I was in the office today – doing an Advanced Pain Management training class for a few of the new nurses. We were taking a break when Nancy, our Administrator, came in and said,

Lisa, George is here and he wants to see you.”

George of George & Ann. Some patients just get underneath your skin, crawl in there and burrow themselves in and make themselves a home in your heart.

I started seeing Ann this past June when I was still in the role of RN Case Manager. She had been diagnosed with Lung Cancer two months prior. They were doing radiation treatments and things were going well, until an MRI showed it had metastasized to the bone, and the tumor in her lung was not responding to the radiation treatments the way they hoped it would. Her Oncologist referred her to Hospice.

Enter me.

I came in that day and Ann opened the door and let me into a home that I would later find out was one of the warmest, inviting, caring and giving homes on the face of this earth – – full of warm, real, down to earth people who were some of the nicest human beings to grace this world. She opened her door – and her heart, and in I walked, not knowing that the walls that I’ve built in order to deal with other people’s grief and sorrow just would not be effective in this particular case.

She was independent at that time. Still driving and fiercely protective over living every single ounce of every single minute that she had left. She had a very realistic attitude toward her own impending death. She called the shots from the word “go” – and she let it be known to me that she was in full and total control over how she would live the rest of her live, and how she would leave it. I need not do anything more than follow her direction.

She was true to her word. She allowed me to visit her only once a week and declined any and all other services offered by our Hospice organization. She drove to have lunch with her friends every day. Her and George had “Movie Dates” every Monday and Thursday. They had “Dinner Dates” every Wednesday and Saturday. I could only visit her on Wednesdays after 3pm, but before 5pm. 3pm is when her soaps ended – – and 5pm is when her and George would dress up and go out to dinner.

And oh how he loved her! He devoted every ounce of energy, every single second of his life to make sure that her remaining days were full of love, joy, comfort and the full and complete knowledge that she was the absolute love and focus of his life. It was so incredibly heartbreaking to see this man work so hard to let his wife know how very very much he adores her.

Ann eventually declined, as I knew she would – – and I did everything I could to prepare George and Ann for this time. She remained very stoic and realistic about it all – – up until the first signs of decline started to appear. When the pain became a daily and unbearable issue for her. When she finally relented and decided to let me have a bit of control of situation and get her the medication she needed to control the pain.

She fought that pain like the strongest soldier going up against the mightiest force. She was determined not to allow it to ‘do her in’ – – and for a long, long time, she would not “give in” and start taking narcotics that threatened to steal away her cognition.

Sometime around the middle of September is when we started the continuous infusion of Morphine. It was killing George to watch her struggle so. That’s what sealed the deal for her on the morphine issue. I sat down with her and had a heart to heart over the struggles and strain I was seeing in George on a daily basis as he sat by, helpless in her struggles. She cried and vented for a very long time that day – – her biggest concern was him. His biggest concern was her.

It was a humbling and awesome experience to be in the presence of such love, devotion and strength.

She continued her gradual decline over the months that followed. Around Thanksgiving – it didn’t seem that she was going to be with us for much longer. I arranged for one of our volunteers to sit with Ann for an hour – and I took George out for coffee at the local Starbucks. We talked about how he and Ann wanted this to be handled. I shared with him the signs that I was seeing in Ann that told me that the most important thing he could do for her right now was to let her know that it was ok for her to go – – that he loved her and would be alright without her.

She was barely responsive that day, when George had his discussion with her and said his heart wrenching goodbyes.

Clinically, she showed all the signs of impending death. The decline in her respiratory status, circulatory status and mental responsiveness. Over the next few days her skin grew different shades of Grey and took on a very cool, moist, waxy appearance.

George called in all her family from out of state. They surrounded her with all the love and warmth they could muster. And do you know what happened? That stubborn woman in absolute control of everything started to wake up. Her signs started to disappear – – and gradually over the course of a week, she was sitting up in bed having conversations with all of her family members who had come in to be with her in her last hours.

I guess she decided that now all of her family were in the same place, at the same time – – well, she didn’t really want to miss a thing.

She ended up rebounding so much so that she was actually getting out of bed and sitting up in the living room, in her favorite chair, for about an hour a day. She spent Christmas with them and was happier than I’d ever seen anyone.

I brought them a bottle of Glenlivet (scotch) for Christmas – because it was Ann’s favorite. She’ liked a little scotch with her Morphine, ya know.

I shared much with George and Ann over the months of my involvement with them. I have to say, that as a professional, those professional/personal boundaries were crossed in a way that I had never crossed them before. I even acknowledged to myself at the time that I knew I had crossed that boundary with these two. It was difficult not to – – no, not difficult – it was impossible not too. To not give into their warm, caring and giving nature would be a disservice to them….it was so important to the both of them that everyone around them knew how much they cared about everyone.

George absolutely broke my heart when he came into the office today. I walked out to see a tall, very pale man in his winter coat and hat looking at me with the deepest look of sadness in his eyes. When he saw me – – he just cried. I walked over and embraced him in a warm hug and cried to. I didn’t have to ask him if he was ok – – because I know he wasn’t ok, but I knew that he would be. Ann was his life – – and in her death, he knows that she wants him to be well, healthy and live strong, just as he had when she was with him.

He told me that the services are on Saturday at 3pm. – – he’d like me to be there and wants me to bring my “British boyfriend” too, because he wants to shake hands with the man who “brings love into the life of one of the most special people he knows”.

I cried more.

I left George after more shared memories and plans for the future. We hugged once again and he sighed and said he had to go to the funeral home for preparations. I walked down the hall and ducked into the first office I could in order to compose myself. It was Nancy’s office – – my Administrator. We talked a little about George and Ann and then Nancy looked at me and said, “See? I knew you weren’t the prickly fish you like to pretend to be. There’s a big heart in there that you just don’t show to the world.”

I’m not a crier, really. That’s not my style. I’m stoic and I absolutely do not wear my heart on my sleeve under any circumstances, except this one. As I said, sometimes there are patients and their family who just get under your skin and burrow deep.

I’m bringing white roses to her funeral on Saturday – they were Ann’s favorite.

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