Working on the Front Porch of Heaven
This booklet contains a series of true stories that highlight the unusual events that happen at the bedside of the dying.
Prologue:
All protected health information has been de-identified in each story. Many of the specific details in the following stories have been changed to protect the privacy of patients and their families.
How do you do this every day? This is a question that I hear over and over again. Every time I hear that question I think, how could I NOT, do this every day? I have been given an opportunity to work with patients and their families in the most vulnerable phases of their lives. I get to hold the hands of your loved ones, smooch on your little ones, and try to answer your most painful questions. I work at the bedside of mortality every day, and it is the most rewarding and fulfilling life experience I have ever had. I am asked questions regularly that are profound existential questions requiring deep thought and reflection. I would like to share a glimpse of what I do to illustrate just one of these most precious moments.
A man in his mid- to late-40s was on our unit. He had two teenage children and a wife. He had only found out that he had cancer a few weeks prior to arriving on our unit. He was a kind and gentle man that could make you full-out belly laugh. I had grown very close to him and his entire family, and with every declining day my heart would break just a little more for this struggling family.
One night he was having trouble sleeping and we got to talking about the "journey" he was on. He had one big concern about dying: he was so afraid about "missing" his family. He said he knew that heaven was going to be the best place ever, and that there would be no pain. He knew his wife was strong and his children had a solid foundation, but his true anxiety lay within the overwhelming grief he was feeling about the loss of the physical presence of HIS family.
How do you possibly respond to this? As this deep sadness hung heavy, I had to find words to help settle this fear. So, I took a deep breath and thought about what I thought to be true of the next "phase" of our soul. I said, I believe heaven is filled with pure joy, pure love, and pure happiness. If all these things are true, then there can be no "missing". I think everyone you love in this life, a little part of you stays in their heart when you pass. That way you are always there with them, watching over them, in a way you couldn't do here. If you are always with them, in their heart, there can be no missing.
You could see him process the words that I just said, and then a gentle understanding fell across his face. He drifted off to sleep for some much-needed rest.
Several weeks after he died, his wife called. While we were having lunch she pulled out some pictures of their daughter’s prom. I looked at the picture of this beautiful girl, and couldn't help but notice a white orb of light the size of a cantaloupe in front of her belly. As I looked at the image, his wife said, "He was there with us, do you see him?"
Hear the Music
There is no “typical” on our unit. Some patients are with us for many days and some with us for only moments. This next account details a precious story that a son shared with me moments after his father passed away on our unit, after only arriving moments prior to his death.
I sat down with the son and listened to what he wanted to tell me. He said, my dad was this amazing man that was independent right to the very end, just like he always said it would be. My father’s big fear was to lose his independence, his dignity. He did not want to live in a “home”, “being taken care of.” It was a very typical day; Dad was out working and around lunch time he came in the house. Mom had prepared one of his favorites but he bypassed her cooking for an afternoon nap. This was completely unlike my father. My mom gave me a call, as I only lived two doors down. When I got to my father’s bedside, he had an angelic smile of peace on his face. I said, “Dad, can you hear me?” My father said, “I hear the most beautiful flute, playing the most transcendent song.” (Many years prior they had lost his sister/ daughter to a tragic motor vehicle accident. She was a prodigy flutist, attending a prestigious university, at the time of her death.) I said, “Dad, do you want me to play some of Anna’s music for you?”
He responded with: “She IS playing for me. Can’t you hear her?”
His father took his last breaths on our unit, but his final words will forever last in the memory of his family. He will always hear his sister’s music on his father’s heaven birthday.
Mr. Macaroni
There are not too many patients that visit our unit more than once. Mr. Macaroni is one of the few, on that short list. He first came in with acute altered mental status due to an infection. He was an Italian immigrant, in his late-eighties and still very active in his garden and community. He would frequently pick his buddies up at the nursing home and drive to the casino. Driving kept him independent and self-sufficient, which, as he told everyone within earshot, was his purpose for living. He had an underlying diagnosis of an aggressive pancreatic cancer, which had a prognosis of months. His family felt that this acute episode was an indication that it was time to find a “place” for him.
As the bedside nurse, I felt that his mental status had cleared with the antibiotics. He made it clear on many occasions that if he were not allowed to go home, and specifically, drive, he would have no quality of life. I knew I needed to help him be heard. I called for a family meeting with the provider team to evaluate who the decision-maker should be. His daughter was his health care proxy and she was pushing for a comfort care home. Mr. Macaroni’s mental state had cleared, so I believed he should participate in this decision. In the end, Mr. Macaroni was able to return home and continue to drive.
Several months later, Mr. Macaroni returned for his final time. He looked older and thinner but still had his sweet charm. He told me about all his escapades while he was “out,” as he called it. He told me about how much fun he had waving to the nurse pulling in his driveway, when he was pulling out. He explained how he would hide from his daughter when she came by to check on him, “just to piss her off.” He was still so naughty and I loved it.
As I sat just outside his room, Mr. Macaroni’s daughter came out and quickly ushered me into his room. She was explained her father was hallucinating and needed my help. I approached his bedside, and took his giant hand in mine and asked, “You ok?” Without missing a beat he smiled broadly and said, “Great! How are you doing Susie?” Smiling in relief I say, “Great!” He told me where he was, the date and who the president was. I then asked him to tell me who was in the room with him.
Mr.: “My oldest son, (as he points towards the window), my last born, (pointing to his son at the end of the bed and my baby girl” (gazing at his daughter).
Mr.: (deliberate long pause, glaring at his daughter’s husband) “And the asshole she married” (pointing at his son-in-law, standing just behind his daughter).
Me: (Nodding and trying not to bust a gut laughing), “Great Mr. Macaroni. Do you see anyone else in your room?”
Mr.: (Hesitates) “No…., well.. Except the angels.”
Me: “You see angels?”
Mr: “Yes, 3 of them”
Me: “Are you afraid of these angels?”
Mr: (rather annoyed) “No! Of course not. They are here to let me know that it’s going to be ok. They will be with me the whole way and there is nothing to be afraid of.”
Me: “Can you show me where the angels are in the room?”
Mr: (He points toward the window) “There’s one, (points toward the bathroom) There’s one, (looking towards his daughter) and that one has her hand on my daughter’s shoulder”.
Mr: “The angel, with her hand on my daughter, is going to stay with her when the others go with me because she’s going to have the hardest time with this.”
Me: “How come I can’t see the angels, Mr. Macaroni?”
Mr: “Oh, Susie. They are not here for you. They are here for me. When it’s your time, you will see the angels. But right now, it’s my time.”
As his words hung in the air, his daughter started tugging on my sleeve, asking what I was going to ‘give’ him to ease his suffering. I explained that there was nothing to medicate for, I felt we were witnessing a blessing.
Daughter: “You and I both know there are no angels, this is classic hallucination, and any nurse knows that.”
I AM
I am a hospice nurse for an inpatient acute care unit and I was born to do this job. I will greet you with a warm smile, soft touch and a kind ear. I will take care of your loved one as if they were my very own family. I will ask you if you are eating and sleeping because I am caring as much for you as I am caring for your loved one. I will hum, make up songs and sing off key while I am tending to the one you love. I will put you at ease by walking you through the difficult steps of the journey you are on. I will somehow find a way to make you laugh at a time when you thought there could be no laughter. I will tell you funny little stories that take you away from this heart wrenching time, if only for a few moments. I will look you in the eyes, and you will see, that everything I say is coming directly from my heart. I will hold your hand, wrap you in a warm blanket and kiss your loved ones on their forehead. I will do all of this with ease and grace because it makes me feel like I am making a difference. I am easing suffering. I am touching the hand of mortality every day. What an amazing gift it is to know that I have found what I was born to do. My heart overflows everyday with the love and kindness that I receive in return from you and your families.
But mostly what I do better than anyone else is fight for you and your loved one. I will do whatever it takes to make sure that the one you love is comfortable in their last moments of life. I will not stop until I get the medication needed to make your family member comfortable. I have been referred to as a bull dog for my patients on more than one occasion. I wear this nickname like a badge of honor. I am kind and sweet with a whole lot of whoop ass mixed in. I look into the eyes of death every day. I know in my soul, at the end of the day, I did everything I possibly could to make a difficult journey end with grace and dignity.
Susan T. Murray
Schedule your free consultation
Please send a request to schedule your free initial consultation