In homecare, skill, education, and experience are vital to success. When the ability to know when to be something instead of do something is learned, the true art is born.


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Through all the days and nights of doing hospice home healthcare there were many Ah-ha! Moments. One of the most important was in the wee hours of a dark rainy night. I learned what the most important role of any caregiver is.

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I got called out to go to a gentleman who was having trouble breathing. Even the family was breathless on the phone as they struggled to help him. They blurted out that he wanted to die at home, and they were willing to try but they felt they were failing. He was so uncomfortable and something had to be done right away.


They said he was begging in between gasps not to go to the hospital. They had his oxygen on and it was doing nothing. They begged me to come see if I could help him, as they were afraid he would die gasping and they could not bear it.


I drove in the black of that rainy night, trying to think what in the world I could do to help if they were at a loss. They were great caregivers and had been caring for him for months.


I got to the house and the brothers and sisters were just beside themselves as they brought me to his bed. I saw Mr. Porter's emaciated, pale, frail body with two huge terrified eyes staring at me. His breathing was rapid and shallow and, as a result, totally useless for comfort. I evaluated him and found the breath sounds were so poor I had no idea how he was alive. Mr. Porter pleaded with me in short gasps not to make him leave the house, all possible medication relief had been used, and I was fresh out of ideas.


We did have a hospice doctor available to us around the clock if need be. I was aware it was 3:30 a.m. and so I thought long and hard before I placed the call. Probably because I seldom if ever called, Will said he would come immediately.


He walked in the door and addressed the family warmly and quietly by saying they had been having a hard time and now they needed to think of themselves, so why didn't they go up to bed and get some sleep. They were still so anxious they immediately negated it, saying they could never sleep with their brother in such distress. He told them that was true but to keep in mind he needed them rested, so as soon as they felt they could, it was important they go to bed.


They just stood around the doorway as Will approached the tortured man. I was thrilled to see him. I felt everything I had done was for naught and that this man deserved more.


The man I knew to be the epitome of a physician walked over to the edge of the hospital bed where Mr. Porter sat gasping for breath. Will bent down and looked Mr. Porter right in the face and introduced himself with a soft, quiet voice, asked if he could sit beside him, and did not wait for an answer as it would have cost the man too much energy to respond.


There they sat side by side. Will did nothing but be still for a minute. Then he asked me for an ironing board. One sister responded immediately. She gave it to me and then resumed her place at the doorway.


From his position on the bed, Will slowly and deliberately brought the ironing board toward them and raised it as high as the legs allowed. The bed was at its lowest and the board at its highest. Will silently and deliberately reached over and took two pillows from the head of the bed and placed them on the board. Mr. Porter just continued to gasp staring down at his purple feet and legs. Slowly and silently Will took the man's wrists in his hand and lifted them up to the edge of the board. This made the wrists about forehead height for the seated man. Will silently rubbed the back of the man's neck and told him to lean his forehead on his hands. The man looked at Will, still panicked and gasping, and he slowly and obediently brought his forehead down to lie on his hands. Then to my surprise Will did the same, only he kept the arm closest to the man free and placed it around him. There was not a sound in the room but the hiss of the oxygen and the patient's desperate gasps.


Will spoke, softly and slowly. "Well, David, my friend, we have the better portion of a long night ahead of us. Let us together try to get a bit of rest. It feels to you that you have to breathe faster to help yourself, but in reality you need to breathe more slowly. Now, now, David, I know that goes against what you feel, but give it a try as we sit here."


Will's soft cadence never stopped. He instructed, encouraged, illustrated, and held the man gently. In the same tone, without breaking rhythm, he asked me to lower the lights. Mr. Porter started for a second as he had previously always insisted on the bright light to ward off the night and, to my thinking, death too.


Will's soft fingers patted the man gently. Without ever looking up or directly at Mr. Porter, he kept his forehead on his hand on the ironing board, always looking at the floor, never stopping his gentle monologue.


Gradually, with only the softer light coming in the crowded doorway, it was just enough to see their outline. They both stared at the floor. I could see the fingers of Will's hand resting on Mr. Porter's shoulder as he patted in unison with his voice. I could feel a peace creep into the room.


Then, I noticed the respirations turning from rapid, violent gasps to far gentler, quiet ones. Will's monologue continued. Mr. Porter never made an effort to move or speak. He just sat and worked with Will's voice. I had no idea of time, but it had to be about a half hour of no movement or sound but Will's voice and the respirations of this exhausted man, which were now almost silent.


I did not move. I just stared and soaked in the peace that had eluded me a short time ago. The room got lighter as the doorway cleared. I saw one by one Mr. Porter's sisters and brothers silently leave, and I assumed they were going to bed. I felt no sleepiness as I listened to Will's voice and the silence of the man. There was magic all around me, and I did not want to miss a minute of it.


Will's cadence slowed until the words were just here and there in the minutes of time as it passed. Mr. Porter never moved. Will stopped talking but never moved. The man effortlessly continued to breathe. It occurred to me that he was dying or even dead; he was so silent. It seemed the silence was soft and warming and so very friendly. I just sat and stared at the two of them.


Gradually, Will's head came up and his arm lowered. The arm on the man's shoulder never moved. Will sat silent and still. The time passed in silent comfort. Then I saw Will gently come to his feet, and with his soft voice he said, "Now, David, you really need to sleep, so I am going to move you to the center of your bed." The man did not move, but the respirations increased a bit. Will stayed still and spoke gently until the pace was again slower. Will turned the man's trunk slowly, and I took his feet. Almost without movement Mr. Porter was positioned comfortably in a sitting position in his bed. His eyes were closed and his respirations even. He was asleep!


We tiptoed out of the room and found that in fact the whole house was still and all were in bed and hopefully asleep. We sat at the kitchen table and I looked at Will. I couldn't find words for what I had just seen. I told him with fatigued eyes moistening that I had done all I could and was not able to afford a minute's comfort and now look all he had managed.


Will just smiled as he explained, "Mr. Porter has such limited lung function, when he got anxious he needed more, and the cycle of torture began. He needed calm and he needed confidence, so I just sat and gave them to him. He did the rest. I told the family they needed to sleep. That gave them the permission they needed to see to their fatigue. By letting them see him calming, they calmed and went to bed without guilt.


"When people need help, most often, you can help more by being something rather than doing something."


He told me to go home. He would stay until the family was ready to take over. Mr. Porter died 2 days later, calm and comfortable.


That night was years ago and I can see it still as clear as when it happened. I can still feel the calm. I remember everything: the quiet, the cadence, the touch, the soft confidence, Will just being Will. In the dark of that night, feeling the pain of uselessness, I learned how to give the best gift: the gift of self.