The square peg in the round hole



Cuts heal.  Incisions close. Infections resolve.  But, does the pain of loss ever really heal?  That is a question that I am often asked and quite honestly don’t always have the answer for. The complex manifestation that we call loss is such a convoluted mix of emotions, feelings, thoughts and memories.  Age is a non factor.  Doesn’t matter how old or young you are.  It hurts all the same.

When you are young and lose someone close, you have some memories , but, in some ways, it is the familiarity of the presence that is more so missed.  That’s not to say that you don’t feel the pain, of course you do.  A child certainly misses the arms of their mother, no matter how old or young.  But, if you are older and have spent many years alongside that loved one, is the loss harder?

If you have spent years making memories with that person, you have a whole lifetime to look back upon.  On the opposite end, if you grieve the loss in your younger years, yes, you do have memories and always feel the ache of the loss, but, you live a lifetime without the presence of the lost soul.  There is no right or wrong answer to this.  People often will try to make one loss seem greater than another.  Really, though, can we ever?

When I would ask my mom how she could love 3 kids the same way, she would smile and say, “Well, it’s like my fingers.  I love them all.  If I cut any one of them, it would hurt terribly.  Each one is different, but the same.”  That’s the perspective I have taken on grief and loss.  The pain is no different for me if you are 22 and losing your mother or 66 and doing the same.  A loss is a loss is a loss.  Each age has different coping strategies.  Each age is able to face it differently.  Each age is able to grieve in its own unique way.

We can support people through grief and loss.  Listen.  Really actively listen.  Comfort.  Some people need to be heard in those moments.  Expression is a huge part of the catharsis of emotions.  No matter how planned or expected, death is painful, life changing and deafeningly silent.  It’s like being put in a vacuum of some sort where nothing quite makes sense anymore.  “Normal” is not normal anymore.  Until things find their own flow again, which takes time, most anything will feel like you are putting a square peg in a round hole.

That shattering lightening bolt of the first days after someone passes eventually gives way to a very odd numbness.  You have done all the rituals associated with one’s passing.  But, now, you realize that the person is really gone.  Now is when you actually deal with the loss.  The anger, the sadness, the emptiness – all of those emotions and feelings all swirled together like some sort of emotional cyclone from hell.  It’s not easy.  I won’t sugar coat it or blow smoke up your butt.  You will cry.  You will yell.  Hell, you might cry, yell, laugh and scream all at the same time.  Do what YOU need to do.  See a therapist.  Let it out.  One day, you will wake up and realize that the pain isn’t quite so acute anymore.  There will always be an ache, for as long as you live, for the one that was lost.  It dulls a little, over time, and we learn to deal with it, but, it is always there.  It is almost like our badge of courage for being brave enough to love someone so much that their loss left a scar on our soul forever.  That my friends, isn’t hospice nurse advice.  That’s a fellow scar bearer’s take on things.


The Certain Uncertainty

pexels-photo-66100.jpegThis particular blog has been hard for me to write.  Not because of anything in particular, but because I had the idea for what I wanted to express, but, getting the words to flow together was another story.  My words, just like our lives sometimes do, just would not meld together with any rhythmic flow.  As people, faced with a mountain of choices, we find ourselves at the cross roads of what we think we should be doing and what we want to be doing.

To this day, I have never met a patient that had regrets about how big his house was or how designer her handbag was.  The most common of woes is time.  That precious commodity that, try as we might, cannot be increased nor can it be taken back.  Time to laugh more.  Time to live more.  Time to just be.  Not time to worry.  Not time to pontificate over things that, at the end of the journey, have no real value.

Learning to just be is such a challenging idea for some to grasp.  Don’t get me wrong, I don’t mean to imply that you lose all ambition and stay stagnant.  What I mean is that you learn to appreciate what is going on all around you.  Take it in.  Realize that tomorrow will bring whatever it will bring.  We can try to change it, but, at the end of the day, our influence on tomorrow only goes so far.  There is always the certain uncertainty of tomorrow.

When an artist starts a new piece, he/she has an idea of what they want their creation to become.  Always taken into account is the fact that art, which imitates life, does not follow a purely horizontal trajectory.  Sometimes, when blips happen, the blips become the most beautiful parts of the piece because it is what makes the piece unique.

I’ve learned so many lessons from people who I know did not set out to teach me lessons.  They need my care and my empathy.  In return, I get a glimpse into how life should be lived.  Getting caught up in “What should I do? Who should I be? Where will my life go?” does nothing but waste precious time.  If you are unhappy, change what makes you unhappy.  If it means altering your life, so be it.  Those that love you will understand.  But, sometimes when we find ourselves questioning everything, the universe surprises us by showing that where we are is right where we should be.

That moment that just went by, that was a moment no one will ever get back.  That is a moment that just like the ones after, was an opportunity to just be.  Appreciation.  Gratitude.  Thankfulness.  Just be.  Go with the flow.  It doesn’t mean disengage and give up.  Fully engage and push forward until you find what sets your soul on fire.  Remember, all of our moments are numbered.  Fretting wastes those moments.  You don’t want those to be the moments you wish you had back.

When Did You Go?


Where you there when you could no longer speak?  Was your soul still present?  Could you hear us all around your bed.. talking with you… sometimes happy.. sometimes sad? When was the moment that you let go?

A lot of times, when people are passing, they fall into states where they are no longer responsive.  Their poor little bodies are so exhausted from the illness that they have progressed quite far along the road of transitioning.  While all of the typical bodily functions still continue to occur, the things that made that person arguably unique may no longer be present.  They can no longer speak.  They can no longer react.  The question can be raised …. Has the person already passed and it is just the body going through the motions of trying to keep itself alive?

As a former ICU nurse, I would see patients come in often… and they were not neurologically intact.  What does that mean?  It means that they were not awake, they could not react, respond, talk, have any sort of protective reflexes or cognitive functions.  Families would still see their hearts beating and would want every possible thing done in the very slim hope that a miracle would occur.  Please do not misunderstand, what you read there… that was the nurse brain speaking.  The wife, mother, friend, sister etc brain would probably do the same thing as most of the distraught families that came in.  After going through days, sometimes weeks of agony for the families filled with artificial highs and crushing lows, the decision would be made to end life support.  I understand this choice.  I had to make this choice.  There is no more agonizing, heartbreaking and haunting choice that you will ever have to make than this one, regardless of how dim or bleak the patient’s prospects are.

My mother was very ill and had always been verbal about not wanting “a tube down her throat”.  Well, being as unwell as she was, the day came where that was the profoundly difficult decision that was left for me to make.  Having the background of a nurse, I, for good or bad, knew the outcomes of either road that we would venture.  They both were agonizing.  Putting her on a ventilator, with all of her health problems, would lead to her staying permanently on one.  There was no guarantee she would ever wake up.  Where was the quality of life in that?

As my hand trembled, heart raced and soul fell to pieces, I signed the paperwork that for the longest time felt like I had signed her death warrant.  That night was long, there were moments where she was awake, but she slowly dipped deeper into the silence and the only thing left keeping her “alive” was the bypap machine.  As that was removed, her poor little face marked by the mask, lips dry from the air and eyes lightly swollen from the pressure, she took three very short breaths…. followed by one longer one ….

In my mind, those breaths were just her body fighting that one last winless battle.  She had “died” much sooner than any doctor ever pronounced her.  Somewhere in those moments, where her soul decided it was time to let go, she did.  On her own terms.  In her own time.  Still in the room with us.  Watching to make sure we were OK.  Listening to all the things we were saying to her… hearing is always the last sense to go.

I believe that is the case for a lot of people.  The spirit exits the body before the physical body cease to breathe.  When did you go?  It’s a mystery.  You went on your own time, in your own terms and when you felt it was right.

A Mixed Bag


As I often do, I found myself thinking about things I could blog about tonight…

Should I talk about the lady with dementia who responds to basically no one and nothing but responded to a chocolate doughnut I brought her?

Or would it be better to blog about the man, whose wife is clearly passing, who looked at me and said that needed to have a get together for all of us who helped care for his wife?

The patient who has every cat I have ever known beaten because it seems that just when I think she is passing, she manages to pull a rabbit out of a hat?

I think I’ll just talk about time…

In my line of work, time is priceless.  How much time?  How long? When? Patients and families always find themselves asking me questions about time… In a lot of ways, patients have lost grip on everything else and only their slight hold on time remains.

No one knows for certain how many grains of sand remain in anyone’s hourglass.  Not even the most experienced hospice professional can be sure of when a patient will pass.  There are clues.  There are signs.  There are hallmarks that I can base my estimate on, but, at the end of the day, it remains an uncertain estimate.  Just as every body lives differently, every body dies differently.  There is also that undeniable role that the human spirit plays…

No one knows for sure how one’s personality influences their passing.  From experience, I can say that one’s personality is fused into different stills of their passing.  Were you a feisty person?  Typically, they are the ones that fight on… even when fighting is a lost cause.. they still fight on.  Were you a fixer?  They are the ones that wait.. or try to.. until everything is resolved..  Were you one that hated to make your family sad?  They are the ones that pass when a family has left the room.

I wish I could so provide the clarity and foresight that patients and families seek.  But, I often find myself wondering what does it really matter?  If you knew you were dying tomorrow and were already sick, what would it matter?  If you were not sick, I am sure it would matter greatly as there would be things to take care of.  But, if you are already ill, why not just relish what time you have left? Devour each second as if another would never exist.

Our lives are a series of seconds… a collage of choices… a mountain of memories.  Seconds become decades in the blink of an eye.  Allow yourself to be present in the here and now.  Time will always be there… just marching along. Counting the minutes or hours is akin to wasting them.  Enjoy this second… this moment.. this present.


They tell us to create boundaries in order to protect ourselves.  Try to limit how much of yourself you give.  When a nurse works in a hospital, it’s a little easier to do this.  You see your patients for a shift or two and then it’s on to the next crew.  But, when you see the same roster of patients… week after week… you hear their fears, you witness their sorrows.. you dry their tears as you hold back your own… you delight in the small things that make them smile… that smile.. more treasured than the rarest jewel.

Maybe I am a bad nurse, but, I can’t seem to always put up those boundaries.  So, let me explain that.  Don’t misunderstand and think that I am at their homes every night, having dinner with their families and catching up.  No, they need their space and so do I.  But, the boundaries that I don’t know how to put up are the boundaries of the heart and mind.

How can I not care for you?  How can I not worry for you?  I catch myself wondering sometimes if you are ok.  How much of your last meal did you eat?  Are you hurting?  Are you getting the right medications?  Are you alone?  Are you sad?  Are you afraid?

The area of hospice is a difficult one.. it is an eruption of fears and regrets, joys and sorrows.. frustrations and passions.  Sometimes, the words that are spoken are ones that even their closest family members do not hear.  I am the secret keeper.  I become the one that tries to make even the smallest wishes possible, so that one may pass without lingering thoughts.  It isn’t always possible, but, damned if I am not going to try.

The fate that caused hospice nurse and patient to meet sets the stage for an intertwined tapestry of lives.  They do not guard their hearts and minds from me.  I believe that I would be giving less than the me they deserve if I did so.  There are moments where it does become difficult, but, remembering that I am the one guiding their forever journey makes me understand that what happens is just as much about me as it is about them.  sunset-hands-love-woman.jpg


People often ask often how I cope with seeing so much death… After all, the purpose of my job is to prepare people so that they have a peaceful and pain free passage.  For the vast majority of the patients, death is almost a welcomed event.  While leaving loved ones behind is not always the easiest, by the time death arrives, if I have done my job as best as I can, my patient and family are ready for this transition.

Even in the cases that death is viewed as almost like that anticipated friend that comes to help you escape, it still always has a bit of a sting.  It’s almost unfair for me to say that it is painful for me because I always think about the loss that the loved ones feel.  But, even if I’ve known the patient for one day, one month, one year – that patient always leaves their own impression into my canvas.  Perhaps it is because as I told someone very dear to me today, that in our patients, we see ourselves.  Even if it is just a tiny flicker, somewhere in that patient, we see a familiar fire…. we see ourselves.

So, with each passing, I mourn… the loss of the person.. the loss of that spirit… the loss of that mirror reflecting back at me.  I mourn the loss of the woman who held on until her daughter told her it was ok to go… that she had provided her with the one thing she needed to survive without her mom… strength.  I worry if they pass calmly.  Some people say that death is like birth, but backwards.  Birth seems pretty traumatic for those little babies and I would hate to have that happen to these dear souls.

So, dear patients, I fight your fights with you… I do feel your struggles and triumphs.  I can sense so many things about you because your essences has blossomed a beautiful vine in my heart.  As I have held your hands and felt them go from warm to cool, know that this is a journey that wasn’t taken alone.

And when the journey ends and my heart alternates between being happy you are at peace and sad that you are no longer here, know that I, too have my own little way of celebrating your life.  This may sound silly to some, but, I light a fire. The papers and notes that were taken during our journey together become the starter kindling for that fire.  As the fire grows and fills the room with light and warmth, my thoughts dance back to the wonderful memories I have made with that sweet patient.  And as the tongues of flame die down, a prayers of celebration and gratitude fill my heart.  Happy journeys my friend..

Sometimes, when the flames have passed and it’s time to close the glass doors of the fireplace.. for just that split second, it’s almost as if I see that reflection there… that reflection of me… of that patient… of that mirror…





I often find that there are many “convenient” phrases that people like to use when they don’t know what to say…

It’s God’s plan

Everything comes full circle.

Everything happens for a reason…

Now, I do have to admit that, the everything happens for a reason one, I use a lot.  I HATE when people use it when someone dies.  It’s such bullshit.  But, for events that happen in one’s life, I do believe to be true… and today, life taught me how right it is..

I was supposed to take my old lady bus trip to NYC with a friend of mine today.  Super excited to go, spend some great girl time with my friend, see some great sights and hunt for knock off Louis Vuitton purse (am totally guilty of this).  Well, last night, my friend texted me alerting me to the fact that NYC was suppose to get 6 inches of snow and be bitter cold today.  Ummmm, if I was in a cozy Broadway theater, maybe, but sight seeing and tracking down my replicas (sounds better than cheap imitations) would not be fun if I was going to become a snowbeast.  Trip cancelled.  Or, postponed.  Those Louis bags won’t be safe for very long.

Anyway, so, here I be… my son has guitar lessons on Saturday.  I honestly dread the drive, but, I drive alllll week, so what’s another 30 minutes in the car.  Normally, his lessons are at noon, but, for some odd reason, they were at 3:30 today.  Initially, I thought they were at 3, so I kept yapping at him and he corrected me (that -never-happens…).  We left at a decent time (see above about never happening) and after a coffee stop (shout out to Dunkin), we were on our way.  Then, of course my gas light starts flashing.  Alex: “Mom, we stopped for coffee, we cannot stop for gas..”  Me: “Ok, Alex, whatever you say” (knowing that I didn’t want to get out in the cold (he had all the cold weather gear on and I hate all that stuff so I wore a sweater as it was freezing and snowing).  We get off on the required exit and as I am pulling off, I remembered there was a gas station right there.  SCORE!  I pull in and hand him the card to pump gas and begrudgingly, he gets out to do it.  Mother of the year here, folks.  Anyway, just as he is getting out, I hear this car horn beeping non stop.  I see the man pumping gas in front of us kind of do that from side to side open mouth head turn that one does when something unbelievable just happened.  I hear Alex go “MOM”.  Hello Mom instincts on high. As I jumped out of my car, I saw an SUV pull into the gas station.  Front end completely destroyed.  A woman hops out of the driver’s seat – sobbing and yelling about her daughter.  I tossed Alex my phone and ran over to see what was going on.  Out of the car right now is stumbling a teenager… blood streaming down her face.  She is confused and not talking.  Add now nursing instincts kicking into high gear – she’s bleeding from the head, she must have hit her head.. concussion… she is disoriented.. concussion.. she might have hit her neck.. neck injury.. she’s got a massive deep gash on her forehead and the blood is streaming down her face kind of like a fresh stream in the springtime.  Guiding her over to the back bumper, I yelled for Alex to bring me supplies from the back of my trunk.  Being a hospice nurse, my trunk is full of things that I just might need when I make a visit.  I am yelling for things that he should bring me and he is just as calm and collected as he can be bringing them over.  At this point, other people have started to come over.  I started motioning to the one lady that I have the girl and she should go after the mom, who is walking around crying hysterically.  None of the airbags went off, so I was thinking the mom might be hurt, too, even though I saw no evidence of blood.  It’s funny how a whole group of strangers banded together to help this mother and daughter out.  Someone brought a blanket, another person brought bags to help clean up the garbage from the mess I was making with supplies to help the girl and another person was trying to calm the justifiably hysterical mom.  No one knew anyone else.  We all however, knew what we needed to do.  Long of the short is that mom and daughter were just running errands when mom lost control on an ice patch and hit a utility pole at about 60 miles an hour.  She is very lucky that the daughter only had that laceration on her head.  As I am sopping up her blood with gauze, someone yelled at me about gloves.  Sorry, but, that was the last thing on my mind.  A girl was bleeding and in distress, I am not going to stop and put on gloves.  Anyway, the ambulance finally came.  Both mom and daughter were taken to the hospital.  I’ve been thinking about them non stop.  As I was cleaning up the young girl, she mouthed out thank you….

I wasn’t supposed to even be in my state today.  I wasn’t supposed to take my son to his lessons.  I shouldn’t have let my gas tank run so low that the light went off (I know.. I Russian Roulette it pretty often).  How is it that a nurse with ICU experience and a trunk full of supplies is right there when an accident happens?  I could have had my old job where I didn’t have a trunk full of supplies.  Someone put me on a path different than the one I thought I was going to take today.  Everything happens for a reason…..