Over the last three days I’ve spent a fair amount of time at the bedside of an 83-year old women who is slowly dying. But until she’s dead, she’s alive. Such a simplistic thing to say, yet it catches the essence of hospice end-of-life care. Lying there, seemingly unresponsive in a sleep-like state, she continues to live and can count on our care. What’s so remarkable about sitting with her is the level of intimacy. If I wasn’t so clear of my intentions, I could easily feels that I’m invading her privacy. After all, she has no say in my presence, cannot give or withhold permission as I stroke her hand, place a cooling cloth on her burning face, adjust her blankets, and lower the shades to keep the spring sun from heating up her room.
Legally, I suppose, she gave “implied consent” when she came to us, permission to do what would be needed to manage her pain and support her journey towards death. Still, I treat each moment of closeness with references and respect. I speak to her, whether she can hear me, respond, or not. They say that the sense of hearing is the last to fail us as we near death. So I say “good morning” as I enter her room, and “may I open the window a bit so you can feel the air and hear the Spring birds?”
I take nothing for granted. To respect her privacy, I don’t reach across her body but walk around it. When I place something on her bed or move a chair closer, I say so first. When the flowers on the night table look droopy, I say that they need their ends cut and the fresh water refreshed before I go ahead. Her bed is her last refuge, the relatively tiny rectangle where she’ll spend her last days, where it takes two nurses to turn her every four hours to avoid bedsores; where medicine is injected through “sites” temporarily attached to her parchment skin, each plastic adhesive with dates and times written on them in felt pen; where meal trays have stopped coming; where her adult children gather each day (leaving aside their disagreements), and where three teenage grandchildren came last night to say good-bye and thank-you to their gran … where her bed has become Holy Ground.