1. Verderame, Lorie RN, CHPN

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It was a memorable and busy week in my life. My daughter was about to be married. My husband and I celebrated our 25th anniversary. The Oklahoma City bombing drew the attention of the world. I did not expect to suddenly meet the person who would teach me what dignity really means.


Ola spent her life among another people's possessions-their household goods by day as she cleaned their homes, their cast-offs by night in her cluttered apartment. In her 70s in 1995, she worked 6 or 7 days a week in the homes of the wealthy. She had never applied for Social Security or Medicare, never considered retirement. She had come to Philadelphia from the South as a young woman and felt proud that she had always found plenty of work. We met when, as a home hospice nurse, I went to her apartment to offer services.


She was unable to come to the door because of weakness. She threw the key out a window and called "Hurry, it's not safe to keep the door open." As I climbed the stairs I heard the multiple locks on the apartment door being released. At the landing I heard "Come on in." Home care nurses see a lot of different homes. This was absolutely the most cluttered space I have ever seen. There was a hodgepodge of furniture of every description, stacks of books (all classics), pieces of bric-a-brac, lamps of various sizes and shapes with and without shades, newspapers, throw rugs, and pieces of china, mostly chipped, on every shelf and horizontal surface, including the bathroom ledges and windowsills.


"I like pretty things," Ola explained. "When one of my employers wants to throw something pretty out, I ask if I can have it." She showed me a few of her favorite pieces: a Wedgewood plate, a Limoges teacup holding a soap pad at the stained kitchen sink. "My apartment looks so much better to me when I come home and my eye catches sight of something that was once so beautiful."


"I used to be pretty myself," she told me. From a worn Bible she took a black and white photograph of a slender young woman standing in front of a field of bursting cotton bolls. This woman had smooth skin and a bright smile, a tiny waist, and shapely legs. At her feet was a fat sack, tied with string. She pointed to the package: "My worldly possessions were in there when I left my home. I couldn't read or write anything but my name. Since then, just look at all I've gained," she said, with a sweep of her arm to indicate her home.


I looked at the woman before me: distended abdomen, swollen legs, bent back, sparse hair and I saw the bright, beautiful smile of the young woman in the photograph. I saw dignity, a person who knew how much she had learned and accomplished, how far she had come on her life journey. She was proud of herself and ready for the last phase of her life.


Over the next few weeks, I saw Ola almost daily as she declined. She had no local family to help with her care. The hospice program coordinated caregivers in the home. I often spoke to the night caregiver after midnight as she helped to settle her patient for bed. Ola would always get on the phone herself. "Nothing wrong with my brain," she would tell me, "or my heart." She would launch into a detailed report of her medical status, what level her pain had been and precisely what medications she had used. Up until the day or so before she died, she was exacting about managing her own care. The conversations always ended with a recital of her intentions for interventions if needed overnight-pain meds, bedside commode, call to the on-call nurse and with the words "make you proud of you."


What did she mean by those words: "make you proud of you"?


A few weeks after Ola died, a friend of hers called to ask me to stop by her apartment the next day. He was clearing it out for the landlord. When I got there, the friend said, "Ola asked me to show you this trunk and what's inside. She wanted you to have something to make you proud of the way you took care of her."


He opened the top of the battered trunk and I looked inside. There were the treasures she chose to set aside, like her picture concealed in the Bible. I found several pieces of old glassware-none broken. There were a few books, dust jackets clean and intact, unlike those she kept out in the apartment. Some clothes, some costume jewelry, a few kitchen utensils, and most surprisingly, a brand new, in-the-box, very expensive type of electric kitchen juicer. The friend informed me, "Ola wanted you to give the juicer to another cancer patient so they can try to stay strong."


Tears came to my eyes. She was thinking about helping someone else, a stranger, as she was dying herself. I did pass that juicer on to another patient who enjoyed trying various combinations of juice and the activity it provided for her to share with her daughter.


And I did select something to keep-in addition to a small iridescent blue glass bowl, I have the gift of knowing how one patient's dignified way of appreciating her own life can be a lesson to me in my own. In nursing, we work hard, juggling many responsibilities through the shift, prioritizing and reprioritizing to meet the needs of our patients and coworkers. We can be proud, but not prideful, as Ola was of what she achieved. I have been a nurse for a long time and have never been more proud to be part of a profession that changes with the times to meet challenges in the healthcare environment. As frustrating as an overbusy workday can be, I hope all of my teammates and coworkers can know that our patients do recognize how we care about them, what we achieve for them, and how they want us to be proud of that good work.