“The Threshold,” by Larissa MacFarquhar. The New Yorker, 7/11/2016.
This is the story of a typical day for Heather Meyerend, a native Jamaican and a hospice nurse. She has 16–20 patients and visits each in their home at least once a week. A good part of the article is a description of specific visits. I hope I have someone like her looking after me someday.
- Hospice believes in caring not only for the patient, but also the family, and not just providing health care but also psychological and spiritual needs. Sometimes family (especially daughters) get so caught up with the patient that they neglect other parts of their own lives.
- Patients tend to resist hospice, because it sounds like a death sentence—which it is. The patient is giving up curative treatments in favor of comfort and dignity. They qualify for hospice only if their doctor believes they have less than six months to live.
- Where a hospital nurse is all about accuracy and efficiency, hospice nurses like Heather linger, chat, touch, usually taking an hour per visit when they could accomplish the necessities in five minutes.
- Twice as many Americans die in hospice care as die in a hospital.
- Medicare only began to cover hospice care in the mid-1980s.
- Many hospice workers, like Heather, feel privileged to be invited into a patient’s life at such a critical time. Some even say it is the closest you can get to the presence of God.
- Removing an impacted stool is a fairly regular part of a hospice nurse’s job (as my wife had to do while still a student nurse). Many nurses do not mind this because the patient feels so much better afterward. And the smell is not that bad. A fungating cancer wound smells far worse, enough to gag even a hospice nurse.
- We are often cared for by black women at both ends of life: when we enter it and again when we leave it. God bless ’em.
One day, many years ago, my mother had a severe stroke at her home in Florida a little before lunch. I arrived that night, and she died the following day. She was unresponsive the entire time I was there, but I was surprised how accurately the nurses could tell when she was about to die. She seemed the same to us hour after hour, but they were able to warn me and my father within 30 minutes of her death.
According to the article, when death is imminent, breathing stops and starts. The normal impulse to breath fails. It becomes shallower. Discoloration begins from lack of oxygen. The skin under the nails turns blue (cyanotic). The legs turn dusky and cool, and that is when Heather summons the family. However, she has seen many times when the patient seems to choose the precise moment of death, either waiting for someone to return to the room, or, just as often, to leave, as if they do not want anyone to see them die. Just before death, the eyes stop focusing and just stare. The tiny, involuntary saccadic eye movements that we perceive as life, stop. The iris no longer contracts in the glare of a flashlight.
In my mother’s case, the nurses were giving her Tylenol every few hours to hold down her temperature. When the Tylenol wore off, her temperature would shoot up to about 104 degrees. Perhaps something about this told them when death was imminent.
Hearing is known to be the last sense to end. The patient may seem to be asleep, but they could be awake and listening to conversations around them. Perhaps they want you all to shut up, to stop all that infernal singing and praying—who knows?—but be aware they may be hearing everything said. And, they may even enjoy that singing and praying.