Working in hospice, part two. The sappier stuff.

Hello again.  Last week I wrote about some of the day to day joys that come with working in hospice–at least for my tea-drinking, friendly, introverted self.  Hospice was such a breath of fresh air after working in research, where I sat in a room by myself and stared at a screen all day, talking to no one.  I think I work a lot harder now, but I enjoy it a lot more.  Next week I’ll write some about the challenges that come with my job, big and small.  But last week I said I would write about what it’s like to work with people who are dying.  And so, as promised, here’s my take on it:

When people ask me what I do, I get one of two basic reactions.  One is filled with respect and awe.  “Oh, wow, that’s wonderful,” I hear occasionally.  “My grandfather (parent, sibling, etc.) was in hospice, and it was such a good experience.  It really takes a special person to do that.”  I have to say, I never received such a gratifying response when I told people that I did research.

Then, there is the other reaction.  “Oh,” people sometimes say with a furrowed brow, frowning, taking a step back, their revulsion and discomfort clearly palpable.  “Why would you do that?  That sounds awful.  Isn’t it depressing?”  That is the reaction, incidentally, that I received from my parents and in-laws.  My husband likes to call me the Angel of Death.

Both of those responses point to the same thing: working in hospice is not for everybody.  Are we in hospice “special?”  Well, I suppose so, in some ways.  To make a career in hospice, you need to be comfortable with death, and also comfortable with the idea that you can’t fix everything–i.e., our patients are going to die.  And those seem to be things that not a lot of people are comfortable with.  I think it’s human nature to a) avoid death and b)want to fix things.  I can tell you that I personally a) don’t want to die any time soon, and b) try to fix things all of the time.  But when it comes to death in general, the idea that all of us are going to die at some point, and some of us sooner rather than later, doesn’t bother me.  I’ll probably spend some time in another post trying to figure out why that is.  I also, however, don’t believe that dying is easy, at least not very often.  And, perhaps more importantly, I don’t harbor the illusion that there is much of anything that I can fix around the end of life.  It’s a hard time.  It’s not always hard on the dying, but at the very least it’s usually hard on the family.  It’s hard and it’s sad and sometimes it’s even awful.  I’m not going to fix that.  It just is.  All I can ever hope to do it try to spread a little comfort around, maybe make it a little easier.  Sometimes all I can do is help people feel a little less alone.

That’s the only expectation I go in with.  And when I feel like I’ve helped someone feel a little less alone, then I feel good.  As it turns out, it’s really important to me to have a job where I feel that we do good work, that we spread a little comfort around.  And, most of the time, I feel that way about the work we do in hospice.  So that is incredibly rewarding.

One of the things to bear in mind is that we at hospice come into the picture after a person has already been given a terminal diagnosis.  We were not there when the patient was vibrant and healthy.  We were not there when they went through the often laborious and frustrating process of figuring out what is wrong with them.  We were not there when they held on to the hope that treatment after treatment would save them.  We were not there when they were given the bad news that they only have six months or less to live.  We start out expecting the patient to decline and die.  It is not a shock to us.  We are not trying to prevent it from happening, which is what everyone else had been doing prior to us arriving at their door.  So we start out at a different point, and with different expectations.  We are free from the pain and suffering that occurred previously.  And, perhaps most importantly, we never held onto the hope that the patient would survive.  We are a (relatively) clean slate when we show up, ready to walk with the patient to their death.  I could not be the hospice social worker for my parents, or my spouse, or, god forbid, my child.  I would be too emotionally invested. I would probably be a wreck.  But, I could be yours.

I think all of us in our hospice realize what an honor it is to be with people at the end of their lives.  I know that sounds sappy, but it’s true.  What a privilege it is to be able to be part of such a sacred time.   As I’ve written before, death, like birth, can be very beautiful.  You get to bear witness to the whole range of human emotions.  But underlying almost all of those emotions is love.  It’s so heartening to witness so much love.  It’s awesome, in the traditional sense of the word.  Not depressing, as many people seem to think.

I also don’t find my work to be overwhelmingly depressing because I often have a lot of fun with my patients and their families.  Not everyone who is “dying” or caring for the dying is spending every day wiping away tears, at least not all day, every day.  A lot of our patients are just kind of hanging out.  A lot of them are really fun to talk with .  I have never been much of a “laugher;” I find a lot of things funny, but I was never one to do a lot of laughing.  That is, until I started working in hospice.  Now I laugh quite often.  Not “Ha, ha, you’re dying,” (obviously).  But I often have a really good time with the people I meet.  Just because there is death lurking in the corners does not mean that there isn’t joy and good humor.  Sometimes death even spurs it on.  For example, just the other day one of my patients jokingly asked me if hospice provided bikini waxes.   Getting very serious, I explained that actually, they were mandatory.

(In case you were wondering, they’re not.)

We all laughed at that.  Even me.  Everyday life goes on for my patients and their families, even if it’s not going to go on for some of them much longer.

Perhaps, though, the biggest benefit that I derive from working with our families is a constant sense of gratitude.  I face death all of the time.  I know it’s coming for me at some point, too.  I don’t ever pretend that it’s not.  My 40-year-old, apparently healthy self could get hit by a bus while crossing the street to see my 105-year-old cancer patient.  And by spending my day going around visiting the dying, I cannot help but be grateful for my ability to get in and out of my car, drive around, drink tea, listen to murder mysteries, and then go home to my incredible family.

I know what life looks like without those gifts.

And I’m very thankful that I have them.