As a Hospice Care Case Manager (Nurse) you are always playing a game of “balance the emotions.” You want to show as much compassion as you can while taking care of your patients during their final days, but you have to do what you can to not become too attached to them or else you run the risk of constant heartbreak. With the wide range of reasons for a patient being in hospice, you can't really know how long you'll be treating someone before they pass on. Sometimes it'll be just a few weeks, other times it can be months. The latter was the case with Mr. Keys.
He was admitted to my care six months ago, in a partial coma, with a very grim outlook. But the doctors were unsure as to when he'd actually pass away, so I just did what I could to make him comfortable. He couldn't speak, and spent most of his day just sleeping or watching whatever happened to be on PBS at the time. His family would only visit once a month or so, because they lived out of state, so he didn't get much interaction with other people besides the time that I'd spend with him. Cases like that always made me try just a little bit harder to make them feel like they weren't alone, even if they were in pain and knew the end was near.
Since Mr. Keys had been there so long, at least when compared to my usual patients, I broke my own rule and became attached to him. He never said a word, but I could tell by his eyes that he appreciated that I'd talk to him like a friend would and not as a Nurse/dying patient. It was therapeutic for the both of us, I believe. I got the rant and rave about my busy life and he got to feel like he wasn't alone in the world, even if none of my issues were all that interesting. The highlight of my work day was checking up on him and seeing how much my visits meant to him. It was the sort of relationship that a young student gets into Nursing for.
I wouldn't say that I took him for granted, but I was so used to patients not being around that long that him being there was the only common thing at work. Our little, one-sided interactions kept me going throughout the day and made it easier for me to deal with the stress. He never said a word, but he did not have to. I knew that he just liked hearing me talk and that's all I really needed in return. You could say we became friends without him ever speaking a single thing to me. That is, until the last day I saw him, anyway.
The day started like any other: I finished early morning paperwork, finished my iced coffee, and began my rounds. Mr. Keys, having been there the longest, was in the room furthest from the nursing station. I always finished my rounds by visiting his room. The rest of my patients were in varying degrees of distress, and by the time I reached his room, I was ready to vent. To my surprise, upon entering his room, I saw that he was sitting up in his bed. The patients are able to control the tilt of their bed and he always had his nearly laying down flat because it eased his pain. So it startled me a bit to see him sitting upright. He looked at me as I entered, smiled, and said “Hello, Dina. How are you today?”
I could not believe it and my jaw must have been touching the tops of my shoes. “Mr. Keys, you're...well, you're talking!” He went on to explain that he appreciated everything that I had done for him during his time in hospice and that my visits were the one thing during the day that he looked forward to most. We spoke for roughly ten minutes which much have felt like hours before I realized that I had to get his medication for him to take during his meal. I mentioned that I needed to get him his medicine and he replied “That's okay; it's been wonderful speaking with you all this time. Goodbye.”
The smile I had on my face must not have gone away at all because when I reached the office, one of my fellow case managers asked me “What's got you in such a good mood? I would have figured you'd be pretty depressed considering the news.” I wasn't sure what she was referring to, and explained to her that Mr. Keys had finally been able to sit up and speak with him after all this time. The entire time, she had a confused looked on her face. When I finished telling her what happened, her confused faced turned a shade more pale than usual and she said “But Dina...Mr. Keys passed away last night right after you left. The night shift found him and they took him to the funeral home before you got here.”