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This happened long ago. I worked for a hospital-based home care program. We, nurse practitioners, received referrals from physicians who had exhausted all options to prolong the patients’ life. We visited the patient in his home and helped the family care for him until death. Traditional hospice services were not an option as yet.

My patient was in his 60’s or 70’s and had a ditzy wife. Just like Edith Bunker on the old All in the Family T.V. show. She looked like Edith with dark hair, a whiney voice and hands that kept flying in the air as she talked. Edith and I sat in the corner of the living room with its high ceilings, dark woodwork and antiquated furnishings talking about her husband. I think he had lung cancer. I can see him wandering around in the turn-of-the-century apartment, seemingly unaware of his wife and me. While Edith jabbered on, I thought about how much information I should give her. Could she handle her husband dying at home? Thankfully, time was on my side. Her husband didn’t look close to death. I could parse out information slowly.

I began by telling her about our program, giving her our twenty-four hour phone number. I would make another visit soon and go into the dying process in more depth and review potential problems. She seemed so scattered, but she cried occasionally giving me the feeling she realized the gravity of her husband’s condition.

At the end of my visit, Edith walked me to the hallway outside the apartment. For some reason, as I perched on the top stair, I told her to pick out a funeral home. “You’ll have to do this eventually. Call them and tell them your husband is on our program and our doctors will sign the death certificate.” Maybe I thought it would give her something to do before I made a follow-up visit.

Before I made that visit, I received a message from the funeral home that Edith’s husband had died over the weekend and that a service had been held just for the family.

A few days later, I made the mandatory bereavement visit. Edith’s daughter and her husband were with Edith in the kitchen. The son-in-law, GI Joe crew cut and heavy shoulders, stood by the sink washing dishes. The daughter, a replica of her mother, but with some extra padding, sat on one side of Edith with a box of thank you notes in front of her. The couple came from out of state and would stay only for a few more days. When Edith introduced them, they nodded without smiling as if I were a diversion they hoped would soon leave. While I sat at the table talking with Edith I could feel their ears on high alert. Was the son-in-law washing the same dish over and over again? I was distracted by the tension I felt in the room while Edith babbled on.

While I drove back to the hospital, I replayed Edith’s words. I heard her squeaky voice tell me her daughter and son-in-law drove a long distance from out-of-state. “But,” she said, “As tired as they were, they thought of me.” Did I notice her daughter’s back suddenly straighten up?  “My daughter said I needed a break. ‘Let’s go and get your hair done,’ she told me.” Edith patted her head full of tight curls reinforced with a heavy application of hair spray. Her smile showed she basked in the attention they had showered on her. She left for the beauty salon with her daughter while her son-in-law stayed to watch over her husband. “When we came back,” she said, tears flowing down her cheeks, “my husband was dead.”

I had other patients to see that day and quickly put the visit out of my mind.

Over the years I have thought about that bereavement visit. I felt so lucky I was distracted and didn’t register the implication of those words: alone with son-in-law and dead when wife returns. I didn’t think the patient was anywhere near death when I first saw him. Sure he could have had any number of problems that would cause system failure and death. However, if I never mentioned contacting the funeral home, Edith would have had to call 911 after her husband died. Without enrollment in our agency, a sudden death in the home would necessitate an autopsy. I would have no grounds for suspicion if the autopsy showed death from natural causes. But there was no autopsy. So I continue to exercise my vivid imagination and rehash possible scenarios. In one, I see Edith’s daughter and her husband nod to each other as the daughter takes her mother out of the house. The son-in-law waits a few minutes after they leave. He walks into the bedroom where Edith’s husband sleeps, takes the extra pillow off the bed, and presses it over the man’s face bearing down with this strong arms until he is sure his father-in-law is no longer breathing. After carefully replacing the pillow on the bed, he pulls a pack of Marlboro’s from the front pocket of his khaki’s. He ambles into the living room, settles into an overstuffed chair, lights up and waits for his wife and her mother to return.

I’ll never know what really happened

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