THE ORCHARD

A new Social Worker was shadowing me today to learn how to do a hospice admission.  The patient and family lived on a 50-acre ranch about four miles out of town.  The patient’s daughter gave us instructions on how to locate their ranch as GPS’s often direct drivers wrong. 

We found the County Roads 24 and 25 as they directed.  The ranch is on County Road 95.  We realized later that my GPS brought us to County Road 95A.  It instructed us to turn right by a gravel road.  We then turned right onto that road immediately into an orchard.  There was a dirt pathway that had impressions of vehicle wheels, so we followed the path. 

We drove about five minutes as it was a huge orchard.  At one point it looked like we could not go much further, but the road allowed us to turn right.  We were then parallel with a paved county road.    Fortunately, we were able to follow the route to an exit.  We then turned left onto the correct route of County Road 95.  There was another gravel road which our GPS then again told us to turn onto.  It was correct this time.  We drove this gravel and then dirt road a few minutes and did find their ranch.  My first thought was; while laughing; “If I ever think I have seen or done it all, I will likely be wrong every time.

THE ORCHARD 

 

We were scheduled to admit her today.

She is eighty-one and confused from dementia.

She and her family live out in the country

about four miles or so out of town.

 

They gave us step-by step instructions

on how to easily locate their ranch.

They didn’t want us to get lost

as a GPS does guide folks incorrectly at times.

 

“Drive halfway between

County Road 24 and 25.

Turn onto the gravel road by the orchard.

Our home is not visible from the road.”

 

We found the County Roads

while also finding a gravel pathway.

We turned into the orchard

driving onto soft, fertile soil.

 

The road was yielding with many potholes;

many dips and frequent downturns.

We realized, we were in an orchard

and not a route for automobiles.

 

I sometimes think I have heard it all.

I occasionally think I have seen it all,

but after driving into someone’s orchard,

I strongly know that I have not done it all.

                   And likely never will.

 

A SMILE

Our agency, along with hospice, also has a Palliative Care Program.   I mostly do hospice admissions, but do help out with Palliative Care admissions as well.  Weakness is not a stranger to many of our patients.  All of us use energy in our daily routines.   We don’t think much about it as we have enough to get us through each day comfortably.  

With these two Palliative Care patients, their weakness impacted their speech as neither had enough energy to say more than a few words at a time.  Body language is so powerful.  It has its own expressive way to communicate.  I saw these two patients only days apart.  Each touched my heart so deeply by their beautiful smiles.  No words were needed to be spoken.  I gave each of them a smile back; which was my way of expressing my appreciation back to both of them.

A SMILE

 She was diagnosed with Alzheimer’s

only a few years back; at age seventy-two.

Currently, she is wheelchair bound due to weakness;

needing help with all of her needs.

 

Conversation is difficult for her

as she speaks only one or two words at a time.

I spoke with her about her loving son.

Her amazing response back was beautiful;

                    one huge, magnificent smile.

 

Five weeks ago, he was told

“It is cancer that has spread to your brain”.

He has undergone five radiation treatments

with chemotherapy now next in line.

 

He was totally independent before this started.

Now, his weakness keeps him in bed

as sitting up in a wheelchair is too demanding.

He, too, is now only speaking a few words.

 

We were talking about his large, extended family

and how his wife spoils their eight grandchildren.

As we were leaving, I turned to him and said,

“I bet you spoil your grandchildren too.”

 

No words were needed

as he replied so expressively

with one beautiful, heartfelt

                  smile.

 

HER BIGGEST NEED

“Annie”, was diagnosed with lung cancer four years ago.  She underwent chemotherapy, and over time, her cancer did spread to her liver and bones.  Her three sisters live nearby and are very involved and supportive.  Annie has become so weak that she spends most of her days in bed. 

Annie was widowed about two years ago.  Her only son still lives in Russia with his wife and three children.  He wants to visit one last time with his mother, but two applications for a Visa have been denied.  Annie’s sister, “Olga”, has temporarily moved in with Annie to help out as needed. 

Olga shared that they have recently applied again, for the third time, to get a Visa for Annie’s son.   Annie wants no extraordinary measures, but wants to stay on the chemotherapy in order to hopefully live long enough to see her son one last time.  

It seems so simple; approve the Visa for her son to come and see his mother one last time.  It feels so cruel to not allow this last visit to happen.  I wish them all the best.

HER BIGGEST NEED 

 

She emigrated here from Russia

just about twenty years ago.

Three of her sisters already lived here,

and she so wanted to be nearby.

 

She found work as a manicurist. 

She loved all of the colors one could use.

But then, four years ago, she heard, “Lung Cancer”.

That’s when her world did suddenly change.

 

She underwent chemotherapy to no avail.

Her cancer continued to spread.

In the midst of all of this crisis and drama,

her husband suddenly died.

 

She was well supported by her sisters,

but she so needed for her son to come.

He still lived in St. Petersburg,

and needed to see her as well.

 

Her sisters have applied for a Visa,

but twice have been denied.

They have tried again for the third time,

while she is trying so hard to hang on.

 

The chemotherapy is making her ill

as her cancer continues to grow.

She’ll hold on for as long as she can,

as her biggest need is, for one last time,

to say “Hello” and then “Goodbye”

                     to her dearest and only son.

 

MY GRIEF

I met “Josh” and his wife, “Kathy” about six weeks ago when Josh was in the hospital.  It was only three months ago that he was diagnosed with Cancer that has spread to his brain.   After Josh was discharged to home, I went back to their home to talk with Kathy about hospice support. I did not see Josh at that time as he was asleep in his bedroom. 

Kathy also had questions about our Palliative Care program.  I educated her on both of those programs.  Knowing he was eligible for hospice, but wanting to support both of them to choose what support feels right to them.

 Josh is my son’s age.  After hearing about the late hospice admission today, I had a strong need to accompany the nurse to this admission.  Kathy has come to terms to Josh’s terminal status. She has hopes that his illness doesn’t last for too long a time as “He is unable to do anything that he loves to do”. 

 She is now ready for hospice and felt strong relief that we were available to help both of them as needed. I spoke with Josh for a few moments.  He was lying down in his bedroom.  He looked so weak and helpless. 

As I was leaving, this strong sense of loss embraced me.  I was strongly pulled into their terminal emotions, knowing that it can happen at any time to any of us.  It makes me appreciate each day and while I strongly embrace my family and my friends.  I will feel my emotions for a little while with awareness of how precious life truly is.

MY GRIEF

 

It was just about six weeks ago

that I met he and his wife.

Two months prior he heard,

“It’s cancer that has spread to your brain.

 

I met his wife again about two weeks ago

as she requested more information about hospice care.

They both weren’t quite yet ready for it,

but she wanted to know what it was all about.

 

We went out again this afternoon

to admit him to our hospice program.

He has declined so rapidly;

bedbound; confused; not eating much.

 

It was a late afternoon admission,

but I so strongly had to be there.

As she opened the front door,

she said what I had been just thinking;

                    “Third times a charm”.

 

He is two months younger than my son.

He has a dry sense of humor, just like my son.

A strong emotion of sadness has hit me.

“There, but for the grace of God, go I”.

 

It brings up intense emotions of loss;

of feeling powerless and vulnerable.

Strong thoughts of “When will our next loss occur?”

It mightily does hit all of us now and then.

 

It has caught me by surprise,

as my grief is so authentic; so true.

But I will feel what I need to feel

while allowing myself

                    to simply grieve.

 

HE IS SURVIVING

We admitted “Cathy”, seventy years old, to hospice three days ago.  Cathy lives with her husband, “Mitch”, who is her caregiver.  Mitch is continually by Cathy’s side to help in any way that arises.   Mitch has a strong personality and deeply shared his stories regarding Cathy’s diagnosis and disease process. 

He strongly believes that any crisis or challenging event that occurs, there is always an answer to solve any event.  He is a very practical man with a thought process that will always search for a tangible answer. 

Cathy died only hours after we admitted her to hospice.  As Cathy took her last breath, Mitch called 911.   When I heard about her death and he calling the paramedics, I had concerns on how he was coping.

 He totally surprised me when I spoke to him today.  He continues to follow his rules.  I feel that he strongly believes in their value.  This is the second time Mitch has been widowed.   He is coping the best way he knows, but I have concerns, that maybe not next week or next year, his emotions of sadness may fully roar, as he is stuffing his emotions down deep inside.  I wish him the best, though, as he definitely is a survivor.

HE IS SURVIVING

 

We admitted her on a Friday.

In the wee hours of Saturday morning,

while holding onto his hand,

                  she took her last breath.

 

We ask the same question at every admission,

“Are you okay not calling 911, but hospice?”

He, like most everyone, gives us a comfortable, “Yes”.

But, he panicked and called the paramedics.

 

They put her on the floor and did CPR.

After twenty minutes, he was told,

“We cannot help her anymore.”

He quickly answered, “Then do stop.”

 

I spoke with him today to offer condolences.

When asked how he is doing, he replied,

“I am optimistic; I am positive; I get rid of sad feelings.

I have to remain upbeat.  I erase my sad image.”

 

“It was not traumatic at all.

She had a very calm death.

She is running around now.

                    She is golden”.

 

I spoke about the emotions of grief.

How sadness can often play a large part.

It is so healthy to process all of the emotions that arise;

                    whatever they may be.

 

He will cope his way by following his rules.

He sees it helping him along his way.

Losing someone is never an easy experience,

but for him, I can say with certainty,

                    He is surviving.

 

HIS MOTTO

“Cathy, seventy years old, was diagnosed with ALS (Lou Gehrig’s Disease) just about one year ago.  Cathy lives with her husband, “Mitch”, who is totally devoted to her.  They have two daughters, who live out of state.  Mitch’s primary focus is taking care of his wife. 

We first met Cathy a year ago; shortly after her diagnosis.    We admitted her to our program, but fortunately for her, she remained stable for quite a while.  It was then that we discharged her from hospice as she did not meet hospice criteria. 

 We went out for the second time today to meet with Cathy and Mitch.  Cathy now totally qualifies for our program.  She is totally paralyzed and bedridden.  She can only move her right arm.  She is amazing as is still able to text her family and friends.  She is on a breathing apparatus along with oxygen continuously.   Cathy responds very softly with one-word answers only as she is tremendously weak. 

Mitch looks at life and challenges in a very intellectual way.  When he hits any challenge in his life, his first response is, “Think out of the box”.  That works for him.  Mitch will likely reach out intellectually to any challenge that rises up in his life.  I wish both of them the courage and strength to meet those challenges.

HIS MOTTO 

 

I met them about one year ago

when we admitted her to hospice.

She was just diagnosed with Lou Gehrig’s Disease

and was reaching out for help; for some support.

 

She was only on for a few months

as she became stable and doing quite well.

Now, all has dramatically changed.

We went out to re-admit her yesterday.

 

She is totally paralyzed except for one arm.

She wears a breathing apparatus continually.

She is now struggling with swallowing

and taking in only liquids.

 

He is a strong advocate for her.

Whenever he hears, “That is not available”,

he will typically respond strongly,

                    “Think out of the box!”

 

That, amazingly, will typically work

as he thoroughly will research any topic.

When asked how does he cope, he replies,

“I ignore it and will find a positive solution.”

 

His deep research does, quite often, help.

He will continue to chant his motto as needed.

Any rough road ahead, I can hear him now,

                    “Think out of the box!”

 

COPING

The hospice nurse and I went out to admit “Danny” to hospice.  Danny is married to his wife, “Rhonda” for over fifty years.  They have two daughters.  Danny was working until about eight months ago when he developed stomach problems and pain.  He had to go on disability.  He went through multiple medical tests with no clear answer as to what it could be.  Then, three months ago, he was told, “It is Colon Cancer.”  He underwent chemotherapy to no avail.  He had his last chemotherapy one week ago.  It was then he told his family, “No more treatment.”

 Rhonda, too, has some health problems.  Their two daughters live nearby.  One daughter, “Shannon”, is taking family leave and staying with her parents to help them.  Rhonda is so focused on all of the tasks that need to be completed.  All three of them are coping their own individual way, but in the end, their unconditional love beautifully shines through.  I wish them all of the best.

COPING

 

He has always taken care of his family.

They forever and always do come first.

Now with a three-month old cancer diagnosis;

that support is much more vital to him.

 

His wife has some health problems too.

Their daughter takes care of both of them.

She has some anxiety; some appropriate stress;

wanting to help her parents the best she can.

 

Dad has recently, dramatically declined.

He is now so terribly weak; so tired.

He is bedridden and no longer eating.

He is sleeping all of the time.

 

The other day, he told his daughter,

“Let me go; I am done trying; I want this to end.”

Then quietly to his father who has died before,

“Make room.  I am ready to come.”

 

His coping style is facing reality head on.

His grief and emotions run appropriately deep.

She will use sarcastic humor to cope.

It always has helped her through difficult times.

 

At one point I asked her, “How are you doing?”

Her response made me laugh so hard.

She is doing what she needs to do

to help her get through this really hard time.

 

“I am tough!”

Then pointing to her left hip added,

“This is my tough bitch button.

                    Don’t touch it!”

 

Coping comes in all shapes and sizes.

It never is totally right or totally wrong.

I am glad that both of them did find

the best way to cope that works for them.                                       Marilou Rennie    July 14, 2023