1. Jackson, Leanne R. BSN, BS, RN

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"WHERE DID YOU learn to do that?" I had no idea what my nursing instructor meant.

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On the first day of my medical-surgical clinical rotation, Ms. S and I walked the hospital corridor after I'd assessed my first patient, a weary, jaundiced 76-year-old woman admitted with recurrent hepatocellular carcinoma. In response to my puzzled look, Ms. S clarified, "Where did you learn to talk with someone about dying?" I had no clue. Who knew talking to someone was a special nursing skill?


I've thought about her question on and off for 35 years, more so after I found my niche in hospice. That's when my friends began asking similar questions: "How can you do that? Isn't caring for dying patients depressing?"


Today, as I looked through a box of vinyl records that my mother inherited from her father, I discovered my answer. I laughed out loud imagining my nursing instructor's skeptical look had I responded, "I learned to be comfortable discussing death from cowboy songs."


Lyrical lessons

When I put "Cattle Call" by Eddy Arnold on the turntable, memories of my grandpa came rushing back to me. Grandpa wore plaid shirts, smelled of mentholated ointment, and told stories of growing up on ranches in Texas and California around 1900. He listened to those folk songs so often that I grew to love them, too.


The familiar words of "Jim, I Wore a Tie Today" by Cindy Walker grabbed me. I pictured my grandfather's western tie, a strand of woven black leather circling his neck, anchored by a lumpy turquoise stone on a silver disc, its two leather tails bouncing on his chest. Surely that was the kind of tie the cowboys in that song wore, both the singer and his best friend, Jim, in the casket.


"Jim, I did everything that I could, but your fever just wouldn't die down."


That's where I learned to speak to dying patients with honesty and respect and to always call them by their name.


"Jim, I wore a tie today, the first one that I ever wore. And you'd have said I looked like a dummy out of a dry goods store."


Gentle humor has always kept my conversations with my hospice patients natural.


"Jim, they said a lot of things, but I don't know a thing they said."


The words at funerals often go over our heads, as do physicians' words when patients are anxious and in new territory with their disease state. My role as a nurse is often to write down or interpret what's been said.


"My mind kept wanderin' off down the trail, back to the times that we've had... We've done everything in the book, I guess, and a lot they'd never thought up."


I've reminisced with hospice patients, honored their regrets and successes, and offered to write down their unique stories. Some patients made extra copies of their stories for family members; one grandniece used hers as part of a school project.


One man told me cowboy stories he'd heard from his uncle, the famous Buffalo Bill. One woman had endured two ocean voyages with severe seasickness to work as a missionary in India during the time of Gandhi. One man collected quilts, but worried that his family wouldn't value them as he did; I created a booklet with pictures of him, his quilts, and their histories.


"Well, Jim, you're ridin' on ahead. I guess that's how it has to be."


In addition to reminiscing, many patients want to talk about their future and what they anticipate at their death and beyond, but often their family isn't ready to hear it. A young miner with end-stage silicosis struggled long nights perched upright on his hospital bed, eyes frightened, struggling to breathe, but needing to talk. Regularly during my shifts, I sat with him in the dark. When I ran into his wife several months later, she thanked me for listening to him.


"When you reach those streets paved with gold, Jim, stake a claim out for me."


More valuable than gold are my memories of departed patients. I miss every one of them. But I never would have missed the opportunity to accompany and learn from them on their final journey.