1. Mullis, Melinda L. RN, CHPN

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It was a beautiful spring day. The sun was shining, the trees showed their many shades of new green, which would become full-blown dark green as the spring becomes summer. Country people wearing straw hats and gardening gloves were readying their gardens for the young plants that would bear tomatoes, squash, cucumbers, and any number of fresh vegetables later during the spring and summer. It was as if the world was being reborn from the cold, harsh cocoon of winter into the beautiful multicolored butterfly of spring.


As a hospice nurse, I was enjoying the warm weather, driving along the winding and hilly country roads, and thinking of the new patient I was admitting this morning. The referral sheet said that he was 61 years old, married, and had stomach cancer.


Pulling into the dirt driveway surrounded by different types of shrubbery that had grown wild during the long, cold winter, I noticed a plot of land that had been cleared, but not tilled, for the new crop of garden plants. Out behind the house was a small, weathered, deserted-looking barn with a rusty tin roof. The door of the barn was closed and locked. There was a small, compact older-model car sitting forlornly in the driveway to the side of the house.


As I parked the car and walked up to the porch, I noticed an old mixed-breed dog that shook his tail lazily as he lay in the warm sunshine. I thought to myself, "He sure looks lonely." Seeing no doorbell, I knocked on the screen door and peered into the darkened room beyond. Hearing the tired shuffling of slippered feet coming toward the door, I stepped back so that the door could open.


Before me stood an older-looking lady, standing about 5 feet tall, hair tucked under a net, with white curls escaping around her face. "Hey!!" she greeted me timidly.


"Hi!!" I replied. "I'm Mindy, the hospice nurse. I'm here to see you and Mr Rabon."


"Come on in," she said. "I'm Mrs Rabon. He's in there." She pointed to the room beyond the kitchen after I had stepped through the door. I invited her to show me the way, but she quietly refused and told me to just go see her husband.


The despondent darkness invaded every corner of the makeshift bedroom. In the middle of the room was a massive, dark, wooden bed with bedposts that nearly reached the 8-ft ceilings. Dwarfed beneath old-fashioned hand-sewn quilts lay a shriveled man who seemed much older than the 61 years mentioned in my referral chart. He seemed to be hiding from death itself in these dismal surroundings.


"Hello?" I called out as I entered the room. "Are you awake, Mr Rabon?"


"Yeah, come on in, if ya want to," he responded softly.


I introduced myself, telling him that I was from Hospice. He replied with a grunt, then let out a sigh as big as he was.


"Mr Rabon, may I turn on a light in here?" I asked.


"I guess so," he replied quietly.


As I switched on the lamp beside his bed, I noticed how the soft light made hollow planes across his gaunt, grief-stricken face. He said, "I'm going to die and that's why you're here, right?"


I knew then that he had the wrong impression of hospice, a philosophy that encourages living rather than dying. "I'm here to make sure that you are comfortable with however much life you have left, not to talk about dying, Mr Rabon. But if you want to talk about dying, I'm here to listen," I said softly.


"Just look at me!!" he said pointing to his stomach. "I can't eat anymore, so I know I'm going to die."


There was a gastric tube protruding from beneath his tattered flannel shirt. "Have you been getting your tube feedings like the doctor ordered?" I asked.


"I'm just too disgusted to take them. My wife is supposed to feed me through this tube and she is scared to do that. I'm too weak to walk or even talk much," he replied.


"So is that why you lie here in the dark waiting for something to happen?" I asked him bluntly.


"The doctor told me I was going to die, so I'm just a waitin' to do just that," he told me defiantly.


"Are you in pain?" I asked.


"My stomach burns and I ache all over. I can't swallow no pills, so I can't take no medicine. If I lie real still, sometimes the pain will go away," he explained.


"Mr Rabon, I think I know a way that your pain can be controlled so that you don't have to lie still all the time. And I know that you're not finished living yet, so why don't we try to teach your wife how to give your feedings so you can regain your strength?" I said encouragingly.


"All right," he reluctantly agreed.


I called out to Mrs Rabon, and she came slowly to the door. Peering in, she asked, "What can I do for you?"


"Mrs Rabon, please come here and see what your husband has to say about his feeding tube and about living," I said, trying to keep the irritation from my voice. "I think you can help him to feel better."


She slowly approached the bedside, averting her soft hazel eyes. "I can't feed him through that tube. I'm afraid I'll hurt him if I give him too much," she explained.


Pouring 4 oz of Ensure into a glass container by the bedside I motioned for her to come closer. "This is how much you should give him every time you feed him, about six times a day. Then you need to flush the tube with about four ounces of clean water afterward," I instructed.


She tentatively took the glass of water I offered and poured it into the end of the tube. Looking up at me through her furrowed brow, she smiled shyly. "Is that all there is to it?" she asked.


"That's it!!" I exclaimed. "If you can do that six times a day, then I think he'll get stronger."


I called Mr Rabon's doctor and suggested that morphine sulfate liquid be started at a rate of 10 mg every 4 to 6 hours as needed. The doctor agreed, and then I explained the new medication to the patient and his wife.


They said that they understood that this medicine could be given through the feeding tube, and that this would make Mr Rabon feel better.


After giving each of them a "hospice" hug, I left the house knowing that maybe I had made their lives a little brighter.


The next week when I approached the little country house I planned to tackle Mr Rabon's feelings about dying, if he was in the mood to talk about it. To my surprise, he answered my knock, himself.


"How are you today?" he asked before I could even say hello. "I am getting stronger just like you said I would, and I don't hurt like I used to."


"It's great to see you up and around," I replied, thinking this was what Hospice care was all about.


"Come in the house and see the missus," he invited, turning into the cozy room beyond and sitting in a lounge chair that had been moved into the kitchen. "I can walk some, but I still get tired real easy," he continued.


Mrs Rabon was busily preparing a lunch spread of fresh vegetables from the Farmer's Market. She offered me a huge smile, walked to me and opened her arms wide for the friendly hug she knew I'd offer. "You sure fixed him up!!" she exclaimed.


"Now, Mrs Rabon, you know you were 99% of his feeling better by feeding him through that tube and making sure he got his medicine," I replied.


She smiled quietly to herself then turned back to her lunch preparations.


"What have you been doing with yourself?" I asked Mr Rabon.


"I've been mostly sittin' in this chair watching my wife cook food that I can't grow and can't eat," he smilingly joked. "She cooks a lot for our children and their families. At least if I could ride my tractor I could get the garden ready for the spring planting."


"So you ride a tractor?" I asked.


"I not only used to ride tractors, I used to build tractors. You know, the miniature tractors that you've seen around. I just wish I could ride one of them before I die," he explained.


"Maybe when you get a little stronger, you could still do that," I encouraged. The visit went as I had planned. We discussed Mr Rabon's acceptance of his terminal diagnosis.


"I'm ready to go when the good Lord calls me. I just wish I could do one thing: till up my garden using one of my own tractors," he said wistfully. As he was talking about his tractors his eyes became bright with tears. This was the task he had left to do before he died, and I knew I would try to help him finish his life's work.


Two weeks passed, several visits with Mr and Mrs Rabon, and still Mr Rabon had not gotten the strength to go outside to his locked and forlorn-looking barn which housed his precious miniature tractors.


I called his son, Roger, and explained that I felt his father would feel better if he were able to ride his tractor enough to start tilling his garden spot. "But Daddy's sick. He can't go outside!!" he exclaimed. "What if he falls and hurts himself?"


"Your Daddy is sick, Roger. But when a person is facing his own death he needs to complete those things in life that are left unfinished. In this case, your Daddy needs to ride that tractor, and you should be able to help him with that. I'll bring a walker for him to use on the uneven ground outside, and you can help him walk out to the tractor barn," I explained.


He reluctantly agreed to help his father reach the tractor barn and ride the miniature tractor.


The next week when I visited, the sun was shining brightly. There were several newer-model cars and trucks reflecting the spring sunshine falling on the driveway. The shrubbery had been neatly trimmed, the grass was newly mown, and a picnic table covered with a red checked tablecloth stood waiting behind the house. A huge watermelon stood in the center of the table with a large knife beside it, just waiting to slice through the sweet juicy redness.


No one answered my knock at the door this time, so I wandered into the backyard. There, sitting astride his miniature tractor and grinning widely sat Mr Rabon. His garden had been freshly tilled, and 4 grandchildren were busily at work planting seeds and transplanting new squash, tomato, and cucumber plants. A party atmosphere prevailed, with everyone talking and laughing excitedly.


"Grandpa is riding his tractor!!" one husky young 10-year-old boy yelled, running up to me as I stood with my mouth agape. Here was hospice in action. The excitement of living had lightened the shadow of death that had hung over this family for the months since Grandpa's diagnosis. He had completed his final task in life and could now face death much more easily.


Mr Rabon died 2 weeks after his family's watermelon party. Knowing that we had played a small part in helping him finish his life's work made it easier for me to let him go and easier for the family to accept his loss.