I
can't believe the alarm is going off, I just put my head on the pillow.
I check my phone for any messages and don't find any from John who had
the earlier 11th hour shift.
11th
hour hospice volunteers are those people who will sit with a hospice
patient whom health care professionals confirmed are actively dying.
This allows families who have often been with the patient for extended
periods of times, an opportunity to get some much-needed rest. All of
the 11th hour shifts I have been on are overnight shifts. 11th hour is
also for the hospice patient who does not have immediate family
available during this transition.
As
a firefighter I have seen people in various stages of dying and have
been part of the crews that have worked on patients that died during
rescue and resuscitation attempts. Now that I am in my 3rd year as a
hospice volunteer, I can't help but think how different the hospice 11th
hour work is. When people observe firefighters working it is easy to
focus on the trauma and chaotic nature of the events unfolding in front
of them. If you are a firefighter, it is very different. As a member of
a crew on an engine you get assigned a specific role when your team is
working to save a life. Focusing on this task takes up every available
bit of your focus, it becomes impossible to see the larger event you are
working at. As a firefighter, you are on scene less than 20 minutes.
Best case is that you are on scene working on someone from 10 -15
minutes. As a consequence, you can't dwell or focus on the more graphic
aspects of what is unfolding in front of you.
There
are of course things that you will see that will stay with you for an
indeterminate amount of time. And there are others that despite how
graphic they are will only stay with you briefly. Many of them leave
with the ambulance that are transporting a critically injured patient to
the hospital. I will never know why some stick and why others do not.
11th hour shifts do not utilize any of the skills I developed as a firefighter.
These
are solo shifts with shifts from 2 - 4 hours in length. Aside from a
patient log there are no specific tasks to perform. There are no tools,
lights, noise, and crews to work with. For the first fleeting moments,
I always feel like I am the gunfighter who has has brought a plastic
spoon to a gunfight.
After
a quick shower and putting a book, bottle of water, and a energy bar in
my backpack I drive to the facility that Jane is at. The drive always
seems short, and I always listen to my comfort music on the way to an
11th hour - bagpipes because they always seem to calm me down.
I have been to the facility before and know what end of the facility Jane will be in.
The room to the door is cracked open and I take a deep breath and say "Knock, Knock."
John
looks up and smiles, he has just finished writing in the log by the
desk and introduces Jane.
"Jane, this is Mike, he will be sitting with
you for the next couple of hours" He reaches out and gives her hand a
soft squeeze and says goodbye to her.
I am always struck by the genuine
way he does this. If you did not know John was a volunteer, you would
think it was a friend of Jane's who was planning on seeing her the next
day. It's the kind of thing that does not translate to a log sheet and
is completely heartfelt. If you have had a family member who has an
11th hour volunteer, I hope you'll remember John. From everything I
have seen in 11th hour, John is the standard.
"Hey
Jane", I say and sit down in the chair that John has kept warm. I
reach out and touch her hand with mine and look to see if her brow will
furrow. In the training I have had they have cautioned us about any
kind of over stimulation. I have sat with a half dozen 11th people and
none of them have been awake or have been able to interact with me in a
traditional kind of way. A furrow of the brow, even a subtle one
indicates the quiet rest of the patient has interrupted. Jane is
breathing regularly, and I do not see any change in her demeanor. John
tells me that Jane gets restless about 30 minutes before she gets her
regular scheduled medications.
"Thanks John, drive safe" I say and then he is gone, and I am alone with Jane.
I
have gotten in the habit of scanning what is in the room, for pictures,
paintings, and the nick knacks that are there. I'd like to say this
was for Jane, but it's not, it is for me. When I accepted the offer to
volunteer for 11th hour, I spent time trying to learn what the process
was for people actively dying, the mechanics of what happens and when.
When I sat with my first 11th hour patient all of my accumulated book
knowledge was tossed out of window the first minute I sat down. On that
first visit, I immediately noticed the smiling photo of the older man
with a young girl. The girl had her tiny arms wrapped around his neck,
head thrown back with a huge smile and closed eyes. That picture is
still in my head to this day. For me, seeing pictures and nick knacks
like this always remind me what a small part I am playing in this
process. The most powerful thing I will be able to do tonight is be a
calm smiling doorman. The doorman who pushes open the door for a person
who has decided to step through that last door. I don't know if it is
luck, but in all of the cases I have been involved with, it is a final
door after what looks like a long journey.
Jane
had a birthday very recently. There are two poster boards full of
smiling people in pictures hugging and holding hands with her. She
looks happy and tired at the same time. The pictures make me smile.
I
am reading the same book I take to all of my 11th hour patients. It is
a John Krakauer book on an Everest Expedition. Jane groans softly and
the fate of the climbers will have to wait for another quieter night.
"Hey
Jane" I say, and her brow starts to furrow. I glance up at the clock
and see that it is close to the time that she should be getting the next
round of medications. She picks up a frail hand and her head moves
from side to side, while she moans softly. I reach out and hold her
hand closest to me and I begin to talk softly to her. I glance at the
clock on the wall and note the time.
I
am scooting my chair closer to the bed when the nurse walks in with
medications and asks how Jane has been doing. Without waiting for my
answer, the nurse reaches out to touch her cheek and looks down at her.
The nurse is in her forties and looks tired. It is just after 3 AM in
the morning.
"She just started to get restless" I tell her, and the nurse looks up at
me smiles and says, "How are you?". I tell her I am good and smile back
at her. She holds my gaze for a minute longer, smiles again and turns
back to Jane.
"Miss
Jane, I am going to give you, your medications" and she administers the
medications. She is talking to Jane is a calm, quiet voice. When she
finishes, she touches her cheek one more time and brushes a strand of
grey hair away from her face. On the way out of the room she reaches
out rubs my arm and says to let her know if I need anything. In this
room, at this time of an early morning, that touch is warm and
comforting to me in a way I just cannot articulate well. That touch,
that smile makes the entire room more comforting and welcoming to me for
the short time she is here. I tell her I am good and turn back to
Jane.
Her
breathing has changed, she will take 2-3 breaths and then not breath
for a minute or more. Her brow is not furrowed, and she does not appear
to be agitated. For a reason I am not quite sure of, I begin talking to
her again. I do not reassure her; I simply tell her that is it OK. I
tell her about the full moon outside and how the birds are waking up
outside. At one point she is approaching two minutes without breathing
and I lean over and reach over to take a carotid pulse.
She gasps, takes 3 breaths and the same cycle begins all over again.
The
cycle of watching her breath, while I am talking to her slows time down
and speeds it up at the same time. The cool dark evening is now
turning into morning. A quick glance at my watch tells me that my shift
ended 15 minutes ago.
I
put everything in my backpack, finish the log entry and tell Jane I am
leaving and hope to see her again soon. Even as a write this it sounds
ridiculous but that is exactly what I tell her.
As
I ride home, the morning air feels crisp and good. The list of the
things I had to do today, that was weighing on my mind so heavily
yesterday seems trivial now. I feel hopeful and lucky today.
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