Chapter 23 - Who will stop the rain

I still cannot believe that my favorite brewery (Wibby Brewery) has named a beer for me.  It is an India Pale Lager (IPL) with a shot of lemonade.  It is on the main beer menu when you walk up to the door.  It is called Mike PL

When my younger brother comes to town, I love to take him there and remind him that I have attained a level of celebrity that he will never be able to duplicate.  I will try to get to the brewery ahead of him and ask the beer tender to point out to him that the beer I ordered for him is named after me.

We have agreed to meet at 4PM and it is just past 3PM now.  I put my Jeep keys in my pocket and am walking out the door when my cell phone beeps, and I glance down to see who is calling me.  

Call me right away - important.  This message is from my younger sister Robin. 

In every family there are branches on the family tree that do not produce leaves or fruit.  I have several branches on my family tree that are exactly like that.  In a family of five siblings, when there is a crisis, Robin will often step in to try to manage the initial crisis.  Except for the time we were all school age and at home, it's difficult to recall a holiday or celebration that was not missing one or more of my siblings.   

Quite often, the member who is at odds with the family, will invoke a scorched earth policy.  Scorched earth policy is the military strategy of destroying resources that may be of use to an invading enemy force.  Even in the military, scorched earth is on its very best days is an inexact exercise.  In a family setting this approach can be very inexact, and only seems guaranteed to add a great deal of color to family interactions and dynamics.

I am the de facto older brother and I get engaged to so she can let me know the details behind the family member (extended or immediate) who has engaged in the transgression that will start the scorched earth process.  I am not asked for advice or counsel during these notification calls.  I am simply notified which crops are being destroyed and what village will be burned.  

I do not question how normal my family is.  The truth is that my family is like every other family out there.  Every family tree needs to replenished from time to time with the blood of misunderstandings and imagined slights.

This cryptic text message is the first notification that the relative quiet family dynamic of the last couple of months is going to be broken.  This also indicates to me that I need to mute my phone while I drink my Mike PL.

I am going to delete the message, and blame WIFI at Wibby's, and hope the storm passes.  While I am deleting the message, the Hospice Volunteer Coordinator number pops up on my phone and I answer it.

"Mike, we have an 11th hour request" she says.

11th hour is a service that hospice provides to families of patients who are in the active process of dying.  It is a way to give a family a needed break during this critical time period.  For loved ones, it also means that a person will be in the presence of another person, when they die.  

Being a hospice volunteer has changed my view of how people die.  In the Fire Service, everything was focused on life saving care, on a trauma, fire, or medical calls there was no time to be introspective.  The engine crew had a focus to save lives, pick up gear, and clear from the scene so families and loved ones could begin to pick up pieces.  In 11 hour shifts, I sit at the bedside with sitting at a bedside, with my backpack, bottled water, and the book I can never finish.  This does not utilize any of skills I learned in my Fire Service career. 

In the event of a death in the field (in the Fire Service), the focus was to respect the sudden passing of life and part of that respect was shielding the sudden death from view and assisting the coroner.  In hospice, you are taught to be in the moment of your patient.  When sitting quietly next to a person is was dying, in the absence of any interventions or support teams, you are left alone with your observations of the patient.

All of my 11th hour shifts have not given me additional insight to how or when people will die.  I believe that when people die, they simply choose to walk through another door in their journey.  When and how they choose to do that is something that we will never know, I think it is different from person to person.  I think when people die, they see someone on the other side of the door and make the decision to walk towards that other person.  I don't think anyone dies alone; I think they elect to walk through that door to see people who they have loved and missed.  

The 11th hour volunteer is that quiet patient soul, who will sit quietly by that door and watch to see if the patient resumes their journey when they walk through that final door.

"Yes, I will take the first shift, where am I going" I tell her.

The coordinator tells me that the patient I will be seeing is in the Care Center just 30 minutes away from me.  He is 4 years older than me (that made me pause) and has been at the Care Center for 2 days.  One of his express wishes was that he would not die alone.

I get off work at 5PM and will have time to stop and get coffee and a quick sandwich before I go.  The rain of the last couple of days has been nonstop for the past couple of days.  There is small stream flooding and the streets, even in town are a mess.  The rain has picked up and I am going to have to leave work 45 minutes early to give myself time to get to the Care Center. 

My Fire Service career has left me with the only bit of carry over that translates into hospice.  I am over prepared, I check the backpack in my Jeep and find my 11th hour logbook, pen, water bottle, my Hospice badge, and the book that I will never finish.

Visiting 11th hour patients in the Hospice Care Center feels more structured.  It is a Care Facility that is staffed 24 x 7 by medical professionals and volunteers.  It looks and feels like a hospital to me.  I check in with the desk of hospice nurses and tell them who I am here to visit.

The nurse checking me in, says she is glad to see me and was wondering if I could make it with all of the bad weather out there.  She mentioned again that the patient specifically said he did not want to die alone.  That simple request has stayed with me since I got the call from the hospice coordinator.  That is the most straight forward request that a person can make.  I have never wanted to be alone during a critical phase of my life or big transition.  I am really happy to be here.  Being with this patient, seems like the most basic bit of humanity that people can extend each other.  To be able to be with him during this transition, still feels powerful for me.

I am very happy to be here, if my patient chooses to walk through that door tonight.  The only thing I am positive of is that when they open the door, they are met by a person who loves them deeply and will hold them in an embrace that will last for a very long time.

One of the unanticipated benefits of being a Hospice volunteer is perspective that Hospice patients give you.  I do not know about my patients past or his family dynamic.  As I put down my backpack and make the initial updates in the 11th hour log, I take another long look at him.  He is past the point of reconciling past grievances or indignities, the things in front of him now are more immediate than any past battles he has been a part of.  

There are not many battle lines drawn in a place like this.

I wish that everyone who is fighting with a friend, family member, spouse, or boy/girlfriend would spend 10 minutes in this seat.  His most urgent request was to have someone by his side when one of his toughest journeys starts.  There is a specific time limit to what he has requested, his life is going to be measured in days and hours. 

I am like everyone else out there, I allow myself to get embroiled in battles at home, work, and with other people because I don't ever feel like I am limited by time.  Except for the times that I sit in this chair, it does not occur to me that those battles shave tiny bits away from my basic humanity.

Even in this chair, I am still not the guy who has been able to bridge the gaps with all of the people in my life.  There are people in my life who I have no longer have contact with.  When extending a simple hand does not work and when the battles are not limited by time, I am inclined to walk away.  This does not stop, change or alter the battle, it just means I am no longer a combatant.  I get hours and days back that would have been spent in a pitched battle that no one will remember in any detail next week, month or year.  

I would love to have all four of my siblings sit in this chair.

My patient's name is John.  John is a big comfortable room with a window that looks over the roof of the first floor.  It's still raining hard and there are puddles starting to form on the roof.  

"Hey John, I am going to sit with you for a couple of hours" I reach out to hold his hand and notice the furrows in his brow are starting to even out.  John's breath is deep and irregular.

"John, its raining like hell out there, they have a small stream advisory out now.  They are worried about flooding in town" I tell him.

He turns his head slightly to the sound of my voice and that makes me smile, he knows he is not alone.  I look out the window and the sound of the rain has stopped.

"Hey John, maybe no flooding after all the rain looks like it stopped".  I look over at John who takes a long deep breath and as I watch him, he has not taken another one for a couple of minutes. I look up at the clock and start counting the minutes.

I watch John for a total of 10 minutes and listen to the rain start to pick back up.   I let go of his hand stand up and look at him for another minute before I get the nurse.   None of my firefighter training seems to apply here.  When people die in the field there is a structured process.  A paramedic will use a specific protocol after resuscitation efforts have been made and failed.  An emergency room doctor will be called and after a quick, detailed review a time of death will be determined.  A firefighter will be assigned to stay with the person who died to ensure the scene remains intact for the coroner who will be called next.  The body is covered in a respectful way, and you wait for the professionals who will manage the next steps of the process.

It's just me and John here now.  I have been with John a total of 26 minutes.  I walk down to the nurse's station.

"Hi, I need to have someone check John in room 208" I said.

"Check him?" the nurse asked me.

"Yes, check him, he stopped breathing about 6 minutes ago."

"Oh, right I'll check him" she says, and I follow her back into the room.

She puts the stethoscope on his chest and listens for a couple of minutes.   She looks down at him and touches his cheek in the gentle way that a mother would.

"Ten minutes ago?" she says without looking up.

"Yes" I tell her, and she is still looking at him.

John's time of death is logged, and I tell the nurse I am leaving.  I pick up my backpack, put my book and water bottle back in.  I did not have time to take anything out.  I update the 11th hour log that I logged my start time in and write a short summary with a timeline about what happened and leave it on the table.

I tell the nurse thanks and she thanks me for being with him and I leave the room.

I am calling the number on the back of my badge to notify them of the death.  One of the volunteer coordinators sees me in the hallway, waves and walks over to say hello.

"How is John?" she asked.

"He just died; I was calling it in" I tell her.

She studies my face for a long moment, to see if I am ok.

"Were you with him, when he died?" she asks.

"Yes, he died about 15 minutes after I got here" I said.

"God, that's great are you OK?" she said looking me over.

"I am glad I was here" I say and I mean that.

I have been given my evening back and I am not sure what to do with it.  I have to make the transition back to the day that was in progress before my 11th hour shift began.  I am not sure how I will do that when my phone beeps with a text message.

Call me right away - important the phone blinks.

It is Robin...