Two Nurses Tell Their Stories in Literary Journals

Two nurses write about hospice services in literary journals. Great reads!

The Sun is one of two literary journals that I have unsuccessfully submitted to over the years. The other is the Bellevue Literary Review.

Close to 20 years ago, I drove to The Sun’s offices, parked in front of a single-family house on Roberson Street in Chapel Hill, and placed my submission, an essay doubled-spaced on hard copy, folded, and slipped into a legal-size envelope along with a cover letter and self-addressed-stamped-envelope, in the mailbox by the front door. I drove back to my home some five miles away and waited.

Imagine my pleasant surprise to find that each journal has recently published an essay by a nurse. And the topic is similar: hospice.

I can’t display sour grapes because I have long promoted nurses telling their stories. And since I have worked as a hospice nurse, I know that hospice care is poorly understood and underutilized.

Every Baby Needs to be Rocked by Barbara Woodmansee, The Sun, May 2022

Barbara Woodmansee is a hospice nurse who is stationed at a local hospital awaiting referrals from the staff. She has been told to keep a low profile. Her essay tells of seven hospice admissions. They give an overview of the types of patients hospice manages and the variety of services that the hospice program provides. Woodmansee shows how hospice intervention makes a difference in a patient’s last days along with the roadblocks she faces in providing care. She also tells us of a personal experience that inspired her to be a hospice nurse.

One of Woodmansee’s patients, Carrie, is a woman in her early 20s who developed COVID after delivering a heathy son. Her immune system has failed, and she has “multisystem organ failure; sepsis has debilitated her heart, kidneys, liver, and lungs to the degree that she has no reserve left to fight her infection.”

Woodmansee is present in the hospital room where the patient’s family gathers while life support is withdrawn. “Once the ventilator is removed, Carrie’s entire family stands at the bedside, each with a hand on her body—all except for her mother. Ann has taken Carrie’s infant son to the car. When her daughter dies, she is holding the baby.”

Woodmansee notes that “COVID has made me even more aware of my inability to support everyone affected by a patient’s death: the dying person, the family, and the staff who are trying so hard. One of the important gifts we (hospice nurses) give to families in hospice is our presence, but we have to move so much faster now, with so many new barriers between us, both physical and psychological. Worst of all, we’re getting used to it.”

With that, Woodmansee shows what nurses feel and the relentless circumstances they have had to deal with the COVID pandemic. Her essay also shows the personal investment a nurse makes to each of her/his patients.

On The Brink by Barbara West, Bellevue Literary Review, Issue 42, 2011 BLR Prize Winners.

Barbara West, an on-call hospice nurse, deals with an unclear after-hours emergency. She visits the double-wide trailer occupied by an elderly sister and brother. What she finds is the brother, slumped over in a wheelchair close to death while the caregiver/sister seems bent on ignoring reality.

After West attempts to lift the brother from the wheelchair to the bed, a loud sound emits from his body, and his breathing stops. She says, “If you work in hospice long enough, you’re bound to be accused of murder at some point. It could be over the phone, in a moment of passion from a guilt-ridden, out-of-state, family member. Or in person, simply because you’re the one at the door at that pivotal moment. Or maybe because you’re the white nurse with a Northern accent, the face of the American health care system that denied Daddy access to dialysis back in Oklahoma. For the first time in my career, I wondered if I might now have actually done what I’d previously only been accused of.”

West misses the interdisciplinary team that is available during usual working hours. Now on a Friday night, she alone must address all the issues other team members would. And it is when she notes their skills, the reader is made aware of the rich services a hospice program can deliver. But we also realize that, in the absence of other team members, nurses can assure that appropriate care is given.

The humor threaded through this story softens the sharp edges that West overcomes in steering the brother’s death to an acceptable closure. But the reader sees what discomfort West carries within her. She seeks reassurance from a coworker that she handled this case correctly. We learn that memories, both pleasant and uncomfortable, long remain with nurses when making judgements they must make on their own.

May we see more nurses writing their stories outside of nursing journals for the public to enjoy and be enlightened and to realize that nurses do make a difference.  

Country Music

I’m not writing my second book whose working title was to be “Home Visits.” The Pandemic has cast a spell on my brain, resulting in lethargy and an inability to focus on structuring another book. So, instead, I’ve decided to take each home visit story and submit it to a literary magazine for potential publication as a “stand-alone” essay. I plan to email one of the stories, Country Music, at the end of this week to an online journal. 

Country Music tells the story of three patients that I cared for when I worked as a nurse practitioner in a home care program at a Veterans Hospital outside of Chicago. They were at various stages of dying. In the late 80s, the hospice movement was just taking baby steps into the medical/nursing world. I was learning about dying and death from my patients and their caregivers. 

The locations of the three patients’ homes lined up perfectly for me to make the visits to them conveniently in the same day. This lasted for about three months. On the day of the story, a dreary, rainy day, I show the challenges I faced working with my three male patients and their wives (few women were enrolled in the VA health care system at that time), how each man played the hand he was dealt and how the women dealt their husband’s decline. 

One of the men loved country music. Talking with him about songs and artists, rekindled my interest in the genre. I found a great country western radio station on my government-issued compact car. The earthy, raw lyrics telling of common human emotions became my therapeutic passenger that accompanied me on my home visits. 

While I am editing this story for submission, I find myself checking into YouTube to listen to the familiar songs that supported me so many years ago. This is more fun than writing that second book. 

Leaving Our Legacy

I have been thinking for a long time about the fact that we older nurses are dying off. We will take with us our memories of nursing history. I have always loved to hear from other seasoned nurses about how they size up their nursing careers as they look back. What was important at the time, what were they happy to see disappear, and how do they assess current nursing practice and the future of the profession?

So I decided I would weigh in, occasionally, by spotlighting a nurse of a certain age, i.e., sixty and older, whether this is through an article I have read or by interviewing someone, or through my own stories.

This post is prompted by an article: Diane Saulecke, “There from the Start: A Hospice Nurse Looks Back,” American Journal of Nursing, 7, July 2017, 56-57.

The article features Dianne Puzycki, an 82-year-old nurse, who began to work with the hospice movement when it first started in the early 70s. She still works “the night shift at Connecticut Hospice once a week. ‘I want to be part of it as long as I can,’ she says, ‘It’s become part of my life, my philosophy.’”

 

 

 After graduating from nursing school in 1955, she started her career at Memorial Hospital (now part of Memorial Sloan Kettering Cancer Center) in New York City. There she cared for patients with cancer, many of them young women.

“At that time, we didn’t talk about death and dying,” she says. “We weren’t allowed to talk about that. It really haunted me for years.”

I remember those restrictions well. The diagnosis of breast cancer was withheld from my beloved Aunt Lena. I was in the first year of nursing school but never visited her in the hospital. One evening, when I was talking to my mother on the phone, I asked, “How is Aunt Lena?” “Just fine,” my mother said. That’s when I knew she had died. My mother would give me the bad new when I next went home to visit.

Puzycki mentions that she heard both Cicely Saunders, a doctor who founded the first hospice, and Elisabeth Kübler-Ross, who opened up discussion on dying through her 1969 book On Death and Dying. The early 70s were heady times in health care as discussion heated up regarding the previous taboo of being honest with patients by telling them their cancer diagnosis.

Kübler-Ross’ book was the subject of a workshop for the medical staff at the time I worked for a community hospital in the early 80s. To this day I remember one of the surgeons storming out of the classroom after loudly protesting, “my patients don’t want to hear that they have cancer.”

Being present for patients and “picking up on the little things” is to Puzycki the key to hospice nursing. And she says that seeing the compassionate actions taken by her colleagues, especially the younger ones, makes her feel hopeful about the future of the profession. She recently saw, for example, a fellow nurse lean down and kiss an elderly patient on the head. “I said, ‘That’s a good hospice nurse.’”

 

SaveSave

SaveSave

SaveSave

SaveSave

SaveSave

A Hospice Nurse is Featured in The New Yorker

Larissa MacFarquhar is a staff writer for the New Yorker. She has written profiles on “do-gooders,” people whose altruistic acts “spring from genuine empathy.”

Her subjects are varied: Quentin Tarantino, Diane von Furstenberg and Paul Krugman. Most recently she spotlighted Heather Meyerend, not a famous person, but a nurse. Her story starts on page 62 in the July 11 & 18, 2016 edition of The New Yorker, titled: The Threshold: A hospice nurse’s encounters.

“Heather Meyerend is a hospice nurse who works in several neighborhoods in South Brooklyn—Sheepshead Bay, Mill Basin, Marine Park, Bensonhurst, Bay Ridge. She usually has between sixteen and twenty patients, and visits each at home once a week, sometimes more. Some patients die within days of her meeting them, but others she gets to know well, over many months. She sees her work as preparing a patient for the voyage he is about to take, and accompanying him partway down the road. She, like most hospice workers, feels that it is a privilege to spend time with the dying, to be allowed into a person’s life and a family’s life when they are at their rawest and most vulnerable, and when they most need help. Some hospice workers believe that working with the dying is the closest you can get on earth to the presence of God.

Heather is not brisk or efficient, as nurses in hospitals are. She is purposely inefficient, in fact. Most of the time when she visits patients, she doesn’t have much to do: she takes vital signs, she checks that there are enough supplies and medications in the house, she asks if old symptoms have gone away or new ones developed. If she were rushing, she could do all that in about five minutes, but her visits usually last an hour or more. Sometimes there is a complicated medical situation to take care of. Sometimes she does something non-medical that needs to be done, which is the hospice way—she might sweep a floor, she might heat up dinner. But, even when there’s nothing else to do, the idea is to be around longer, to chat, to sit close by, to put her hands on the patient’s skin as she goes about her checkup. Her visit may be the high point of the day for the patient, who may not be able to get out of bed, or for whoever is taking care of the patient, who may not have left the house or seen anybody else for a day or two; either or both of them may be going a little crazy and may badly need interruption or variety of any kind, ideally someone different to talk to. So Heather moves slowly; she sits down; she delays; she lingers.” (Italics mine)

 

 

Heather Meyerend examines Mary, a ninety-two-year-old woman, at her home, in Marine Park, Brooklyn, in September, 2015. Mary died later that month. Heather believes in caring for the whole person, body and mind. PHOTOGRAPH BY EUGENE RICHARDS FOR THE NEW YORKER
Heather Meyerend examines Mary, a ninety-two-year-old woman, at her home, in Marine Park, Brooklyn, in September, 2015. Mary died later that month. Heather believes in caring for the whole person, body and mind. PHOTOGRAPH BY EUGENE RICHARDS FOR THE NEW YORKER

 

Weaving throughout Heather’s story, MacFarquhar gives us the scope of hospice:

“Hospice believes in caring not only for the patient but also for the family, and tries to address psychological and spiritual needs as well as physical ones, providing social workers and bereavement counsellors, music therapists and chaplains, who work together as a team and consult one another frequently.”

And the history of hospice:

“The first modern hospice was founded in 1967, in London, by Cicely Saunders, who was both a doctor and a social worker: she wanted to offer homelike care that aimed to provide comfort and serenity rather than to prolong life. Two years later, Elisabeth Kübler-Ross’s book “On Death and Dying” focussed public attention on the idea of the “good death.” The first American hospice opened in 1974. In those days, hospices were small nonprofits staffed mostly by volunteers; but in the mid-nineteen-eighties Medicare began to cover hospice, and now roughly twice as many people in America die in hospice as die in hospital.”

And an overview of the dying process:

“As the end approached, patients sometimes fell into an agitated delirium in which they saw people from their past appear in front of them as they lay in bed, often people who had died years before. This happened more often than Heather had expected—to about a third of her patients. The spectres appeared sometimes sitting in a chair by the bed, sometimes standing near the door. Often, a dying patient saw his mother or his father in the room, waiting. Sometimes these spectres were welcome: it seemed to the patient as though someone he loved who had gone on before had come back to accompany him to a life after. But other times the spectres were terrifying. Sometimes a patient believed that someone was running after him, out to get him; sometimes he was haunted by someone he had hurt long ago.

When death drew closer, a patient usually began to withdraw, not wanting to see people, and talking less if someone came. He began to sleep more. There was a kind of quieting, a kind of drawing in, as if he needed time to prepare. He might open his eyes for a minute and smile, but then he closed them and returned to wherever he had been. Hearing was the last sense to go. The patient might seem to be asleep or far away, but still he might hear what his family said around him. People tended to whisper around a dying person, so Heather might say to them, Don’t whisper! Talk, play music, he can still hear you.

When death is imminent, the breathing changes, and discoloration begins. The skin under the nails starts to get cyanotic, to turn blue. The legs grow dusky and cool. When Heather sees these signs, she calls family members who aren’t there and tells them, If you want to be here, this is the time. But she has seen, many times, that the patient seems to choose whom he wants there at the moment of death. Sometimes he waits for someone to arrive; but just as often he waits for someone to leave. Heather would see a husband or a wife or a child sit by the bedside day after day, hour after hour, and then he or she would say to the patient, I’m just running out to the market for ten minutes to get lunch, or I’m just going to take a shower, and that would be the time the patient would go. This happened over and over again. She wasn’t sure why. Maybe the dying person wanted to spare his spouse or his child the grief, or maybe it was harder to let go with that particular person around. Maybe dying was just easier to do alone.

If Heather was there when the end was very near, she would ask if the family wanted to gather together in the room. Then she would hang back, leaving the family to say goodbye. If the family were Christian, and if they had talked about that before, she might ask if they wanted to pray together. If the family were not Christian, she didn’t want to impose her beliefs, so she prayed silently in her head: God, here is this person, have mercy on him.”

“The patient’s breathing changes. He might stop breathing altogether for half a minute or so, and then start again. Then he stops again, but for longer. Then starts again, but shallower. This means that death is very close. For a person who hasn’t seen dying before, this strange, unpredictable breathing can be bewildering, a horror: because of the irregular intervals between the breaths, there is no knowing until a while afterward which breath is the last. Just before it happens, there is a staring. The eyes don’t focus anymore. The person is not there behind the eyes. Even so, Heather may need to step forward, after waiting some time, because the family may not know that the patient is dead.”

***********************************************************************

Impressive how MacFarquhar entertains and educates The New Yorker reader about both hospice and the life of a hospice nurse, topics not usually given such high visibility. It’s the attention to Heather’s interactions with her patients that I so enjoyed reading. You see, I once worked as a hospice admissions nurse. The immediacy of connection with the patient and family could be overwhelming. I never knew what I would find with each new admission—anxiety, fear, apprehension resided in most households. The caregivers, who could be spouses, friends, siblings, adult children, and parents, had to learn about medications, side effects, how to care for the patient, and be prepared for the final outcome, death. It was not a time to rush with instructions. I knew that assessing strengths and shortcomings of the family unit would save problems later on. I loved my job.

One day, the supervisor pulled me aside before I left to see my first patient. In the chill of an empty hallway, she told me I was too slow. Not that I was performing poorly, but that I was too slow.

I knew “too slow” meant that I was costing the organization money. But I also knew I was doing a good job as evidenced by the frequency of hugs I received from the family/caregivers before I left, and the appreciation from the nurses who took over the care of those I had admitted and went out of their way to tell me, “the caregivers are always so well informed.”

It saddened me that management didn’t appreciate my efforts. I didn’t want to work for an organization that valued the bottom line over patient/family satisfaction.

And since I didn’t want to be faster, I quit.

It’s clear MacFarquhar’s did her homework, depicting the specialness of hospice and a nurse who chose to work there. Hospice is not the same as an acute care hospital. The patient and family needs are different and there is no need for hurried nursing care. What is necessary is a nurse who lingers.

THE TIME IS RIGHT

Taking a Blog break. This post appeared on March 10, 2013.

Nursing Stories

A friend deliberated whether she should visit her father for his 95th birthday. She was swamped with commitments. Since he was unaware of his birthday as well of his surroundings and didn’t even recognize his three daughters, there was no urgency to travel to another state.

However, she cleared her schedule and made the trip, as did another sister and a niece. Both lived out-of-state also.

As it turned out, on his birthday, he had a choking episode with difficulty breathing. He stopped eating and died three days later, surrounded by those he loved who otherwise would not have been there had they not come to commemorate the day he was born.

This story reminded me of a patient I cared for back in the early ‘90’s when I worked as a nurse practitioner in a home care program. I had made a first visit to an elderly man…

View original post 409 more words

Lois Roelofs posted this story of Martha Keochareon, a nurse dying of pancreatic cancer who selflessly allowed nursing students to be present during her last days at home in order to learn about hospice care.
I hope this poignant story moves you as much as it did me.

Write Along with Me

As she lay dying from pancreatic cancer, Nurse Martha Keochareon wanted to do more than plan her funeral. So she called her alma mater and offered to become a “case study” for nursing students. She reasoned she could help students learn about the dying process while, at the same time, it would be a way for her “to squeeze one more chapter out of life.”

I loved this story. First, as a retired nurse educator, I was struck by Nurse Keochareon’s selfless giving. I could identify with her desire to teach; as nurses we are taught, along with being caregivers, to be teachers (as well as communicators, researchers, leaders and more). I believe we consider it a duty and a privilege to empower our patients or students with the resources they need to function successfully in their lives.

Second, Nurse Keochareon had lived with pancreatic cancer for more than six…

View original post 191 more words

TRICK OR TREAT AT THE FRONT DOOR; HEARSE AT THE BACK

I have been pestering my classmates from nursing school (we are about to celebrate our fiftieth anniversary next month) to write their stories so I can post them on my blog. Maybe pestering is too mild a word. Regardless, I have succeeded. Two women have sent me stories.

The first comes from Joan Moore. 

This is her story when she worked for a Hospice in Central New Jersey in the late 1990’s.

THOUGHTFULNESS IN THE FACE OF GRIEF

Written by Joan Moore

One of the most important aspects of hospice nursing is that a nurse is available 24/7 for the patients. This means every nurse on the team is required to take a turn being “on call”.

I’d like to share one of my many on call experiences.

My weekend started quietly. It was a Saturday in October. Halloween. In that neighborhood when Halloween falls on a weekend, the kids start trick-or-treating in the early afternoon. I received my first call at twelve noon. Molly, a much-loved fifty-year-old with ovarian cancer that I had admitted two months previously, had just died. I offered my condolences and said I would be there in about twenty minutes.

I drove past many happy, costumed children on my way to the house. When I arrived, Molly’s brother-in-law was sitting on the front porch with a big bucket of candy for the neighborhood children. Inside, Molly looked very peaceful surrounded by her sister and three dear friends.

Hugs all around and emotional support. I explained what I needed to do to pronounce, per protocol, since it might seem silly to onlookers as I took a blood pressure and listened to lung and heart sounds on a person who just died. Then I called the doctor to inform her and the funeral director who told me he would probably arrive in an hour.

Since it was Halloween and children all around, the family told me to ask the director if he could please drive the hearse around the back of the house so as not to cause any commotion in the neighborhood. Conversation then revolved around Molly and good stories about her.

As I was about to render post-mortem care—washing and dressing the body—the body-language of the women told me that this was a task they wanted to do. They lovingly bathed Molly and dressed her. One laughingly remarked about Molly’s favorite sweater—it had silver threads running through it. She said, “I wonder what will happen when she’s cremated? Would she be all sparkly?”

The funeral director arrived and drove around the back of the house. Molly’s brother-in-law remained on the front porch giving out candy. It’s always difficult to watch as your loved one is taken out of the house for the last time.

I left, happy that my beeper never went off during this visit. I was available to listen and care. I wondered what the rest of my calls would be like. Turned out I was able to manage with only supportive phone calls and didn’t have to go out on any visits.

An epilogue to this—unbeknownst to me—one of the women was a nurse and a good friend of my supervisor. Monday when I went back to work she pulled me aside and told me that the family appreciated my silently watching over them while they rendered care. There is nothing more wonderful for a nurse to hear that you really helped.

 

Next week: Ruth Donoghue’s story: NAKED IN THE DELIVERY/LABOR ROOM

%d bloggers like this: