Hospice Care

by Dennis Green

Flaubert wrote a lovely little story, St. Julian the Hospitalier, about a knight who saw the light and swore that he would devote the rest of his life to helping other people. In one incredible scene, he takes a dying leper in his arms and embraces the leper to relieve the man’s chills. Tolstoy’s The Death of Ivan Illych describes the death of an aristocrat who is cared for by a large, silent serf named Gerasim. These stories I first read so many years ago, as an English major, become all the more dear to me now.

Both giving and getting care takes a certain nobility and graciousness. I’ve worked in health care and seen the exchange up close and yet less personal than what I’m going through now. The very best nurses, and the worst; the altruistic doctors and those who are in it only for the money.

One of the more curious phenomenon is how culture seems to determine the nature and quality of care nurses give. The very most compassionate and kindly nurses are plump African-American women who themselves are mothers. At the risk of bringing to mind the “Mammy” stereotype, let me say that I’ve also known, and worked with such women who were not nurses, but were the most determined in the mothering of their own children.

But the nursing profession is becoming dominated by Pilipinos. They are remarkably similar in their approach — brusque, efficient, rough in performing procedures, and uncommunicative. Why this is I do not know, so I attribute it to the cultures these women grew up learning. But when the nurse who comes on duty to care for me in a big fat Mammy, I’m reassured.

For when you’re ill and in extremis, the last thing you need is an automaton performing procedures on your body the way a butcher proceeds to separate the steak from the bone. What you need is tenderness. That’s all, really. Being treated with compassion, even affection, the way your mommy did when you were a kid.

Many docs and nurses will say that you can’t afford to have any feelings for your patients, that you must remain detached and “professional” in your bedside manner. Others tell you how they go home from work some nights and cry themselves to sleep.

Because the very nature of the work itself — healthcare — implies that the caregiver really does care, really does give a hoot how you feel, how they can make you more comfortable, take the sting out of the hypodermic needle. Healing has to focus on the emotional and spiritual bodies of the patient, not just the flesh and bone.

So for me, the hospice I’m in right now has more to do with Diane giving me a back rub, or helping drain the bag strapped to my leg, and atake so much time off work just to drive me to the next appointment, and the way she mediates and insists I get the best possible care. Medicine without compassion isn’t healing.

It’s hard to say this is my last bout, or even my last round in the ring. I remember a night in Berkeley when I was working in a gas station, and the manger and I were changing a big truck tire, with much strain and exertion. Suddenly a knife-like pain cut into the lower right side of my back, and I knew it, another kidney stone.

The manager, Dick, drove me to Herrick Hospital where they had me pee into a bottle, and my urine was dark red with blood. I was in hospital that time for a week. But I never thought that would be my last illness, so I’m doing my best not to jump to conclusions now, and at the same time staying out of denial.

©2010 Dennis Green