Thursday Thoughts

Lately I have had time to think. The weather is still gray and snowy, not the pretty kind. Yesterday it rained. There is mud everywhere and going outside feels blah. Sitting by my fire upstairs in the den has been a balm, until thoughts intrude.

A few days ago I was called to the ER for an urgent hospice admit. We have a level of care in hospice that is called GIP, general inpatient. These are patients for whom we cannot get symptoms managed at home.

The family received the bad news of metastasized cancer while in the ER. The discussion from the ER MD was perfunctory and brief. It left the family in shock and that is how I found them after 5 hours in the ER.

I often find myself in this position during my work days. The bearer of bad news. Telling them about hospice, end of life care. I normally phrase it as comfort. Let’s get your symptoms under control and make you comfortable. Sounds good, but causes anguish to the family. Will we give too many meds to snow their loved one, or worse yet, will it hasten death. This is not something I take lightly and spend much time talking about how we could manage pain. Then I call the hospice MD and discuss the patient ‘s concerns. We look for the best balance between pain and comfort and quality of life. It’s definitely a balancing act and it is all based on starting something and seeing how it goes. It’s observation driven and my motto has always been start low and go slow.

I finally did get this lovely patient admitted, started IV pain meds and started to get her pain better managed, got her some dinner, comforted the daughter who was distraught and then the next morning I was pleased to see she was so much better and could go home on home hospice as was her wish. This doesn’t always happen but when it does it is a good day toward a good death.

A good death. How does one describe that? I have been witness to many deaths, some good, many bad. The bad ones still haunt me. The good ones, well, they seem right. It’s all still sad as can be, but for the family, a good death leaves them at some peace and a bad death will stay always in the corner of their soul and distress them. And that’s what we try to avoid.

A good death is a patient who is not filled with fear. Who is in a zone of comfort. Who can still participate in life until the end. It’s not a Hollywood movie death, none are. But it is peaceful.

A bad death is chaotic. Pain, vomiting, shortness of breath. Family members in disarray and arguing. Needs not being met. Feeling like a burden. This causes so much anguish for the patient. I cannot describe this in detail but I can see every detail in my mind.

The reason I am thinking about this is because of Mary Oliver. And her poem In Blackwater Woods.

“Every year, everything I have ever learned in my lifetime leads me back to this: the fires and black river of loss whose salvation, whose meaning, none of us will ever know. To live in this world you must be able to do three things: to love what is mortal, to hold it against your bones, knowing your whole life depends on it. And, when the time comes to let it go, let it go.” ~ Mary Oliver

Mortal: (definition) of a living human being, often in contrast with a divine being, subject to death.

I think we forget this sometimes. That we are merely mortal. Someone is here and yes, we think, they will always be there. I can call them later. I’m busy now. I’ll try to get there to visit.

Or we plow through our lives with dreams of where we want to be hovering in the background because “someday” it will happen but not right now because I am too busy and can’t you see I’m working right now and I have these errands to run…..and we pause our dreams for the practicality of life.

It’s interesting how our lives get in the way of our lives. I know we must be pragmatic, but every day is a chance to embrace our true selves even for just a moment.

So I guess the point is to remember you are only mortal. You get one shot at life, and it really does end. It’s so easy not to think about that as we distract ourselves and fall victim to our busyness or other ways we drown out the sound.

Seems heavy for a Thursday, but it is a good day to look around and see where you are right now and sit with all of it. Sit with silence and just observe what is there. Where your life is right now, today. Are you at peace? Can you find peace in pockets of your day? Do you make time to sooth yourself? Are you unafraid? Are you comfortable and pain free? Why wait until death to know this is so important.

I will leave you with this. Mary Oliver was very wise. When she wrote The Summer Day, the end of it was the heart of everything. “Doesn’t everything die at last, and too soon? Tell me, what is it you plan to do with your one wild and precious life?”