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I REMEMBER THAT JUNE DAY so clearly, it seems like yesterday. In 1993, I was all of 20 years old, dressed in my white uniform and cap, graduating from 3 grueling years of nursing school with my family in the audience. I'd be ready to sit for my licensing exam in 1 month, and then it would be all over: the long hours, the study, the total lack of social life.
I was free to do what I wanted, where I wanted, and when I wanted. The sky was the limit, and my career expectations were just as high. The patients under my watchful eye would be the best cared-for patients in the world, or at least in my part of New Jersey!! I imagined they'd love me so much that they'd be happy to be sick as long as I was their nurse.
More than 15 years into my career, I'd had many nursing jobs, including 5 years in a medical-surgical unit in a city hospital, 2 years with a big pharmaceutical company, and some per diem positions here and there in between. But none of these positions ever felt quite right. Sure, I learned a lot from each job and the experienced nurses who were my supervisors, but I never felt fulfilled.
What had happened to my sky-high expectations from graduation day? I never felt like the best nurse in my department, let alone in New Jersey. What was missing?
In 2001 I took a position as a case manager with a small hospice agency. I must admit, I didn't love the job in the beginning. But it was different and challenging and I stuck with it.
My patients ranged in age from 35 to 105 and suffered from many different illnesses. Every one of them had families-families that were scared, tired, angry, or just plain ready for their loved one to be at peace. They all had needs, both physical and emotional. Yes, hospice was turning out to be very challenging. That's when I met Jason and Helen.
Jason, 77, had end-stage lung disease. His devoted wife Helen had waited on him hand and foot throughout their entire marriage. He was, quite literally, her life. She'd never worked or done things outside the home without his approval. He wasn't unkind; this was just how they'd chosen to handle their relationship. They had no children, only each other and some friends and neighbors who were willing to help out.
Jason was referred to hospice by his physician because he wanted to die at home. At first my visits were brief, as he was fairly independent and private.
As his nurse, I addressed his pain and his ongoing struggle to breathe comfortably. The hospice social worker and chaplain addressed Helen's emotional struggle.
I liked to think I could give emotional support just as well as the next person, but this couple was something different. I didn't know what to say to Helen when she repeatedly asked me, "What will I do without him?" These two people had been married longer than I'd been alive. How could a "kid" like me possibly understand what she was experiencing?
Toward the end of his fourth month on hospice services, Jason really started to fail. Friends and neighbors pitched in, providing visits and help. Helen was always at his side, dictating his care with precise directions. She fed him every meal, never allowing anyone else to pitch in. She insisted on helping the hospice aide bathe her husband daily, even though we encouraged her to take a break and get out of the house. We realized this was her way of coping and maintaining some control over an otherwise uncontrollable situation.
Then the time came when Jason was actively dying. As an experienced hospice nurse, I'd seen this last stage many times. The hospice team prepared Helen as best we could. With his wife by his side, Jason took his last breath one afternoon in his own bed. I was alone with Helen when the funeral home staff arrived to take Jason's body.
When they came into the room to transfer Jason's body onto their stretcher, Helen suddenly lost control, crying and begging them to take her with her husband. I asked the funeral home staff to give her time with his body until she was ready to let it go, and they agreed.
Shocked by Helen's unexpected outpouring of grief, I had to ask myself, Had we failed in preparing Helen for her husband's death? What did we miss? What kind of nurse am I to let this happen?
After Jason's body was taken away, I sat with Helen for a long, long while and let her express herself in her own way. She told me more stories of their life together, such as how they met, where they vacationed, and what their dreams were.
She also told me how we'd made a difference in their last months together. She told me that they'd never had children of their own, but she now considered the hospice team to be their children. She said that without us, she surely wouldn't have been able to do it. She acknowledged she didn't know how she would go on without her beloved husband, but over the past months had realized she had no choice.
She cried on my shoulder a long time, we hugged, and I realized, This is what nursing means to me. I was able to help her every single day I was there. I was teaching her, comforting her, listening to her, and preparing her, although I didn't know it then and had doubted myself. I'd touched her life in a way that will stay with her forever.
I don't look for those "oh wow!!" moments any more. I now know that things I do everyday in my job as a hospice nurse make a huge impact on someone, even if I don't realize it until much later, perhaps long after the patient is gone.
I can honestly say, after more than 15 years of being a nurse that I am a good nurse and I do make a difference. The sky is the limit. And some of my patients even think I'm the best darn nurse in New Jersey.
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