(A bit of context for these reflections… I have a solid and thriving gratitude practice which consists of listing five things I’m grateful for each day on my Facebook page, often before the sun comes up. Been doing this for years, and have occasionally wandered back to these lists to see what I wrote, inevitably finding one-liners whose backstories are worth telling. “Thanks…Again” is where these stories live. I hope you enjoy them. Oh, and the bolded one is the featured story o’ the day).

Posted on May 17, 2019

Good morning dear friends! Today, I’m grateful for...

Thunder at 3:00am, a singular huge ball of rolling, window-rattling sound

An unexpected yet just delightful after-work sprint around the 17-acre field

Laughter with nurses, tears-streaming, water-spewing, endorphins-flowing laughter

Daniel’s easy smile

Ending the day with the solid feeling of a job well done

What are you grateful for today?

The words “hospice” and “laughter” don’t often team up. Even if you’re inside those sacred walls of care and give yourself over to the reality that, when helping someone close their circle of earthly life, you never know when you’ll be right smack in the lap of those anything-can-happen-and-often-does moments.

I work in a hospice setting, and my role is situated about six circles out from the center of that tender and poignant bedside care. Managing the volunteer staff involvement aspect of our work, I broker the space between one person’s selflessness and another’s need, linking compassion to loneliness, relief to caregiver fatigue. My place in the end-of-life constellation of support is well-suited for my expertise and abilities. I work in the company of physicians, nurses, social workers, chaplains, personal care specialists and unpaid companions to the dying.

In my first couple of years, I sat in the presence of my clinical co-workers, mystified and humbly silent in the face of their collective work. At weekly patient review meetings, I was immersed in the medical details of our patients’ struggles and stories, the family dynamics that stretched across a continuum bookended by unflagging support at one end and chaotic dysfunction at the other. The constant throughout was the skill of the care team working in alignment with each patient’s desires and wishes for a peaceful and painless death, and reassurance that those left behind would be taken care of, from spouses to children to beloved pets. I still sit, mystified and admiring, but less silent than before, because the good work of my fellow staff members—paid and unpaid—requires acknowledgment and praise spoken aloud to anyone who will listen.

Our patients are givers whose gifts cover a broad and deep expanse of life’s most precious and hard-won learnings. Ask a member of the clinical team “what have your patients taught you?”, and the answers tend to settle on a profound appreciation for this moment right here, the fleeting, graced and unguaranteed nature of our existence, and a well of gratitude that never stops bubbling up to the surface. And…our patients remind us to laugh. Some insist that we laugh with them. So we do.

An aide tells this story at a new volunteer training, to offer reassurance to anyone in the room who’s worried about saying the “wrong thing” to a patient or family member: a husband and wife are in our care, husband is the patient. He passes away at home just like he wanted to. The assigned aide is three weeks new on the job, there to provide post-mortem care (bathing, preparing the body for the funeral home transport) but is alone in this physical task, and at one point in the process needs help turning the patient over. Wife steps in to assist, and it’s tough going. Aide grunts beneath the husband’s heft and blurts out “geez, this guy’s deadweight!” Wife freezes for a split second, locks eyes with the aide across her husband’s body, and then they both burst out laughing. Tense moment broken, tears of much-needed release and relief flowing all around. “Wrong thing” said? Not at all. Couldn’t have been scripted better.

I suspect every branch of healthcare has its gallows humor, its raw moments of uncensored expression, and understandably so. What hospice nurses—indeed, all hospice clinicians—deal with daily is beyond most of the lay person’s scope of experience, and certainly mine. When vomit and diarrhea are the topic of discussion over lunch and people keep eating, you know you’ve entered a different mindset entirely. There needs to be a place to unpack all that without apology. Once, at an in-service on wound care which took place in the common area of our administrative offices, I was trying to quietly take a shortcut through the back of the room to the kitchen when I made the mistake of looking up at the PowerPoint projecting an uncomfortably close-up photo of a tunneling wound (do a Google images search if you’ve got a strong stomach. I couldn’t even type that phrase without gagging, and a photo doesn’t give you the whole experience. There’s odor as well and a three-dimensional aspect that would knock me to my knees). One of the nurses on the aisle noticed the unedited reaction on my face and smiled at its honesty. From that day forward—and we’re talking twelve years at hospice now—I am nowhere in the building on in-service days. Hospice nurses have a permanent place on my daily gratitude list.

The clinical team spends most of their time in the field; I’m at the office printing off volunteers’ applications or standing in front of a group of pre-med students inviting them to join us in our good work. What time I do spend with the nurses and other members of the clinical team I cherish, and also register a sort of perpetual ache that I’m not doing enough to support them. Couldn’t I give them some of my unclaimed PTO days, have dinner delivered to their homes, shower them with all the chocolate I keep stashed in one of my desk drawers? What would “enough” look like anyway? I doubt even they could tell me. So we rub along together with this mutually respectful posture between us, the finer points of our respective job duties sometimes blurry at the edges but acknowledged and appreciated nonetheless.

Two years ago, we celebrated the opening of a new branch office to anchor a large part of our service area, hosting a party for our business and community partners to mark the occasion. I was standing near a tall and chair-less cocktail table, holding a plateful of cheese cubes and bell pepper slices in one hand, drink in the other. Our vice president of clinical services, the new inpatient unit manager and the program manager for the new branch office—all seasoned hospice nurses—somehow got to sharing stories of working 12-hour shifts without a restroom break. One of them began describing some of the products on the market to “assist” females in their profession with elimination in such circumstances, and soon we were careening off into a conversation for which I had no context at all (in my 38 years of volunteer management work, I have yet to experience an unpaid staff emergency that would keep me from heeding nature’s call, much less one that lasted twelve hours. Heck, the restroom is right across from my office. Easy street compared to the life of a hospice nurse). I tossed in a bon mot of my own and it must have landed well because the inpatient unit manager sprayed us all with the sip of water she’d just taken from the bottle she was holding. I was drenched in the laughter of three hospice nurses who had collected more than their share of hard and indelible bedside images, who had logged uncounted hours of treating tunneling wounds, of holding the hand of an exhausted caregiver while the loved one’s body waited nearby for one final and dignified bath. In that moment, humor balanced the scales that teetered too often toward the grim and heavy realities of death, giving three good souls an endorphin-rich moment of release.

I don’t even remember what I said. I was just glad I did. Maybe it was better than chocolate or free dinners or unused vacation days. If those three nurses even remember it at all, I hope they call it up the next time the weight of their days is more than they can bear. In that tender and poignant moment, let it be enough.