My phone rang at 830 in the morning.  I didn’t hear it, but it did.  I work until 930 at night and paint until 2 am sometimes. When I  checked my messages at 10, there was a distress call from one of my patients.  Patients eventually get my number and I don’t mind calls.  I tell everyone that if they need something urgently, please call the main number in case I happen not to be working and that usually works fine.

Fredda was not much older than me and a wonderful artist.  I always enjoyed making visits to her because we would meet in her studio with its big glass view of the woods. She had a anal tumor that had recently grown so large it was visible under her clothing. At her admisson visit, she told me that she had lived a blessed life and was not worried about dying. She was only concerned about comfort. She showed me her bed, tucked into a cozy nook and surrounded by photos and paintings that represented the memories of her life

“That’s where I will die,” she said, pointing.  “Right in that spot.”

I so admired her.  She had lived her life her way and that was the way she would die.  She didn’t want too many interventions.  She told me she really only agreed to hospice care to get morphine.  It was such a hassle to get enough of it through conventional care. She was right about that.   She otherwise used medical marijuana and some supplements.

We talked about what to expect as the end draws near.  It was likely that the tumor would begin to bleed and eventually, bleed so much that she would fall asleep and be carried away. Over the last month, I had encouraged her to get dark sheets and towels in order to minimize the visual effect on her family.

“I can’t sleep on black sheets,” she told me.  “They will just have to deal.”

Fair enough. I still mentioned to a family member that black towels were a good idea.

Her phone message was garbled but I heard, “It’s a bad day. I am having so much pain.  I am on my way out…which is okay but I’m bleeding again and it’s a little scary. Anyway, I just wanted you to know what’s going on.  Thanks.  Bye bye.”

Normally, I start work at 1 o clock in the afternoon so I try really hard to do my own thing until then.  Hospice nursing is emotionally and mentally demanding so we learn that if you wish to be able to do the job for any length of time, caring for yourself is non negotiable. It’s so easy to try to be available whenever your patients need you but important to allow the team to cover issues when you are not working.  Fredda was different though.  She was suspicious of new people and intensely private.  I was the only nurse who had seen her.  Our medical director had met her and that was it.

I texted Eileen, our nurse manager.  I gave her the information and asked her to call Fredda.  I WILL START EARLY TODAY IF THAT’S APPROPRIATE. I added.  I COULD BE THERE BY NOON.

I am a registered nurse.  I have seen some things that I sometimes forget not to talk about in polite conversation, and then, when I see the looks on people’s faces, I realize they are scared. Nurses can take a lot.  In addition, my baseline personality is pretty calm.  I don’t worry about much because it seems like a poor use of time.  Today, however, I couldn’t get to Fredda’s fast enough.  I was certain that I would arrive just in time to witness her last breath and  wanted her to be comfortable and not scared when that happened.  I wanted to protect her family from the gallons of blood that it would look like were running from her body.

Her sister, Jen, met me at the door.  “She’s in the studio.  Her friend Kit is with her.”

Kit is a pediatric nurse and her presence is reassuring for Fredda so I took a deep breath, and slid open the studio door. “Knock, knock. It’s Brenda,” I said.

“In here.” Kit called. “We’re in here. By the bed.”

I rounded the corner and saw Fredda, standing next to the sink, eating a slice of watermelon.

“Hello,” she said.  “I am feeling so much better.  I am very sorry for the call this morning.  Thank you for coming.  I hope I was nice to Eileen on the phone.  I didn’t want someone else to come.  I am a suspicious sort. I felt better just knowing you were on your way.

“I am so glad you are feeling better.”  That was for sure.

On my way to the next visit, I was still thinking of Fredda.  This is how it is as a hospice nurse.  I sometimes wake up in the night thinking about my patients.  I often dream about them.  I do a mental inventory about their medication and supplies, did I choose the right plan for wound care, is the estranged daughter going to show up before her mother dies. That sort of thing. I worry that it isn’t healthy for my mind to be racing every second and I know that my colleagues have the same issues.  What I don’t know, is how you help that. Yes, we are nurses.  We are also human.

While thinking about Fredda and how I had felt on my way to the visit, I wondered if I was feeling protective of her as I would any of my patients or if I was basking in the knowledge that I was the only nurse she wanted there. I’d like to think the former, but, like Fredda, I am suspicious, but of myself.   Thankfully, I realize that most patients want their own nurse and I can feel good that my patients are no different. But I also remember that I am part of a team. When I am not available, other nurses take brilliant care of my patients and I would be wise to prepare my patients up front for this possibility.  It’s good for me and good for them.