One Foot In Heaven by Heidi Telpner PRINT

One Foot in Heaven by Heidi Telpner
nonfiction hospice book
topics include end of life care, dying, nursing, hospice, family
50000 words
Cover Art by Winterheart Design
ISBN# 9780982678435

BLURB:
People die every day. While most people in America die in a hospital, many families choose hospice for end of life care. Death, as experienced by hospice nurses, can be beautiful, peaceful, humorous, touching, tragic, disturbing, and even otherworldly. Hospice nurses act as midwives to dying people every day. Death transforms not just the patient and family, but the hospice nurse as well. The stories in this book are presented with the hope that their transformation extends to you, too.

EXCERPT:
There’s always a beginning, whether we realize it or not. My beginning happened long before I ever interviewed for a position with hospice or ever considered the possibility of entering nursing school. Shortly after my sixteenth birthday, I was in a serious horseback riding accident. I nearly died.

Who knows? Perhaps it’s entirely possible I became interested in hospice because of my own near death experience. However, that’s not why I’m a nurse. I became a nurse because my original plan for my life didn’t pan out.

I majored in English at the University of Iowa. The plan was to publish my first novel by the age of twenty-five, be a complete degenerate by the time I turned thirty, and dead long before I was over the hill at forty. Unfortunately, though I managed to get some poetry published, my first novel was rejected. I found I had little interest in teaching, but I wasn’t qualified for much else with an English degree. My college roommate had been in nursing school. I frequently helped her prep for her tests and along the way discovered that her classes interested me. Since I had nothing better to do at the time, I completely shocked everyone who knew me, including myself, by applying to nursing school. The biggest shock came when I found I liked it.

My first real area of interest, my calling if you will, was obstetrical nursing. I still love it. Every aspect of the pregnancy and birth process amazes me. Each birth I attended during my training reduced me to tears. I even apprenticed briefly with a lay midwife in Utah. I intended to apply to the Frontier School of Midwifery in Kentucky after nursing school graduation, and it was my dream to spend the rest of my life birthin’ babies. However, a quickie marriage, a baby of my own delivered by a midwife, a divorce that left me without any financial support whatsoever and looming Government Student Loan payments forced me to make an abrupt change in plans. After graduation, I got the highest paying job I could find. I took a position as a staff nurse in the Intensive Care Unit of a regional Trauma Center.

I’m a quick study. Within eight months, I’d been promoted to Night Charge Nurse for the ten bed Coronary Care Unit, managing both cardiac patients and overseeing another ten-bed Intensive Care Unit. I also monitored the Telemetry Unit and covered resuscitations, or Codes, throughout the hospital. In addition, I scheduled staffing for our after-hours Recovery Room and became the hospital’s official IV-starter.

My first months of trauma care were an adrenaline junkie’s dream. Between working nights and single-parenting an active toddler, sleep didn’t really factor into my life. At the time, I didn’t mind because I considered myself part of a special breed of health care providers. We were doctors and nurses who could look serious injury and death in the face every day, yet leave the hospital in a good mood. In fact, the more trauma patients the staff handled successfully, the better our collective mood at the end of a shift. By necessity, immunity from emotional distress came with the job description.

In my defense, I was young and like almost everyone else I worked with, caught up in the crazy business of keeping people alive. Frankly, I didn’t have time to get attached to my patients. I’m not entirely certain I even saw them as people. They were more like a set of complicated systems. At the start of my shift, I’d break every patient down into a series of tasks and assign staff accordingly. It was the simplest and most effective way to keep each set of systems running. That was my job, to keep systems, or patients, alive long enough to get them out of my Unit so I could receive the next admission. If patients didn’t transfer to the step-down unit, it was because they Coded and died.

As Charge Nurse, I deliberately assigned myself the most complicated patients on the Unit because I enjoyed the challenges. I took exceptional care of everyone. It’s funny that to this day, I still remember the most difficult procedures I performed, both on my own and those I assisted with, but I can’t recall a single patient’s name.

The suffering, the deaths, and even the success stories were never personal. I took them all in stride. We very often cared for people who had suffered horrific injury, illness and loss. “Personal” would have made my job impossible. “Personal” would have traumatized me. I figured out pretty quickly how to compartmentalize in order to survive. For better or for worse, it seemed to come naturally to me. I made every effort to leave my work behind the closed doors of the hospital. After all, I had a young son depending on me to be a normal mom during my off hours.

In four years of deaths, only a single one really got under my skin. It was an extraordinary experience; something I carry with me every day. I assigned myself a gentleman who had been diagnosed with pancreatic cancer. He landed in Coronary Care because we had an empty bed and Med/Surg, the Medical-Surgical unit, was full. Pancreatic cancer is nearly always a death sentence. Death usually comes quickly, though I’ve since managed a number of hospice patients who survived as long as five years after experimental treatment before the disease caught up with them.

Early in the morning, after I had worked a grueling double shift, this very polite gentleman Coded. His situation was unusual because according to the monitor and my stethoscope, he had no heartbeat, yet he lay there wide awake, talking to me. I hit the Code button and the team came running.

At that moment, the patient’s own physician walked into the Unit on rounds. He waved off the Emergency Room doctor and elected to run the Code himself. All through CPR and repeated shocks, the patient continued to speak and I repeatedly apologized for hurting him. While he seemed unaffected by our actions, I was in agony. I had never Coded anyone who was conscious. Ultimately, beneath my compressions, this man’s sternum broke clean away from his ribs and remained depressed. I burst into tears. I could not continue the Code and informed the doctor.

He shrugged and said, “Call it then,” and strolled nonchalantly from the room. Everyone else packed it in and left.

The poor man was still awake. The monitor reading showed his heart at seven ventricular beats a minute. For those of you unfamiliar with the way the heart works, that’s pretty much dead. I got down on my knees beside the bed, leaned my head close to his and whispered, “I am so, so sorry.”

He lay a weak hand on my shoulder and said, very clearly, “Don’t worry, I’m no longer in my body. I didn’t feel any of it. I’ve been floating up here near the ceiling watching you all work.”

I sat back on my heels for a moment, pretty choked up. While his words didn’t surprise me because I’d once been in his position, I felt myself overcome with awe and could barely speak. My voice shaking, but ever the pragmatist, I finally croaked out, “Well, let’s get all this stuff off you and give you a bath. The least I can do is send you to heaven clean.”

He replied, “Thank you.” Those were the man’s final words to me.

Though my shift had ended an hour before, I waved the day nurse away and stayed with him myself. I bathed him gently, covered him with a clean gown and then pulled up a chair and held his hand until he died. He took his time. After a while he sighed deeply and left his body.

You can always tell when someone dies because up until the very moment of death, up until the millisecond a person leaves his body, he or she is still present. I guess I would describe the phenomenon by saying that you can literally see someone inhabit their body because you can watch them leave it behind. The instant the person dies but not a moment before, every cell gives up the ghost, or the soul, or the spirit, or whatever you choose to call it, and the body grows waxy and lightless.

To me, it seems obvious that the body is a shell, a wonderful machine built to house the soul. There’s a Star Trek episode entitled Spock’s Brain, in which aliens remove Mr. Spock’s brain and use it to power their environmental systems. Thanks to Dr. McCoy, Spock’s body lives on as a soulless automaton until his brain is reattached. That’s the body. However, another Star Trek episode may be even more descriptive of death. Its title is, That Which Survives. In that episode, Ensign Wyatt, one of the Enterprise’s typical expendable crewmen, dies in the transporter room because the holographic projection of a woman touches him. After examining the body, Dr. McCoy says, “It’s as if every cell in his body’s been disrupted, Jim.” That’s death. The soul inhabits every single cell and death disrupts every one of them.

In my capacity as a hospice nurse, I see dead people every working day. Well, sometimes they’re not all the way dead, at times they’re almost dead or they’re on the road to being dead fairly soon but who isn’t? Birth and death are two sides of the same coin, and they’re two of the most intimate actions a human being can witness. The only other act that compares in terms of intimacy is making love. Obviously I don’t make love to my patients, but it is a service of love that a hospice nurse renders. Patients and families I’ve just met become my closest friends in a matter of minutes. They give me an all-access pass into their homes and their lives. They entrust me with the management of their death or the death of their loved one. It’s an enormous responsibility and one I do not take lightly.

Under no circumstances can this be considered a “how to die” book. Nor is it an instruction manual designed to teach the layperson how to care for a dying patient. It’s a collection of true deaths that have touched my heart and my soul, changing me in the process. Dealing with patients and their families, or caregivers, as they go through the dying process can be rewarding, touching, tragic, frustrating, frightening, disgusting, enlightening, spiritual, chaotic, hysterically funny and all of the above at once. My work as a hospice nurse is never dull.

I’ve cared for incredibly wealthy patients living in isolated compounds with their own staff of private-duty nurses and desperate, homeless people who travel along the road of death in the backseat of a old van parked at a strip mall. The end is the same. Movie stars and politicians have mothers, fathers, grandparents and aunts and uncles who use hospice services. Drug dealers have brothers who get cancer or suffer strokes. Criminals have mothers too and sometimes they die on hospice. I’ve cared for the family members of CIA agents, police officers and district attorneys and at the same time I’ve been the nurse assigned to patients dying in homes that have been converted into meth labs and grow-houses. Like I said, my job is never boring.

My role is to midwife every patient into the next world with as much grace and dignity as possible. I guess the most astonishing thing is that I’m good at it. I no longer see my patients as a set of systems or think of them as a series of tasks to complete. They are real to me. I laugh with them; I cry with them. Their stories are written on my heart. I remember their names.