Seaside bench
The first continuing education program on palliative care that I ever attended was held at the Beth Israel Medical Center in Boston, in 2003. I don't remember how I heard about it, but it was a day-long program, and there was no cost for me to attend other than $20 or so to park my car. I even got lunch.
Most of the people there worked at BI, or at one of the other nearby hospitals. I think I was the only man, and one of the few there who didn't work in oncology. I was doing outpatient hemodialysis at the time, and it was that clinical experience that really sparked my interest in end of life care. I've always thought of hemodialysis as the ultimate form of palliative care - it doesn't cure end stage renal disease, it just addresses the consequences and the symptoms of that fatal illness.
I don't recall making very good connections with those colleagues at the time, but I don't know if it was due to my being a stranger among people who knew each other professionally more closely, or my own social awkwardness.
The following year, I signed up for the first Art and Science of Palliative Nursing course developed through the Harvard Medical School's Center for Palliative Care, which has been offered annually ever since. That was when I knew that I had found a group of like-minded colleagues, and when I knew I wanted to work and learn among them. I haven't looked back since.
There's just something about the character of nurses who've chosen this work that resonates with me. Maybe it's the level of maturity, or the shared acknowledgement and acceptance of our mortality. I've found that nurses in this field don't have the kind of need to prove themselves, or to outshine or even put down their colleagues, in ways that nurses in other settings can sometimes display and sadly act upon. It's like everybody working in end of life has finally figured out what's really important. I don't know.
But there you have it.
One of the things I like about this work is the role narrative plays in end of life care. Everyone who works in it seems to not only have a huge collection of stories, but also the eagerness to share them, and the ability to recount them so compellingly.
Here's a story told to me by a nurse who manages a residential hospice and home hospice service in an oceanside community:
The nurse had come to speak about bereavement to a church group, and while there several people told her that one of their members had recently lost his wife. They said that he had become very withdrawn, and had resisted all of their attempts to reach out to him. He spent many hours of every day simply sitting on a bench across from the church, looking out at the sea. She saw that he was sitting there even as they spoke. They asked the nurse if she could go over and talk with him.
She didn't think that was a very good idea, and instead soon placed a call to one of her agency's social workers. She described the situation to her colleague, and gave her the location.
The following day, the social worker happened to be walking her dog in that area. The man was sitting on the bench. The social worker stopped for a minute, sat on the bench to re-tie her shoes, and resumed her walk.
Since she needed to walk her dog at the same time every day, she continued to use the route that brought her by the bench. Each day the man was there. Sometimes she stopped, and sometimes she didn't. Sometimes she sat for a moment, at other times not. She always looked towards the man, and when their eyes met she silently acknowledged him. A week or two passed.
Finally, one day she sat at the other end of the bench, looked over to the man, and said hello. "It's a beautiful view from here, isn't it?" she asked him. "Yes, I like it," the man replied.
"I often see you here when I'm walking my dog," the social worker continued. The man said nothing, and they both sat silently for several minutes before she got up and continued her walk.
This continued for several more days, with the man and the social worker simply exchanging nods or brief greetings when they met.
One day while sitting together in this way, the man reached over and patted the dog. He then began to talk about his wife, and how they would often walk together along the ocean-edge path. He told the social worker that be missed his wife very much.
It's not my story, but I know it's true.
