Velvet's Touch

Velvet, The Hospice Nurse – Monday: Pre-Admission

She hoped today there would be no deaths.

No desperate families.

No inconsolable emotions too heavy to bear.

No last breaths.

Please, she thought to herself, not today.

Velvet straightened her ever-present blue uniform. Her hair was pulled back to keep it from falling in her face. It wouldn’t do to have it fall in her face. She took a step closer to the mirror to fix her makeup. She felt she owed it to the people she would see today to look her best. They deserved that much. They always deserved more than she felt she was capable of giving – any more anyway – but after twenty years of grateful acknowledgment of her work, she guessed she did right by them. Most of the time.

Nobody was perfect; even the best efforts can go awry.

She put on her shoes and her name badge proclaiming herself as Velvet M, Hospice RN. It was 1990 when she graduated, so full of hope and the desire to save the world. Her first job after graduating was as a hospice nurse. She knew nothing else. It was during one of her rotations in college that she first became of aware of hospice and what it meant. Dying with dignity.

What a concept that was in 1990! Back then she fought prejudice and stereotypes while providing care. So few people were truly educated on what hospice meant. Today at least, the public was savvier, most doctors understood the benefits and providing dignity no longer meant drugging and dying. Today she provided patient-directed dignity. She soothed, listened, educated, medicated and everything in between. She held her patient’s – and their family’s hands – and proffered twenty years of focused knowledge. She was one of the oldies. One of the nurses whose life calling was to help, to be there, to touch, calm and educate, and yes, to allow her patients to die.

Hospice.

She had lived and breathed it for over twenty years and now she felt like it was swallowing her up.

She knew that everybody who saw her only saw the uniform. She was no longer just Velvet. After so many years of service she had somehow transformed into Velvet, The Hospice Nurse.

She picked up her purse, grabbed her considerable key ring from the belly of the bag and headed toward her day. Her one-of-a-thousand days. At least she didn’t have any fragile patients right now. No one was imminently dying. She expected no one to die anyway. Sometimes hospice fooled you; death was right around the corner for every one of her patients and it didn’t necessarily follow a set pattern. Yesterday’s patient who was sitting up in the bed, talking to her, laughing through their dementia about a past love or crying through their cancer about wasted years, could suddenly, without warning, die today. Her days never changed. They flowed one into the other as they took a customary redirection and she would reschedule, rearrange and accept the need to readjust as she did every other day. Hospice never changed by never being the same, and somehow, she had lost Velvet in twenty years of helping others die with dignity.

She opened the door and her heart shuddered as she became painfully aware of how cold it was. The frost filled her lungs and strangled her ability to take a deep breath. It would be like this all day long. She had six visits scheduled, all of them home patients. The houses would be exceedingly warm, families of the dying tended to keep their houses too hot. They seemed afraid that the worst of winter might prematurely snatch their loved ones from their lives. If they didn’t keep their house heated to a toasty seventy eight degrees, a terrible cold might wrest the lives of their loved ones from them before they were ready to say goodbye. There was always a quiet, almost resigned desperation to the acceptance of dying and it seemed to manifest itself in odd ways, like controlling the temperature of a room. Velvet knew the reasoning behind it, but it made stepping out into the expected high of six degrees a shock every time. After an hour or more in a patient’s home she would have to wipe sweat from her brow and reaffirm to the family or the patient that, No, really, I’m fine. Not too hot. Don’t worry about me.

She knew she was a little over-weight, but even when she was skinny she easily broke into a sweat – glow, as her grandmother used to say – but now, twenty years older and forty pounds heavier than her skinny days, she carried a wipe with her and smiled to her patients as she dabbed at her forehead. At six degrees for a high, if she didn’t wipe away the perspiration, it would crystallize on her brow and not only would she be unable to breath, a deep chill would settle in that would take the better part of night under a thermal blanket to conquer.

God, she hated winter. Everything about it. Especially the fact that it took more than ten minutes of shivering in her frigid car before it warmed up enough to ease out of the driveway. It hadn’t snowed in several days but the warm spell of thirty-three degrees a couple of days ago had melted the considerable snow on the ground to a nice glassy ice rink on her driveway today. Winter! Each year it seemed to hang on a little longer, get a little colder, snow a little more.

Global warming, she said aloud. What a joke.

The day passed in what she considered a cruel joke of over-heating and over-freezing. February, it truly sucked. Finally, at four thirty five p. m. she had only one more visit before ending her day. Too bad it was an admission; they usually took two hours or more if not rushed.

Velvet pulled up to a stop sign and punched her last patient’s address into her GPS. The calculated time of arrival was about twenty minutes. She studied the paperwork she’d been given that morning. Allergies, history and physical, current med list, his date of birth. He was about ten years older than she was which made him fifty-seven, young by hospice standards, and dying of AIDS, or for hospice purposes, complications due to AIDS. The referral to admit came in yesterday and nobody wanted to be his nurse. They all knew the stereotypes, they’d been educated against the prejudice of AIDS for years, but it still didn’t matter. Arming yourself with all the knowledge in the world still couldn’t fight the fear of exposing the people in your own life to whatever might be clinging to you as your shift ended, real or imaginary. Nurses were human too, and possessed all the same frailties everyone else did. Personally, she didn’t care. AIDS was a disease. People died of AIDS, unfortunate, but true, and AIDS patients had the right to die with dignity just like everyone else. Nobody chose AIDS, it chose you, and regardless of all the stereotypes, at the end of the day, or in the case of this patient, at the end of his life, he had the right to her help. Besides, this wasn’t her first AIDS patient, and unfortunately, he most likely wouldn’t be her last. True, it wasn’t the killer it once was, but the complications from AIDS could be just as devastating as the diagnosis was in the eighties.

Her brother had died of AIDS when she was just sixteen. She remembered it well. He matched all the stereotypes of the then disease. He was gay, was an IV drug user, and he lived on the streets. He had never been able to reconcile himself to the fact that his parents, her parents, had kicked him out because of his lifestyle. No, not the drugs, but the choice to be gay. She wasn’t proud of her unenlightened parents, it was just a fact. Part of their upbringing. Part of her religious upbringing. An upbringing she had gladly shed many years ago.

Velvet again focused on the paperwork. This patient was the same age as her brother, they were born months apart, but in the same year. She had a pang of sadness with the realization that her brother would have been fifty-seven years old. She always felt this way when she thought of Mike. It was once labeled survivor’s guilt. At least that’s what the psychiatrist to problem teens had called it one year after her brother’s death. Her silent year as she referred to it. From the moment she found out about Mike’s death, two months after it happened when she accidentally overheard her parents talking one night, she stopped talking.

Literally. At least to them.

They finally took her to a psychiatrist. He talked to her, she kept quiet. He stared at her, she kept quiet. He cajoled and acted like a best friend; she rolled her eyes but still kept quiet – until she couldn’t take it anymore, that is. To get her parents off her back and to stop those ridiculous sessions, one year after Mike’s death she had finally started talking again. Her first words, FUCK YOU! had helped the psychiatrist who specialized in children make his very wrong diagnosis of survivor’s guilt. Where did that come from?

But once diagnosed and talking again, their lives finally moved on.

The truth was she was just pissed. Pissed as hell. At her parents for kicking Mike out, for letting him die alone and for not telling her about it for two months.

Pissed. That was it.

The pain she felt now as she thought about him was in that she had let her vigil go to make life easier on herself.

That year of silence was great, though, while it lasted. After about a month her parents just became worried and in the guise of wallowing in her own grief she got away with a lot of shit. She was pissed, but she did use it to her advantage.

She sighed. Oh well, by the time she started talking again, she was just seventeen. It’s expected to do selfish and stupid things at that age.

No, it wasn’t AIDS that bothered her. Her only consternation at all about taking on this AIDS patient was in where he lived. There were few places in her home town of Phillipsburg that she could say were difficult for her to find. Hospice took you everywhere. The territory was as wide and vast as was the need for end-of-life care.

She was used to the south side of town, and the north. She could find her way around the east, but the west had always been Susie’s territory. Although Susie was the only other nurse in her agency that would have been fine with an AIDS patient, she was out on maternity leave and no one else wanted to take the risk, let alone deal emotionally with the prospects of how he may have contracted the disease. Sometimes, like her parents, the whole of Phillipsburg was very archaic in its thinking.

She drove up and down several blocks as