Hospice is designed to let people have the choice to spend their final days in their own homes. Surrounded by familiar sounds, and smells. No rules of quiet time, people can stream in and out all day and night if that is what is wanted. As an ER nurse, I have seen many families that have a moment of panic as the time draws near. Maybe the reality of the impending death now upon them, they call the ambulance. That is how a terminal hospice patient ends up in the care of an Emergency Room.
I have seen families almost come to blows over decisions made many weeks earlier. What many families do not know, is if one immediate family member says “no”, the person you love will have a rescusutative effort done on them. Hospitals would rather err on the side of life and take their chances legally. It isn’t a perfect system, but most have good intentions.
It was a Christmas eve. The ambulance bell rang, it was my turn. The doors opened and I stood ready to work.
“Hey Ruth. She yours?”
“She is. Take her to 4B.” As she rolled by, her eyes were closed, her breathing very shallow, and her skin was the color of a setting sun: Orange and flush. I pulled the Parameic to the side after I directed the family to register her. “Is she a code Jim?” I rolled the red crash cart to the room and popped the lock. I yelled for the Doc, and everybody else to be called. It is so much easier to slow down than speed up.
“Complicated.” My poster looking Paramedic responded.
“Try me.” I spoke as I undressed her, transferred her to my monitors that showed a heart dying. “Code or not Jim!” The team started to work and listen.
“She is hospice. End stage Liver Cancer that has mets everywhere” (“mets” is short for metastasized. This means the disease has spread to different systems of the body) “Apparently a prodigal son showed up today with his son. He has been absent for years according to the sister, and he is demanding a full code status. The husband got so flustered, he called us. That complicated.”
The Doctor was needing to speak with the family as we watched the screens document her exit strategy from this diseased riddled body. She was trying to get to her heavenly home promised to her through her very well read Bible, and the Preachers promises of wonder and streets of gold. She was trying so very hard, and I was about to step in and deny her entrance to a land of perfect. Or at least go to battle to keep her here. A wrong at every level. But not my call, legally or other.
The yelling coming toward the room alerted us that the family was on the way. We braced for the blast. They were fighting and loudly over their mother. I tried to back them up, but they were too into their footing, instead of looking down at the frown and tears that their quiet dying mother displayed. I looked at the Supervisor not knowing what to do. That was when my miracle happened. I didn’t want to start pushing on this woman’s chest. Breaking bones, a brutal act for nothing. I would have, but I really felt it was a terrible thing to do to a person who planned ahead so this wouldn’t happen.
Then the little boy, her grandchild from the son who had left her so many years before went to her. He was little with dirt that seemed tatooed on his hands, his knees, and through the curls of his blonde streaked hair. He didn’t ask, he just slid through the bars and climbed in the bed next to her. The room quieted and we all watched the two souls. One leaving, and the other at the beginning of his journey. I realized this is what it looked like when two crossed paths.
“Hi Gramma, I’m Blake. You are really sick huh.” Her eyes cracked open just enough to see the beauty of the origin of that voice. She was unable to speak, but there as a tiny smile. It was her salutation. It was over. We looked up to see her heart stop.
Nobody stepped up to start CPR. The husband moved to the bed and climbed in the other side of her, laying his head in the nape of her neck and crying. We looked at the son who was fighting he thought for her life. The realization that the war had been lost a long time earlier was apparent as he saw his son rub the forehead of the Grandmother he never heard speak. He turned and closed the door quietly behind him.
We all left. I pulled the curtain, closed the door and left the three of them alone. One man, his wife, and a grandchild just introduced that day. The strength and purity of a child, a cherub. He delivered the message the family needed. It was time for her to go home. She took her invitation and went eagerly to the land of health and happiness. Heaven.