This Amazing Heart: Reflections From A Hospice Nurse

It’s almost three o’clock in the morning. I am doing an infrequent night shift at a hospice residence in St. Paul. My nursing career has taken me down amazing paths in my thirty-four years as registered nurse: children’s rehab, pediatric neurology, newborn ICU, orthopedics, medical-surgical, elderly home care. These experiences, as well as my roles as a wife, mother of five, and grandmother, I bring to this chair in the wee hours as I sit with beautiful Sara, not much older than I- also a wife, mother, and grandmother, who is dying of a rare brain disorder.

For the past six years I have been blessed to be a hospice nurse. I feel Sara’s pulse. In her chart I note, “Pulse thready, respirations shallow.” These clinical terms mark the approaching end of her final journey. It’s an end- ing I’ve witnessed with other hospice patients over a hundred times just this past year.

The awesome human heart! Feel- ing Sara’s radial pulse, I remember my student nursing years and how I struggled with the anatomy and physi- ology of the heart: the EKG’s, the four chambers, the intricate musculature, contracting, filling, perfusing. I learned it then, but the years since then have taught my own heart so much more, lessons that go beyond book learning: heartfelt, heartless, heartache, dis- heartened, broken-hearted.

It’s these words that truly give “life” to the way a person feels. It’s these qualities that speak more loudly of the hundreds of hearts that have ceased their beating, here in this building, over the past six years.

People often ask me how I can do this kind of work. “Isn’t it terribly depressing?” Sometimes it is, but tonight, and most often, it’s an awe- filled, rewarding type of nursing. For the patient, the struggle, the pain, the heroics, the side-effects of aggressive treatment are over. And the living that’s left is real, stripped of all but the reality of relationships, family, friends; a touch, a laugh, a tear.

Sara lies here quietly now and I reflect on the amazing mark she leaves on those she’s touched. Her beautiful daughters look a lot like her. Their hearts will go on, with sadness, but also with happy memories of an incredible mother. And so it will be, as well, with her loyal friends who sat with her in a chair that hasn’t been va- cant much. Now I, too, am privileged to sit and be here with her. Her body is ravaged by this disease but she is still amazingly beautiful.

This year, death profoundly touched my own family. My fifteen-year-old niece, Shayla became ill on a Sat- urday in February with strep throat. The following Tuesday, she died of meningitis. We never knew if she heard our goodbyes because she had massive brain swelling and was on a respirator. She had wanted to bake cookies with my sister (her grandma) on that Thursday before. Now, Renee was sad that she hadn’t spent that time with her: “…maybe I would have seen something wrong.” Then, just three months later, Carrie, my other sister’s thirty-nine-year-old daughter (Shayla’s godmother) was found dead by her seventeen-year-old son. It’s a Sunday morning that will be forever marked in her three sons’ lives. Carrie lived for these guys. She was a single, devoted mother and her parents, fam- ily and friends were left with a hole that will never be filled. A heartbeat, then no pulse, no respiration where once a loving heart had been.

It occurred to us last weekend that we sisters hadn’t had any quiet time to just “be” since these tragic and un- timely deaths. How DO you get your heart around the death of a child? So we drove to Chicago and we laughed, and we played, and we cried. We are all busy caregivers and working moms. But it was so important to take the time to tell one another stories, to re-remember, to gather our broken heart pieces. We felt that we’d done at least a little of that together.

Losses are a part of life. Grieving is ongoing and this was our start. We realized that we, like most in our cul- ture, had initially tried to move on as if nothing had happened. Shayla’s mom was considering releasing 16 balloons on her daughter’s sixteenth birthday. Would that somehow lessen her grief or just make it feel worse? The rituals seemed a vital part of the journey. No more “Hi Mom!” when Shayla came home from school. All those things that you take for granted, even com- plain about. Does it all come down to a visit at a grave site or staring at an urn of ashes. How do we reconcile losses?

So here I sit with beautiful Sara. No matter how many times I witness the dance, this journey called dying is still an amazing miracle to me. We hospice nurses have all witnessed people who have “seen” someone at the bedside, (unseen to us!), who gives the dying the courage to cross over; offers them the peace of heart to know they’ll be okay and always, gives them the as- surance that they will be remembered. And that, yes, the heart, indeed, does go on.

Soon, someone will write in Sara’s chart, “No pulse…no respirations.” But we who knew Sara know so much more about her amazing heart—danc- ing, singing, holding, living. Thank you Sara, and thanks to all who have graced this life and this residence with their own unforgettable, courageous hearts.

by Joann Mason

Editor’s Note: JoAnn is a hospice nurse who works in a private hospice residence in St. Paul, MN.

This article reprinted, with permission, from the December, 2006 issue of Coalition News,, Minnesota Coalition for Death Education and Support a publication of the Minnesota Coalition for Death Education and Support.