How are your bones?
As in, all 206 of them. When born, babies have 270 bones. Some soon fuse together. The actual number depends on what you read, and how argumentative you like to be! Me, I wouldn’t want to be tested on the names or number of bones. In a single wrist, there are eight: capitate, hamate, lunate, pisiform, scaphoid, trapezium, trapezoid and triquetrum.
However counted, bones are the solid infrastructure of our bodies.
Once, in a hospice team meeting, as we reviewed a patient’s concerns, a nurse mentioned the ulna.
“What is that?” I asked, ever ignorant.
“It’s a bone in the upper arm,” answered another nurse.
“No,” the hospice physician said, “the lower arm has the ulna and radius. The upper arm bone is the humerus.”
All of us professionals smiled and chuckled. How . . . humorous? Come on now, and sing with me:
The foot bone’s connected to the leg bone.
The leg bone’s connected to the knee bone.
The knee bone’s connected to the neck bone.
Doin’ the skeleton dance.
The thigh bone’s connected to the hip bone.
The hip bone’s connected to the backbone.
The backbone’s connected to the neck bone.
Doin’ the skeleton dance.
The Skeleton Dance, a children’s song and a long 200+ list of Latin names we can barely remember and even a thoughtful nurse will occasionally mistake one for the other.
On a wilderness hike in my early thirties, I had a tib-fib spiral fracture, or so said the orthopedic surgeon that repaired my left leg. Before gravity and I tumbled down a mountain and busted my body, I probably knew there was a big bone above the knee (indeed, the biggest in the body), and two slender bones below the knee. But I had no clue about their names. Once my leg was damaged, I’d forever know the bone between the knee and hip was the femur, and the two south of the knee were the thin fibula and stouter tibia.
My brokenness meant I needed other people. When the body’s infrastructure is broken, we will only get by with another’s help.
As the laughter receded in the room, and maybe a nurse’s cheeks colored red because she forgot the difference between an ulna and a humerus, I thought of how all our bones are connected—just like the song says—and how I hope each person is also connected with others.
With a loved one enters hospice care, connections are critical.
One of the misconceptions* about hospice involves how the patient will be supported. Once a patient has “six months or less to live,” doesn’t her or his family step back and let the crack team of hospice experts handle the medication doses, hygiene, and, well . . . all the demanding (and messy, boring, and scary) stuff that needs to be done?
Hospice doesn’t “take over.” The hospice team, in the majority of situations, provides regular, scheduled contacts with the family and friends caring for their loved one. A nurse may visit once or twice a week, there to check on the patient and make sure the caregivers understand how to continue caring for the daily needs. A home health aide may come in several times a week for an hour or so to bathe and tend to the patient, but they certainly aren’t moving in.
Like the 206 bones, the family and friends are the primary structure that holds everything together.
But of course, intact or fractured, it’s not just the bones holding us together. In the best times, in the worst times, as the German philosopher Friedrich Nietzsche mused, “Invisible threads are the strongest ties.” His words are echoed by what the Fox said in Antoine de Saint-Exupery’s The Little Prince, “And now here is my secret, a very simple secret: It is only with the heart that one can see rightly; what is essential is invisible to the eye.”
Even though caregiving for a dying loved one is arguably one of the hardest of all efforts anyone will make, it is essential. Most of the “work” done will never been seen by others.
A common experience for those grieving is how they were surprised by the family or friends that drifted away. We talk about this in the grief support groups I’ve led. Were those who “vanished” afraid? Did they think dying or grieving was contagious? But there were others—often unexpected ones—that provided the essential, quiet structure of kind words and gentle presence.
We are made strong—when whole or broken, dying or grieving—by the visible and invisible connection of the family and friends that humbly represent the many “bones” supporting us.
(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)
*If you read other hospice-related thoughts from me, you’d notice that this misconception is frequently mentioned. If a patient is at a skilled nursing facility, the family’s day-to-day support may be minimal. Some hospices, though not many, have hospice “homes” with in-patient beds and 24/7 nursing staffs. However, a high percentage of patients (nearly 50% according to 2018 data) are served by a hospice in their home. The stay-at-home patient’s primary support will be family, friends, and hired caregivers.
And, oh, a few bones to consider if you did want to take a test:by