1. Diers, Donna PhD, RN, FAAN


The RN, the CNA, the LPN [horizontal ellipsis] she needed them all.


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They walk toward me in the cemetery in a little town in Wyoming where we have just buried my mother: Linda, Carol, and Beverly, my mother's nurses.

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Mom's osteoporosis had shrunk her from her proud 5'4" to barely 5'. Arthritis had turned her hands into claws. Chronic obstructive pulmonary disease, which tethered her to an oxygen machine hidden discreetly behind a living room chair, had caused congestive heart failure. She was on enough medicines to fill the biggest plastic container the drug store carried.


I lived many guilty miles away in New England and my brother was a full day's drive south in Colorado. Dad took care of Mom and it had become a full-time job. The only time he really got away was just after dawn, while Mom was still asleep. He would meet an old friend for a quick round of golf on the rough public course where the fairways were sagebrush and weeds and the greens were beige sand.


Mom and Dad decided they needed a little more help at home. I was relieved when I heard that community health nurses-my professional sisters-were going to be involved.


Carol came first. She was an LPN. Deeply tanned, she looked as if she'd be more comfortable on a horse than in her Subaru and spoke only when she had something important to say. Carol took over the complicated medication regimen and the weekly "checkin' in."


Not long after, Linda joined the team. Linda was a nursing assistant. The flaming red hair I remembered from when she was growing up a few years behind me had faded to dusky rose. Linda came two or three times a week to help Mom with her bath, a task that had Dad buffaloed. Mom and Linda clicked right away, and when I was there on one of my increasingly frequent visits, Mom would rather have Linda help her. I would listen to them laugh as Linda jollied Mom through the shower that exhausted her. She was especially good with Mom's hair, about which she was deservedly vain. Hair care has always escaped me.


Mom began to slip a little bit more every time I flew in.


Without telling Mom and Dad, I went to the community health agency to see Beverly, an RN and case manager. I needed to sort out how to talk to my parents and shore them up. Bev, a calm, centered woman with huge brown eyes, suggested that we all meet. When we did, and we sidled up to the question of palliative care, Mom refused to be dying.


Then one day Mom got breathless and Dad took her to the hospital. The X-ray showed lung cancer. When Mom told me about it on the phone as I was preparing to visit them, she seemed almost relieved. As a long-time smoker, she understood getting lung cancer. Although it probably wouldn't do much more than relieve her labored breathing, radiation was planned, in keeping with Mom's desire to be treated. Dad was tired and anxious about what might be next. We decided that short-term nursing home placement just up the street from their home would be best. Mom agreed.


I wanted her there too, in the hands of nurses-she already knew many of them, since her own mother had been a patient there, as had many of her friends. I helped with the move. Knowing I had a professional commitment in Arizona, I had packed my fancy dress. Mom loved clothes, so I modeled it for her in the nursing home. She liked it. She even said my hair looked good.


But Mom didn't settle in. She got twitchy and irritable. She began to call Dad at dawn, at noon. Dad started going to the nursing home early in the morning and spending most of the day with her. When I returned home from Arizona, the RN in the nursing home called and we had a conversation that led to a tricky dialogue with mom's physician about using morphine to make her more comfortable.


I got on a plane again.


Carol came to visit Mom in the nursing home. Dad was there. Mom was sleeping but woke to Carol's voice, smiled into the middle distance, took a deep breath, and died. I was somewhere over Iowa.


It took a small squad of all kinds of nurses to care for all of us.


Now, at the cemetery, I hug Linda, Carol, and Bev-a CNA, an LPN, and an RN-in wet, salty gratitude. They did for my mother what this fully credentialed, multiple degree-bearing nurse daughter couldn't do. They made all the difference to her-and to me.