Like evil twins in a grim horror movie, fear and ignorance stalk caregivers.
This once happened . . .
A hospice nurse described one of her patients—let’s say this was a mother of several adult children and also a wife of over four decades—who was under hospice care in a rented hospital bed in the living room. Most of the family had gathered at the home. Most talked with their dying loved one or did chores like cleaning the bathroom or preparing meals. But one family member—let’s say it was the oldest daughter—never entered the living room. Never offered to help. This daughter surveyed the activity around the metal-framed rental bed from the entryway, and then hurried down a hallway, away from her family, away from her mother.
Was she afraid of death?
This happened . . .
A doctor described a lengthy conversation with several siblings about adjusting medications for their oldest brother. Because of his health condition, there was no longer a need for certain drugs that had once been critical. Coumadin, a blood-thinning medication for reducing and preventing blood clots, was no longer necessary. Some take Coumadin for short periods of time; others may require long-term use. But the hospice physician felt the patient was no longer benefiting from the current dosage.
One of the patient’s brothers asked, “So if he is no longer on the Coumadin junk, will he move slower because his blood will be thicker?”
When the doctor shared that story in a patient care meeting, several nurses chuckled and most of the other hospice staff smiled (yes, even medically stupid me couldn’t resist a grin). But the doctor immediately cautioned about how careful we have to be with patients and caregivers. How could the brother—indeed, most caregivers—grasp the complexities of medicine in general, let alone the specific reactions from a particular drug?
Isn’t it funny to imagine a blood “thinner” like Coumadin could help someone move faster, while eliminating it might slow the patient down! Well . . . maybe? However, there is a peculiar logic to that perspective. As a long-time San Francisco Giants baseball fan, I recall my amazement at the speed of—I’ll be polite here—husky third baseman Pablo Sandoval in the 2014 World Series. Sandoval, long gone from the Giants, was a “thick around the waist” professional ball player. While he moved fast for his age and girth, most of Sandoval’s “thinner” teammates could easily outrun him.
Thick is slower? Thin is faster?
As the doctor pointed out, most served by hospice are ignorant about medicine. Perhaps they are experts in law, teaching, budgets, plumbing, baking, or farming. We are a nation of experts, professionals, and specialists.
But, to quote lyrics from Sam Cooke’s “Wonderful World,” many . . .
Don't know much about history
Don't know much biology
Don't know much about a science book
Don't know much about the French I took
And most of us don’t know much about 21st century medicine.
A hospice nurse should remember everything requires a clear explanation. A caregiver—who’s trying to make sure a loved one is as comfortable as possible—should feel free to ask any question and deserves an answer he or she understands.
There are no stupid questions. We often reassure people with those words, but it’s important for the one asking and the one answering to remember that statement is true.
Why? Because ignorance’s evil twin lurks in the corners. The dying, and those caring for the dying, are afraid. We gaze into a room where death has arrived, where the mother who’d always been strong, had been the one to care for others, has become dependent on those others. No one invited death in. No one is prepared for this time. While there are hundreds of bad and sad excuses to turn a back on the dying and walk away . . . quite a few of them make sense. We do fear the dying. We do fear the changes. We do fear the absence of a future. We also fear the obvious, like how a room smells of stale urine or cloying flowers. We fear the complicated, like unresolved anger between mother and daughter or festering rivalries between siblings.
In a bad horror movie, the evil twins are usually overcome because, well, Hollywood likes an ending where the hero wins. But nothing in hospice is scripted.
This I would say to the professionals in hospice: every patient and caregiver is hurting. No one wants to appear ignorant—ever—and yet in the time of dying, there are so many moments that expose ignorance. And every patient or caregiver we serve is afraid. Even the ones who don’t seem afraid . . . are afraid!
This I would say to patients facing their final days and to those caring for the people they love the most. Ask your questions—any question—and you deserve the best answer. And especially for ones who walk away, or for the ones where it takes all their strength to stay in the room, don’t ignore your fears. Don’t keep them only to yourself.
No carefully written Hollywood script resolves the real ignorance or real fear. Instead, we overcome the “twins” by sharing awkward, honest, risky words with each other.
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Photo from Stanley Kubrick’s The Shining (1980)
My book, A Companion for the Hospice Journey, is available at Amazon.