My phone rang. “Hey Brenda, it’s Eileen. We have someone over in the Emergency Room for an informational and maybe sign on. It sounds like she isn’t doing very well. She is in room 12.”

Nursing is always about re-prioritizing, no matter what your specialty is. I checked to be sure I had the information booklets I needed, made a legal u turn and headed for the hospital. When I pulled into the lot, I took a moment to open my computer and get an overview of the patient I was about to see. While the computer came on, I phoned the facility where I had been headed to make sure they knew I would be delayed. Gladys was 5 days away from her 94th birthday. She and her son were in one of the glass doored rooms with a curtain pulled around them. Gladys was unresponsive.

” Hello. I’m Brenda, one of the nurses from Hospice,” I began. “Are you Peter?”

“Yes.”

Peter looked bewildered but we talked a bit about hospice. His father had been on hospice service years earlier. Peter’s mother had been sick with respiratory difficulties for a long time but now, with pneumonia, it looked like the end was very near and Peter knew exactly what to do.

“I just want to take her home. That’s what she wanted. To be at home in her own bed.”

“We can help with that.”

I texted our team coordinator, Kristen, to “stand by.” I would need equipment fast. Gladys needed a specialty type of oxygen delivery system because she needed a high flow. I asked Kristen to please order a bed, an overbed table, and the high flow oxygen. The case manager in the ED already had prescription for morphine and lorazepam faxed to the local pharmacy. There was no time to wait for delivery from hospice pharmacy tomorrow. People with respiratory difficulties respond well to morphine and lorazepam. Morphine is a pain killer but also eases shortness of breath and lorazepam takes the edge off the scary feeling that you can’t breathe. Peter would send his nephew Bruce to pick up the medications and wait for the equipment company.

I went out to the desk to touch base with the case manager. “Has anyone seen Robin?” I asked amidst people buzzing by in every direction. Our hospital has one of the busiest EDs in the area and it often feels like it.

“Okay,” I told Robin. “The equipment is on its way. You should be able to book the ambulance for about 5 or 530 and I will go see her once she is home.”

“Great.” Robin said. “I will go call them now.”

Gladys arrived home at 600pm and I made a visit to her there. She remained non responsive but was comfortable and her face and body were relaxed. She was tucked into a hospital bed in her little room at the back of the house where she had raised three children, where her husband had left Earth years before. There were black and white photos of her children on the walls over her bed. They were graduating from high school, or posing in their Easter clothes as little kids. Gladys had a small framed wedding picture on the table by her bed. In the picture, she and her husband were no older than their youngest grandchildren.

I made sure that Peter understood how to administer medication if it were needed and how to turn her in bed. There were other family members in the home and all listened carefully as I showed them how to draw up the medications. They asked thoughtful questions and were prepared to do whatever was needed for Gladys for however long it took. When I was certain they had our phone numbers in view, and would be okay until we visited again tomorrow, I said goodbye.

As I stepped off Gladys’s front porch that evening, I couldn’t help notice that directly across the street was a bar. Outside the side door was a woman in flip flops and pajama pants smoking a cigarette. She was also having an animated discussion on her phone I thought it so ironic that behind me, the veil between this world and the next was growing so thin, while in front of me, it was as thick as a stone wall.

At 830 that same evening, Gladys passed away. I visited again to do the pronouncement. Peter had been in the other room at the time, though he had been by her side the entire day. Some people worry that their loved one is alone at the time of death, but some people need to be alone to die and won’t until they are. Peter was sad, but not distraught. His mom had gotten what she wanted. She had gotten home. EDs are wonderful places and many, many lives are saved there. When the end is inevitable, however, many people feel much more comfortable at home. Gladys got home just in time to die. Lots of people mobilized quickly to make it happen and it was a big win for her and for her family.