelve
her final wish came true.

Today.

TIME

Seventy-one year old “Annie” suffers from lung cancer. Annie lives with “Sheila”, her partner of thirty-eight years. “ Annie has been on hospice for quite a while. She has had a slow, but steady decline these past months.

Annie is open about her emotions and easily verbalizes how she is feeling. Sheila is more close to the chest with her feelings. Sheila won’t say much when Annie is talking about dying, but her tears will flow easily. She will grab a tissue, dab at her eyes, and stay silent. One can see the pain she is feeling.

This past month, Annie has declined to where she is in bed a lot of her day. She can slowly walk using a walker in the home, although needs someone next to her as she is at risk for falling. Her appetite is way down and each time I visit, I notice that she has lost more weight.

Annie is so weak that, quite often during one of my visits, she will doze off. With Annie sleeping, Sheila is more comfortable sharing her emotions. She will share a sentence or two and then make a joke to ease the anxiety she feels. Our conversation will then turn to other topics for a few moments until, she again, will share how she is emotionally.

Annie and Sheila are protecting each other. Sheila worries about Annie as much as Annie worries about her. During our conversation today, Annie expressed how she is ready to go, but worries that Sheila needs more time. I reinforced to Annie how hospice does follow up for a year afterwards. I told her about our bereavement department and I promised her that I would make sure Sheila will have access to those supports. I added that I was available to make a home visit to give Sheila support if she wished at any time.

Annie and Sheila have a large network of friends, but Sheila may be resistant to call when needed. I encouraged Sheila to reach out to her friends as they will need her as much as she will need them. I have met several of their friends, and know that if Sheila doesn’t reach out, they will come to her. Their support system is that strong. I believe that if one has a good support system, they will be able to handle whatever comes their way.

TIME
　

She’s getting tired of it all.
“Why is it taking so long?”
She’s ready for it all to be over,
but knows her partner needs more time.

She’s been slowly declining for months,
where now she’s in bed a lot of the time.
She’s losing weight as her appetite has waned.
There’s not much joy during the course of her days.

She’s holding on for her partner.
She worries a lot about her.
She knows the pain that will be left behind
and the difficult times that will follow.

They’ve been together for many years.
Their love is intertwined and strong.
It breaks her heart to have to leave,
but she is so ready to go.

She sees the sorrow in her partner’s eyes;
the quiet tears that flow so easily.
She knows she may never be ready to say goodbye,
as there likely will never be
more than enough time.

SOMEHOW

Eighty-nine year old “Stanley” suffers from lung cancer. Until recently, he was up and about and could manage many of his personal needs. Stanley is widowed with four adult children. All of the children reside in the three bedroom home with him. He and his two daughters each have their own bedroom, while “Stanley Jr”, sleeps on the couch in the living room. Stanley’s other son has a makeshift bedroom in the garage.

Stanley’s eldest daughter, “Barb” is the primary caretaker for him and the rest of the family. Barb is a nurses aide by trade and is familiar with the needs of the elderly. Her three siblings rely on Barb to know what to do. Barb has a part time job out of the home caring for an elderly client. While she is working, Stanley Jr. cares for his father. Stanley Jr. has had a stroke and heart attack which limits his abilities, although is attentive to his father.

Barb has to direct her siblings to what needs their father has. Only Stanley Jr helps Barb out when he can. Her other two siblings do not help much at all. Her sister, “Lana” suffers from depression and anxiety which makes it difficult for her to pitch in at times. Their other brother, “Bob” refuses to help at all.

Only Barb and her sister Lana work out of the home. The family depends upon Barb to care for their father, do all of the cooking, yard work and housework. Stanley is declining; is bed bound and dependent now with all of his needs. Even though his care needs have increased, none of Barb‘s siblings have stepped up their limited help.

I have been visiting the family weekly to give Barb support. She’ll complain about her siblings, but then she’ll make a joke and show a big smile. Barb’s only support is her own daughter, who lives nearby. Barb says her daughter texts her throughout the day which is helpful. Even though Barb has little support, she thrives on helping others and doing the right thing.

Somehow this has always worked for this family and will continue to work for the years to come. I know Barb will continue on as usual with a quick joke and easy smile.

SOMEHOW

　
Her family depends upon her.
She’s never let them down.
She continues to be there for all of them,
while putting her own needs aside.

She gets frustrated at times
knowing they all could do a little more.
But she’ll give them a pass, crack a quick joke
and follow up with an easy smile.

She has little support from others,
but somehow keeps moving on.
She gets satisfaction in doing the right thing
even though she’s in this alone.

She’ll never protest or make a fuss
in spite of all their demands.
Somehow it all works for this family.
They know of no other way.

She’ll continue to be the caretaker.
They’ll continue to lean on her.
Somehow it allows them not to even try.
They know she’ll get it all done.
Somehow.

HEVEN

Part of my responsibility as a hospice social worker is to make two phone calls to the family after a patient dies. The first call is when the death occurs, while the second call is about a month later to give additional support. Many can struggle in the weeks following a death, especially after things have supposedly turned back to “normal”.

I called a mother whose son died about four weeks before. She was coping appropriately as had tremendous support from her family and church community. It was during this conversation when she shared the story about her eight year old granddaughter “Amy“.

I counsel children frequently about grief and loss and am always amazed and impressed by the fact that they just want honest answers to their questions. They are not afraid of the truth. Quite often parents want to protect their children from any pain and feel pressured to shelter them. It is always best to answer children’s questions simply and directly. It is a wonderful opportunity to teach them about loss. So much loss in life in not just a death of a loved one, but also when a best friend moves away, parents divorce, etc. Giving children the tools to deal with future losses is so important in a young one’s life.

Amy’s grasp of her grandmother’s explanation of things was profound. I was surprised at how quickly she understood what her grandmother was telling her and then able to replicate it on paper. One could have easily forgotten how young Amy is, but her misspelling of the word Heaven, was a reminder that, yes, she is only eight years old. Children are often our best teachers.

HEVEN
　

She was angry.
She was mad at God.
“God is not good.
He has taken my uncle away.”

Her grandmother tried to explain.
Whenever she does something wrong;
whenever she gets mad at mom and dad,
they will always love her, no matter what.

She sat down with her crayons and paper.
She made two separate drawings.
One she labeled “Uncle Then, Earth”,
the other, “Uncle Now, Heven”.

On “Uncle Then, Earth” she drew a globe.
She sketched a wheelchair.
She sketched a hospital bed.
Next to he bed, she put a lift.

On “Uncle Now, Heven” she drew God on a throne.
She put stairs leading up to the throne.
She drew Uncle walking up the stairs.
She printed God saying, “Well done.”

An eight year old listening with her heart.
An eight year old teaching us all.
All about life and death,
but mostly all about love.

FROGS

Fifty-eight year old “Pete” was on hospice for only about two weeks. He lived with his wife, “Margie” who was on leave from her job to care for Pete. Pete and Margie had a tremendous support system between family and friends. Folks were drawn to them by their genuine love for each other and for life.

Pete was diagnosed with cancer only two months before I met him. He totally accepted his situation without fears or anxiety. Even with his weakness, he would always give visitors this wonderful, warm smile.

The family started a web page documenting his progress and, within two months, there were over 16,000 hits. Pete was a elementary school teacher and, I know, touched so many young lives. The cards displayed all over his home were a testimony to him from so many admirers.

I called Margie today to check in on her and to see how she was doing. It has been about a month since Pete died. She became tearful, but so appropriate for what she is going through. She so easily was able to verbalize her emotions and process them as they came. It was during this phone call when she shared the story about the frog. She said that she has always loved frogs and finding the little frog in the maple plant was a sign to her from Pete. It gives her comfort.

Margie added that the same day she was plant shopping and discovered the little frog, another friend, had also been shopping.. She shared the frog story with her friend. Her friend then told her about her own experienced that day. Her friend was at a Home and Garden Show and was drawn to this whimsical frog that was sculptured in silver. She didn’t buy it as said she doesn’t even like frogs. She was surprised that she was even mesmerized by it. When she heard Margie’s story, she quickly went back to purchase the frog.

Both Margie, her friend and I, all believe it was Pete letting them know that he is okay and still around.

FROGS

　
Their love was so intense.
Their love was so true.
They were meant to be together.
They were soul mates.

He had no fears about dying.
He said he’s never been afraid of death.
He accepted it like everything else in life;
with a positive attitude and a genuine smile.

He’s been gone about a month now.
She sees reminders all around.
“I’m on the path to where I am suppose to be
seeing the magic, the gifts,
the blessings of each day.”

She was drawn to a maple plant while shopping.
Hidden inside the vase was a little frog.
It looked at her with mystical eyes.
She knew he was saying hello.

She loves her Native American Cards.
Each card a photo of an animal with an inspirational quote.
She went home and looked up the frog card.
She wasn’t surprised by what she read.

“Honor your tears.
They cleanse the soul.”
There was no doubt in her mind.
he was and always will be
her everlasting soul mate.