"Optimist."

Ok, so I know that the second to last post was a little bit of a downer, but thanks for reading and hearing me out on a tough day anyway. I can't stress enough though that working with kids was actually more emotionally draining for me than this job. People tell me thank you, for example. Or, "Talking to you helped me feel better." The other day a patient's wife (who is so cute and I wish I could make her my adopted grandma) even gave me a hug and said, "I love you!" No, I love you! How sweet is that?

Anyway, I hope that this post doesn't end up being a downer, because it's not meant to me, but a really interesting thing happened today that I thought was blogworthy. Actually, events started to unfold yesterday when I was talking to one of our patients, a really sweet 80-year-old man who would have me write my name down in his notebook every time I saw him so that he could remember my name. I asked him how he was and he said he was thinking that he would be headed to the "great beyond" soon, and that he didn't have much time left.

Now, a week ago in lecture (the psychology fellow and I go to a lecture every week) the nurse practicioner was teaching us about the last 48 hours of life, and said that people often seem to know when they are about to die and will sometimes talk about it. Sometimes if they are delirious, they might make reference to dying in obscure ways, like saying that they're "waiting in line", or trying to "get on the train".

So, when this patient started talking to me this way I paid attention. I said, "What's making you feel that you are getting close?" He said that he was feeling very sick, and he had been confused a lot that day, and just felt that it was time. He even asked for the telephone and his phone book so that he could call his relatives and say goodbye. He also asked to see the Chaplain, which I arranged. He told the Chaplain the same things he had told me, and said that he was not afraid of dying and that God had helped him his whole life. After talking with him, I said, "I'll see you tomorrow." He just snickered and said, "Optimist."

This morning when I got into work I checked our roster to see if he was still alive. He was! Oh good, I thought, maybe he was just having a bad day. I went to say hi in the morning but he was sleeping. Later this afternoon, about a half hour before I was off work, I was working on some notes and just had a thought that I should go check on him and joke that I had been right, I would see him today! I walked down the hall and my supervisor and a CNA were there, and they said, "Oh, did you hear? Mr. So-and-so just died." My supervisor and I went into his room and said goodbye to him, and I reminded the nurses that he kept his wallet in his pillowcase, and that was that. He was gone, and he had known the day before.

I guess I felt privileged though that he could share that knowledge with me. He had not been a patient that liked to make idle conversation, so I wouldn't usually go in to talk to him unless I had a specific purpose. I didn't have one yesterday, but he called for me as I was walking by and asked me to hand him his phone book, telephone, and re-hide his wallet. When he told me that he thought he was at the end, I pulled a chair over and sat next to him. He said, "Oh, you don't mind sitting down for a little while?" I told him no and that's how we were able to have this conversation.

In my last semester in grad school I took a "Death and Dying" class, which is how I became interested in palliative care in the first place. I used to get so frustrated with the teacher for not being more specific about how he would work with the patients and what exactly he would say, as if there were some magic formulas. His big emphasis was that it was most important for the patient and their family to feel that you are present with them. I thought, "Thank you for taking my out-of-state tuition and giving me a lame social work term rather than some actual models and interventions." I have really found that to be so true, as silly as it probably sounds. I should probably email him and apologize for rolling my eyes every time he said that. Anyway, like I said, hopefully that wasn't a downer because it was actually a positive experience for me, very special.