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A Caring Stranger

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Reflections from a hospice nurse

His eyes and skin were bright yellow. Shocking to see. In his final hours, “Michael” was severely jaundiced, semi-conscious, twitching and jerking spasmodically, eyes rolling. Only in his mid-40s, my age exactly, Michael died of liver and renal failure due to alcoholism. Knowing only these tragic facts about him, I held his hand as he took his final breaths.

I’m a certified nursing assistant at Zen Hospice Project’s Guest House in San Francisco. I have the honor of giving direct care to people from all walks of life in their final weeks and days of living. Sometimes I get to know the residents at the Guest House very well, spending many weeks with them and sharing in the various stages of their final journey. And sometimes people are here for such a brief time or remain remote and hidden in their private processes at the end of life, that I am a caring stranger, only knowing them as suffering human beings worthy of compassion.

Michael was with us for less than a week. Deeply withdrawn, he mostly just lay in bed watching TV alone. He had been up and walking around a little the days before his death, and he had been clear in not wanting interaction with anyone, politely declining all offers of company from nursing staff and volunteers. I checked in with him periodically but didn’t push him. Everyone has different needs at the end of life; some people want lots of connection, and some want to be left alone. We honor what each person desires; this is their life, their death.

Michael’s partner of many years, “Erin,” valiantly sat at Michael’s bedside for much of his last days alive. She was his only visitor. Bravely allowing herself to grieve, she always had tears in her eyes as she sat holding his hand, talking to him, playing show tunes and dance music for him. Sometimes she just sat in silence with him in the recliner by his bed, pain and anguish dripping from her face. I’d had only a few passing words with her, letting her have space and privacy with Michael but making sure she knew we were here for her, too. I brought her sandwiches and tea.

On what was to be his last day, Erin invited me into Michael’s room, and we sat together, each holding one of his hands as he lay twitching, his belly and legs swollen with unprocessed fluid. He was a terrible sight to see. I felt my heart quiver in distress at his suffering, and I quieted my breathing and my body in order to be steadfastly loving in the face of his pain. He looked so familiar to me as a person my own age, someone who could have easily been my friend, and yet the extreme yellow color of his skin made him look alien. Feeling his humanity still there, I held his hand and spoke kind words to him; he squeezed my hand back in recognition.

Erin told me stories of the good times they’d shared and acknowledged that they’d had some really hard times too. Although I was virtually a stranger, I felt the human connection among the three of us, the gravity of the situation creating a sudden and precious intimacy. His eyes met mine briefly as they rolled in his head – he was there. I also had the distinct sensation that he was listening to us although he could no longer respond.

After a while, as Erin and I talked, I noticed that Michael’s body had grown still; the twitching had stopped. I noted this, yet didn’t call Erin’s attention to it as she continued to share stories with me about their relationship, sometimes laughing, sometimes crying. Soon after this stillness started, he began what is called “guppy breathing,” a silent, very shallow gulping breath that usually indicates that death is minutes away.

“Erin,” I said quietly, “I think he’s going. Now’s the time to say what you need to say that you haven’t yet.” Her face crumpled with the impact, and she immediately took action, “I need to call his mother.” She quickly called Michael’s mother who luckily answered right away. “Say it now,” Erin told her urgently. Putting the cellphone on speaker, Erin held the phone toward Michael, and I heard his mother’s disembodied voice from across the country say, “Michael, it’s Mom. Honey, I love you, and it’s time to let go.” Erin hung up, bent over onto Michael’s bed, and sobbed.

He breathed his final breath as his mother said, “I love you,” and black-streaked fluid bubbled from his mouth. I felt his last few faint heartbeats as I held his hand, feeling my own heart beat faster with the sorrow of the moment, feeling Erin’s grief at the loss of her partner, feeling his unseen mother’s grief at the death of her son, and feeling the sorrow of what must have been a very painful life for Michael to have drunk himself to death at the age of 46.

In the minutes after his last breath, Erin continued to cry and speak to Michael, saying very intimate things to him about their relationship. I sat quiet, still and respectful with them in that intense intimacy, a caring stranger welcomed into this moment of private love and grief. I felt my own experiences of love and loss well up in me as I listened to Erin, tears in my own eyes as I witnessed the end of a complex and painful love story.

At some point, I quietly asked Erin if she would like some time alone with Michael’s body. She said no and decisively stood up. “I’ve got my image to hold forever; I said what I needed to say. I need to go now, I’m done here.” I reassured her there was no need to hurry, yet she was clear that she was ready to go. I inquired about support at home for her, and she said she’d already arranged to take a month off from work to be with her grief, and she had friends and family waiting to care for her. She was in pain, but I could feel her strength through her direct expression of that pain; she wasn’t pushing her pain away. With this observation and hearing of her support plan already in place, my sense was that she was OK. We hugged for a long time; I praised her strength and skill and thanked her for letting me be with her and Michael at the end. Even though we’d only known each other so very briefly, we felt like sisters after sharing those incredibly intimate moments of Michael’s death together.

No one else came for Michael. The lovely bathing and flower petal rituals we offer at the Guest House were not wanted by the family, who remained back east; no other visitors came to say goodbye. On my own, I prepared Michael’s body, cleaned up the fluid that had spilled out of him, and took some moments to just sit quietly with him before the mortuary came to take his body away. I wondered what his life had been like to end here, like this, at age 46. I spoke words of compassion to him as I brushed his hair. And I said the phrases of loving-kindness to wish that Michael, his family, and devoted partner Erin be free from suffering. Wishing that we may all be free from suffering. And I walked out of the room, a caring stranger filled with gratitude for the lives and deaths I am privileged to share.


Learn more about how Zen Hospice Project is helping to change the experience of dying.

Read more from This is Terminal:

A Beautiful Thing

Born to be Wild at the End of Life

Dying Surrounded by Laughter and Song