My hair was still wet from the shower as I stood in front of the television absentmindedly watching the news with my best nurse ever mug in hand. I was sipping my coffee when I felt a tug on my scrubs. Looking down, I saw Brody’s big blue eyes peering up at me.
“Juice, please?” he said, shaking his empty sippy cup in his still-chubby three-year-old hands. I smiled and picked him up, placing him on my hip as I walked over to the kitchen. After giving him his juice, I tapped my phone to check the time. I needed to leave by 7:20 a.m. to make it to the office by 8:00. It was 6:40 now, which meant I had just enough time to finish getting both of us ready and fed.
My phone rang as I opened the refrigerator to grab some eggs. I looked down to see my manager Kristin’s name flash across the screen. She never called this early. I wondered what was wrong.
“Hello,” I answered nervously.
“Hey, you!” she greeted me, sounding like she’d had way more coffee than me. “I need you to come with me to a patient’s home. Check your email for the address. I’m about ten minutes away.”
I quickly looked up the address, panicking when I realized that it was in a very nice part of town, just minutes from the beautiful white sandy beaches that Destin, Florida, is known for. Although I’d spent the latter part of my childhood in Destin, I now lived in the next town over, aptly named Niceville, in a little blue house that I had bought for Brody and me earlier that year. As a young single mom, I couldn’t afford anything bigger or closer to the beach, but I was so proud of this home that I’d managed to buy for us a few months into my first nursing job.
“I’m at least thirty minutes away and need to drop off my son at daycare. Is that okay?” I asked cautiously, worried the delay would annoy her.
“No problem!” Kristin replied cheerfully before hanging up the phone.
Anxiety set in as I realized I needed to move quickly. I put the eggs back in the fridge, deciding to forgo breakfast altogether, twisted my wet hair into a low bun, and threw on my scrub top. After making sure Brody was dressed in the appropriate number of layers (because, yes, northern Florida does have a winter!), I stepped out into the crisp, cold air and headed to his daycare.
Brody’s teacher barely looked up from her phone as I dropped him off at his classroom. “So sorry to bother you,” I said, approaching her timidly, “but I didn’t have a chance to feed Brody this morning. Can you make sure he gets breakfast?”
Without saying a word in response, the teacher rolled her eyes and let the kitchen know there would be one more kid than usual eating breakfast. I felt the familiar no-win pull between work life and mom life tug at my heart. One of the practical elements that appealed to me about hospice nursing is that it was generally an eight-to-five job, which meant predictability for my schedule with Brody, but not every day was like that, and apparently today was one of those days. It wasn’t even 7:00 a.m. yet, and I already felt like a failure in the mom category, but I couldn’t afford to lose my job. I was a few weeks into my new position as a hospice nurse, and in the process of training, which meant that I spent my days shadowing more senior nurses like Kristin as they visited patients. Keeping my manager happy had to come first.
I drove to the patient’s home, passing many beautiful beach houses just like the one I had grown up in. I turned left onto Coral Cove, and saw Kristin’s Hyundai sedan in the driveway of a beach bungalow with green shutters, surrounded by a few palm trees artfully placed around the front yard. The home wasn’t imposing in the way I had feared. On the porch, two rocking chairs swayed back and forth in the breeze, and the lights that glowed from inside the house were warm and inviting. I took a deep breath.
Kristin met me in front of the house, her impeccably curled blond hair framing her face, which was beautifully made-up even at this hour. “Ready, Freddy?” she asked, flashing her perfect smile. I smiled slightly in return and nodded, feeling insecure in my wet bun and bare face.
The truth was, I didn’t feel ready. As a hospice nurse, of course I knew that attending a patient’s death was inevitable, but I hadn’t had to face it yet. I had a sense this patient was going to be different.
As we walked up the concrete steps, a frazzled red-haired woman in her forties opened the door before we could even knock. She looked like she had just rolled out of bed, yet hadn’t slept for a moment.
“Come in, come in,” she said, waving us inside. I could smell coffee brewing in the kitchen as a barking teacup poodle ran up to us, pausing to sniff my brand-new sneakers, a gift from my mom to celebrate my new job.
“So, she’s been talking to deceased loved ones?” Kristin asked the patient’s daughter, Maria, who was now trying to herd the dog into a laundry room off the kitchen. Hearing this, I raised my eyebrows, my suspicions confirmed. This was not another “normal” visit, after all. Despite what movies and television might lead you to believe, most of a hospice nurse’s day is spent driving from one patient’s home to the next, where we spend thirty minutes to an hour checking in on the patient and helping their caregiver or family member with whatever they might need to keep the patient comfortable. Maria did need help, it seemed, but not in the usual ways of checking to ensure her mom had the proper medications, that her symptoms were under control, or routine wound care.
“If you want to call it that,” Maria replied as she grabbed a coffee mug from the kitchen cabinet. “I call it being out of her damn mind. She’s mostly talking to her sister, who passed before I was even born. Please make this craziness stop. I can’t sleep.” Maria took a long gulp of coffee, as if to emphasize the point. As she drank, I took a deep whiff, allowing the strong smell to help ground me as my mind buzzed with confusion. “All she does is talk to herself nonstop. Y’all must have some medications to make her sleep. If not, I’m going to call 911.”
“Okay, Hadley and I will go take a look at her,” Kristin told Maria reassuringly.
As we walked down the hall, I began hearing the faint voice of a woman. We entered the bedroom and I took in the sliding glass doors that led out to a patio, a heavy wooden dresser and matching nightstands, and a smaller table next to the dresser, piled high with books. A large chandelier hung over it, beautiful and ornate. As my eyes scanned the room, they finally came to rest on Ms. Glenda, whose white curls were cut short to frame her face. She roared with laughter even though there was no other sound—or person—in the room.
I watched Ms. Glenda incredulously as she continued pointing and laughing at the air in front of her, seemingly unaware that Kristin and I were there.
“No, no, no!” she exclaimed. “I didn’t say that. You are too much!” Her laughter echoed throughout the room.
Kristin walked up to her bedside and lightly touched her arm. “Hey, Ms. Glenda! It’s Kristin and one of our newer nurses, Hadley.” I stepped up to her bedside and waved awkwardly.
“Well, hey!” Ms. Glenda greeted us. “You’ll have to excuse me, we haven’t spoken in years.”
“Who haven’t you spoken to?” Kristin asked.
“Oh! I couldn’t be any ruder, could I?” Ms. Glenda said with a heavy Southern drawl. “This is my sister. Do you need to take my blood pressure now, sweet pea?”
Kristin nodded and pulled out the blood pressure cuff from her nursing bag. I stood nearby, looking on in confusion, stunned that she was so unbothered by the fact that we had just been “introduced” to an invisible, deceased sister. Before coming on as a hospice nurse, I had worked in a hospital, where Ms. Glenda would have been medicated with antipsychotics before she could even finish her sentence.
After Kristin finished taking Ms. Glenda’s vital signs and declared her numbers to be perfect, she went to grab Maria. For a moment, it was just me and Ms. Glenda. I wasn’t sure what to do or say, so I met her eyes, half smiled, and awkwardly played with the zipper on my own nursing bag. Thankfully, Kristin was only gone for a moment, and once she returned to the room with Maria, she started laying out the “game plan.”
“I know you’re tired and concerned about your mom,” she said to Maria. Then, turning to Ms. Glenda, she said, “And, Ms. Glenda, I know you have people you need to catch up with, so what we’re going to do—as long as you two are okay with it—is initiate something called continuous care.”
It’s only at the point when the family caregiver can’t handle a situation anymore that we initiate continuous care, where a nurse remains at the home round-the-clock either until the patient’s symptoms are more manageable or the nurse is otherwise no longer needed. I hadn’t been in a continuous care situation yet, and I was eager to see it performed and to learn all about the antipsychotic medications hospice used.