Southern Comfort: How My Work as a Hospice Worker Changed My Life

Engdahl 1 Southern Comfort; How My Time as a Hospice Worker Changed My Life Her hand trembles as she grips the puzzle piece. I have been here over an hour waiting patiently for her to place the pieces together. Her mind has withered away, riddled by dementia.

She struggles to connect her thoughts just as she struggles to complete this puzzle. I watch her eyes light up as a memory creeps its way across her frontal cortex, tiptoeing across huge gaps in her history. When she notices some of the images placed across the US puzzle map, with cows in Texas and corn in Iowa, she recalls that she used to have a farm and that her husband and their family drove across the country once. The memories slip away as quickly as they appeared and I try to reason with her when she gets frustrated that a piece won’t fit into a spot not made for it. I struggle.

At this point, I had been visiting with her long enough to understand her and her illness as best as one can from a distance. I wasn’t her daughter or her doctor, but I felt the ripples of her dementia just the same. When I got the volunteer request all those months ago, I prepared myself for someone to die in front of me. I reread the books, went over the training, talked to other volunteers. I am taking a step in my hopeful medical career, I told myself. I walked into the long-term care center imagining a crumpled old man, ready to tell me his old war stories as he realizes the light is fading. I anticipated someone with cancer, dying slowly in front of me, begging me to remember them or to simply listen. I wanted to be the family they were missing in their dying moments.

When I walked in that day, I was unaware of the extent of her illness. I had no idea she was incapable of recalling her name or where she was. When the nurse took me to her room, I tried to keep it together. She was in her wheelchair, facing the wall, shivering. No matter what we did, she was never warm. We spent months together, and I knew she felt no closer to me than

Engdahl 2 to herself. I hoped that my time there brought her comfort, if fleeting. I let her shaking hands place the puzzle piece wherever she felt it fit best and I tried to not let the moment pass me by. I remembered my own mortality and the likelihood that my mind will someday fail me. I let whatever stories she managed to tell reach my ears. I held on to every word and understood they could be her last.

Weeks after our last visit, I received an email; she had died in her sleep. The family wanted to reach out to thank me for spending time with her when she needed someone the most.

I offered my condolences and tried to move on to the next patient. I couldn’t let it go, regardless of the fact that I wasn’t actually present for her death. This was the first time I had been up close to someone in their last moments. It seemed to force me to stare at my own reflection; I noticed the wrinkles forming around my eyes and around my mouth, and I ran my fingers through my hair and wondered if I would go bald like most of the patients. Only a year before, my life seemed so clear and open. Now, in the face of this loss, I felt so old. My life seemed to shrink before my eyes, becoming just a dot on an ever-increasing expansion of other dots. It seemed the brevity of human life was crushing, and yet before I could even attend her funeral, I was already assigned a new patient. ~ When I realized I wanted to be a doctor, I had a very clear vision; a patient is brought in on a gurney after wrapping his car around a pole and his family is hysterically following close behind. I would take a minute to assess his injuries before deciding our game plan, then take a second to walk outside and comfort the mother of his child. I would take just a moment to embrace their devastation, to carry the weight of the situation on my shoulders when I walked

Engdahl 3 back into the trauma bay. I would promise myself to remember the tears streaming down her face as I tried to save his life.

Working with hospice patients is very different; I don’t get to rip my lab coat away to reveal my superwoman insignia before pulling off a miracle and saving the life of a patient who was destined for the grave. There won’t be salvation for these patients. I can’t spare them from their inevitable demise. I do, however, hold on to the one thing I can do—bring comfort. I can take the time to speak with the family. I can hold their hand and listen to the stories of their family member in their prime. I can bring comfort to the patient and do my best to ease their transition to whatever lies beyond. I can listen to the memories that fight so hard to reach the tongue—but I can’t save them. ~ My next patient request came as a very simple email: “Someone needed for patient yard care.” I would love to spend some time in the sun while enjoying the smell of fresh cut grass, I thought and volunteered. When I arrived at the patient’s house, I was surprised to see weeds taller than me and at the door, I was greeted by the patient’s father. He must have noticed the sadness creep across my face when I realized he was watching his own son die, but I tried to keep it at bay. I spent hours taking care of his yard and listening to him tell me all about the stuff he used to do around his home. He had planned to remodel everything, even down to the color of the garage trim. But then his son got sick and he was overwhelmed. The lawn that he once obsessed over became nothing more than an unchecked box on a growing list of things left to do.

I never went inside or offered my condolences for losing his son—I simply mowed his lawn. But in doing so, I afforded him peace of mind, if only for a moment. Most of hospice work, I’ve found, isn’t caring for those dying; most of the time, we are meant to care for their loved ones.

Engdahl 4 ~ Shortly after the funeral, I became obsessed with the way our society deals with death. As I thought of the woman in her room, shaking in her wheelchair and fighting for some recollection of her past life, I needed something to relieve the weight I felt on my shoulders. Her later years were so focused around her diagnosis— was she better off now? Was she finally warm? And herein lies the reason there are so many different beliefs about life after death—comforting those left behind.

For centuries, people have been comforted by a belief in reincarnation of some sort.

Christianity argues that all life is judged upon death and is placed in either Heaven or Hell.

There, you are either tortured and forced to pay for your sins for all of eternity or rewarded beyond belief. They believe that death is not necessarily the end, rather the end of human life.

All earthly possessions are left behind, so you’d better enjoy them while you can. The Christian view of life after death creates an interesting view to life on earth; it’s a race to get everything done that you can before death, all while trying to be a good Christian. In other words, life is about getting the job you want, the money you need, the perfect family, all while trying to keep in line with your faith. However, Hinduism posits that all life is in a continuing cycle of birth, life, death, and rebirth—until one can achieve Moksha, or the liberation from this cycle. To reach Moksha, one must achieve self-realization and lose the focus of their ego. This allows them to align with the Supreme Being, and in turn, focus on the divine self.

Alternatively, Scientologists believe that at death, a person simply moves to another life, called Thetans. The list goes on, with different beliefs of life and death, and different interpretations of what death means to the living. For some, it’s an endpoint where if you have lived a good life, you will be rewarded in the afterlife. For others, death is simply a stepping

Engdahl 5 stone in a larger cycle. These perspectives lead people to live their life in different ways. If there is a promise of Heaven, one must live in a way that allows them access. If they are only expecting to inhabit another life form at death, what obligation do they have to act a certain way?

What’s more; should they fear death? ~ I have a handwritten copy of “The Truth the Dead Know” by Anne Sexton in my wallet.

I’ve carried it with me every day for 3 years. In it, she says “And what of the dead? // They lie without shoes in their stone boats. // They are more like stone than the sea would be if it stopped.” I hold on to my need to help people; to be the best doctor I can be. I have come to realize that I do have that superwoman insignia, after all; empathy. I remember the first patient I worked with, and the poem in my pocket. I hold on to every day because I know it could be my last. I embrace the idea that whatever happens after death— whether it’s a continuation of my life in another form or simply the end—it will happen, and the life as I know it will cease to exist. I try to savor every moment, but it has become increasingly difficult as I have gotten older.

I am weighted down by my commitments and obligations and the strains of living. It can be a burden to even be alive some days. In those moments, I remember every patient I’ve worked with. I picture them, imploring me to seek more for myself, to enjoy even the dull moments, and I recall a poem from a documentary about hospice, written by a patient: “If the sun sets every night and rises every day, If the flowers die and die to bloom again, If the deepest wounds heal, If the greatest pains are forgotten, Tell me what does one fear in life?

Engdahl 6 Of course.

Sometimes I will bloom, Sometimes I will die.�

I can see them, asking, if everything dies to be born again, what do you have to fear? If death is the period at the end of the sentence, the finality we fear it is, then what else do we have but to live for now? If any of the perspectives on death are true, if there’s something after this life or if there isn’t, I promise to always remember that sentences are only complete with punctuation, and so too are we; that dot among the ever-increasing expansion of other dots is all I have. In this life, and in the next.