A patient died last Saturday. The phone call came on Sunday afternoon, when the patient's husband called on my cell phone to let me know about the death and the details for the funeral. I knew it was something different when I saw the unfamiliar phone number on the screen, and when I heard his voice I knew it was about her. It was a good death, surrounded by family and friends, in a hospice known for exemplary care. "We knew it was coming," he said, as if that made it better. I didn't know it was coming- I had spoken to her a week and a half prior and although she didn't sound great, I didn't expect her to go so quickly. In fact, before his call I had been toying with trying to set up a visit with her for today. Since his call I've been struggling with many different conflicting thoughts.
I work with terminally ill women, so I expect them to die at some point during our relationship. In fact, often after the first or second visit I do a little anticipated grieving, because I know often more than they about how their next few months will look. I follow them for five months, and usually when I terminate my role with them as their research nurse practitioner they are right at a point where they know if they are going to die soon or not. Or, they've died or are dying. With this patient, when we terminated I knew she wasn't going to live long, but for once I had a little hope that she might just survive this disease. I hoped that she would be the one person who defies the odds. But when the odds almost guarantee you're going to die, I should know to abandon my foolish hopes. I try to hope that they will have good deaths. I try not to think too much about optimism and miracles because my experience shows me that they just don't really happen. There are small miracles, but the miracle that you see on television where the prayers and sheer grit cause the cancer to disappear- that's pure fiction.
For the first time since I got into this field I started reconsidering whether I wanted to work with cancer patients any more. The nagging feeling that everyone you know is going to die of cancer is a burden I just don't care to shoulder at times. Usually I love my work. Usually I can't wait to have a new challenge in this field. But this death really gave me pause.
This morning I was late to see another patient. Another one with bad disease, who will probably die in the next year. She just started chemo and is having a hard time with insomnia. I was rushing down the road, listening to a cd a friend just sent me. Actually, she's just an acquaintance, but I sent her a CD and she sent me a CD and through her choices of songs I felt totally connected to her. There was a series of songs that played that just tapped my sadness until I was crying. Crying, flashing images of the patient who just died, the other patients I've lost, my uncle, my grandfather, my grandmother, my friends who've died running through my head like a tragic and blurry home movie. I imagine I shouldn't have been careening down the interstate in this condition, but whatever.
But then I thought of the people I was about to visit. And I thought some more about the patient I'm grieving. And I realized that there was a lesson there, a lesson I have needed to learn repeatedly.
Apaches believe that heaven is a place just like this. This is our heaven, this our afterlife. I am healthy, I have a gorgeous family, I have security and safety and love and kindness. I have exhilarating bike rides and hugs and intimacy and love. This is heaven. For these women I see and talk with, their days of unencumbered joy are over. These women never knew that that particular milkshake would be the last one they would ever enjoy. Or that would be the last time they would ever have sex with their husband, or pet their cat, or go for a long and lazy drive on a hot day with the windows cracked and the air conditioner on. They weren't warned that every day until the day they died they would have to juggle nausea and pain and thirst and depression and fatigue. It just happened. My lesson is to enjoy today. My lesson is that I have been blessed to know that these days are limited and there will be a day when I won't have the simple joys I am surrounded by now. So I better make the best of it.
So what if my son doesn't sleep or my husband is cranky or my apartment is filled to the brim with crap. I am surrounded by love, I am healthy. Now I'm going to go for a bike ride. I might cry a little, so if you see someone cruising down the road with tears streaming down her face riding on a green bianchi volpe, slow down, give a wave, and give her plenty of room on the road. Because I probably can't see that well through the joyful tears.