What Was Life Like Before? (Death and Terminal Illness Aren’t the Only Things We Deny)

In the television program Virgin River, Melinda Monroe (“Mel”) has left her Nurse Practitioner position in Los Angeles and moved into the wilds of California’s Northstate (very like the communities I served for over two decades). Mel’s decision follows the death of her husband Mark, and others around her and in his family especially demonstrate the kinds of behaviors chaplains, counselors, social workers, and other hospice staff members refer to kindly as “family dynamics.”

 But in the midst of varying layers of drama, at one point she’s questioned about her perspective on their marriage and its challenges. Wanting Mel to return "the family's" wedding ring, her sister-in-law asks, “If Mark were still alive, do you think you’d be still married?"

 True, those around the bereaved can often be horribly insensitive. But this scene (in Episode 5 of Season 2) reminds me, too, of how often our patients’ loved ones fall prey to pretending that everything in the patient’s relationships were uncomplicated by conflict, or that somehow being gravely ill results in some new sense of nobility, respect, or at least stability in the life of the patient.

 As we’ve seen frequently in recent months, though, even as our patients face their impending end-of-life, they are still who they have been. We work with families where relationships have been damaged by substance abuse, abandonment, disagreements, religious conflicts, and many other factors. The questions raised by these realities sometimes needs to be asked:

 “If your loved one wasn’t dying, would you let them live with you?”

 “If your loved one wasn’t dying, would you have taken an interest in their religious beliefs?”

 “If your loved one wasn’t dying, would you have stopped the divorce proceedings?”

 “If your loved one wasn’t dying, would you…?”

You cannot resolve what you will not address. Ask the questions.

 

So Much Can Go Wrong: Tropical Fish Edition

 At San Francisco State University, our Biology professor noted that he didn’t believe in any personal deity, and so we should take his terminology with a grain of salt. “But,” he said, “there is so much that can go wrong with the human body that it’s a miracle that any of us survive until birth.” As hospice workers, we get to see a lot of what can go wrong. In eight years of law enforcement chaplaincy, I think I saw most of all the other things that can go wrong.

 

To illustrate that, I looked up a list of all the things that need to go right in order to be a successful pet owner for tropical fish. According to those who admittedly want to sell you supplies and equipment related to keeping fish alive in your home, here’s the list:

 

1 – Get everything out of your household water that will kill your fish. Chlorine is just one of the many poisons that we tolerate, but that your fish will not.

2 – Don’t shock your fish with rapid temperature changes.

3 – Don’t shock your fish with sudden changes in their aquarium.

4 – Maintain a consistently proper pH and other chemical levels.

5 – Maintain a consistently proper temperature in the aquarium.

6 – Change 25% of the water monthly, without messing up any of the above.

7 – Clean the tank regularly so that all of the above are maintained without waste building up.

8 – Don’t put fish in with other fish that will kill and/or eat them.

9 – Also, don’t put fish in with other fish that they will kill and/or eat – because the uneaten remains of dead fish will violate #7 on the list.

10 – Don’t overfeed your fish, since it’s not just uneaten dead fish that will violate #7 on the list.

 

As hospice workers, we could compile a similar list for our patients, their friends and family members, caregivers and collaborators, and even our own team members. But here’s the point I’d like us to remember:

 

There is so much that can go wrong, that we will never give anyone “The Perfect Hospice Experience.” Still, providing them with hospice care is so much better than the alternatives that it wouldn’t be inaccurate to call it, if not perfect, then at least a miracle.