1. Engs, Samuel Franklin BSN, RN

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IT WAS JUST ANOTHER Monday morning at my job as a homecare hospice nurse. My first assignment was Mr. M, 67, a patient with quadriplegia who had a diagnosis of bladder cancer with metastasis to the liver. He lived at home with his wife.

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I arrived at Mr. M's home to find a well-maintained residence with a circular driveway offset by a series of beautifully sculpted rock gardens. I'm not a geologist by any stretch of the imagination, but I can tell ebony from quartz. These gardens had both and much, much more.


A small fenced yard adjacent to the house contained children's swings and play sets. The sign over the entrance to the house read "Mrs. M's Day Care."


When I'd called to make the appointment for my initial nursing visit, Mrs. M had sounded very business-like, almost cold. She'd consented to my request to visit later in the day, but that had been the extent of our conversation.


Lifetime of caring

When I knocked, Mrs. M answered the door and invited me in. She told me that she'd been taking care of children for 43 years in her home. It was the perfect way for her to be able to attend to Mr. M's needs and, at the same time, provide a living for both of them.


Mrs. M shared the story of how Mr. M had become quadriplegic 43 years ago. Mr. M and his brother ran a plumbing contracting business, and business was booming. Mr. and Mrs. M had been married for 5 years and had two small sons. Life was good. But one day, everything changed. On a summer weekend, Mr. and Mrs. M and their family went to the lake for a picnic. Mr. M decided to swing out over the lake on a rope that was hanging from a large tree limb. As he swung out over the water, the rope broke. Mr. M fell backward into the water and his head struck a rock just below the surface. His spinal cord was severed, and he was instantly sentenced to life with quadraplegia.


As Mr. M completed an extended period of rehab, Mrs. M converted their home into a day-care center and made modifications that would help her care for Mr. M. Despite having no healthcare background, Mrs. M quickly learned to care for her husband by doing, and the results were astonishing-not one skin breakdown or urinary tract infection. Mr. M had also learned to drive a modified van providing a minimal, but much needed, sense of independence.


Mrs. M's care of both her husband and the children continued each weekday until the last child left at 6:30 p.m. Weekends were devoted to her own family.


One day I remarked to Mrs. M how impressive her rock gardens were. She smiled and responded that because she couldn't leave her home for any length of time, the parents of the children she cared for began to bring her rocks from the places they'd visited. And after 43 years, she literally had rocks from all over the world.


Mr. M's decline was rapid, and he died in the early morning hours about 3 months after he'd been admitted to our hospice program. Soon after his death, I went to see Mrs. M.


She was composed and calm. She'd prepared herself for his death and appeared to be coping well. I casually asked her what she planned to do from this point on. She quietly answered, "I'm going to go out and find my own rocks."