In the Room Overlooking the Bougainvillea

With a window overlooking the bougainvillea

The patient was restless . . . to the extreme.

An ambulance transported her to our hospice’s inpatient facility—a renovated suburban house in a neighborhood close to the main office—for pain management. The only local family for the dying eighty-something woman was a granddaughter, overwhelmed by raising her own kids while serving as her Gram’s sole caregiver. The patient’s siblings had already died. The patient’s daughter was, again, in rehab in Florida. Her son was an Army officer stationed in Germany, scrambling to organize a plane flight to be with his mother before she died.

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Right now, in the hospice home, in a room with a window overlooking the bougainvillea adorning a fence, the restless patient, a nurse, the doctor, and the chaplain were gathered. One bed was empty. But the second bed by the window, where the patient lay, shifted with her unsettled body, with her soft random moaning, with her eyes opening and closing.

The doctor had tried several medications that she thought might calm the patient. To a certain extent, the dosages worked. Her agitation had lessened. Barely.

The doctor knew the granddaughter planned to visit that night. The son would likely make it late tomorrow. Would he arrive, only to see his mother unsettled and in pain? Would his final images be someone with a grimace on her face and moaning filling the room?

The doctor and nurse felt they’d tried everything. This drug. That drug. Even with an array of modern medications and research providing detailed knowledge about the progression of illnesses, the medical staff sometimes hits the proverbial brick wall. It is frustrating when “everything” has been tried and “nothing” succeeds. What could be a Plan B or C or any other desperate letter to address the disease’s pain and agitation?

The patient shifted and groaned.

The nurse sighed. Shook her head.

Partly resigned, partly anxious to try anything, partly having no other options, the doctor retreated a step from the patient’s bed. After making eye contact with the chaplain, the doctor said, “I’m not sure what else to do. Maybe it’s up to you now.”

This chaplain is one of my colleagues. He’s a nice guy. He’d do anything for his patients. He also knows a number of his assigned patients will never meet him because they don’t want “religion” or “spirituality” in their hospice care. He’ll be a name on their charts, but will never be in the same room with them. For other patients, their families have their own pastor, priest, rabbi, or imam.

This patient was his assigned patient, but he hadn’t met her. She’d entered hospice care only days before and the chaplain had just called the granddaughter to make a first appointment. He knew she was Christian, but hadn’t been part of a church for a long time. He didn’t know much else.

He settled into a chair by the woman’s bed.

She shifted and groaned.

Would the medication never work? Would she never relax? Would her granddaughter and son see their beloved Gram and Ma in misery until the end?

The chaplain held her hand. For the longest time, that’s all he did. Just two hands intertwined. Maybe the air conditioning softly grumbled on. Maybe an oxygen tank in another patient’s room rhythmically stuttered. Maybe the doctor and nurse, now by the door watching, cleared their throats or whispered details about another patient’s needs. But for the most part, the room became silent . . . except for the woman’s random groans, and the creaking of the bed—like branches rattling in the wind—as she shifted back and forth, back and forth.

The chaplain quietly prayed.

He softly spoke Psalm 23. And then repeated it.

Lips barely moving, he sang several hymns.

The doctor and nurse only heard snatches of the chaplain’s words and songs. Focused on the patient, his every word, and every pause between words, was directed at the woman in the bed. And then, maybe after five minutes, or perhaps it was longer, she began to settle, to become calm. Her movement slowed. The moaning ceased. The eyes remained closed. The face relaxed.

The chaplain kept holding her hand. He sang another hymn. Whispered the Lord’s Prayer.

The patient rested. Breathing in; breathing out.

She lived another day or two. The granddaughter, raised by her Gram, was able to bring her children for one last goodbye. The son, bleary-eyed and caffeine riddled, was able to say his final hello and farewell to his Ma.

I recall when the doctor spoke about these events that occurred in the room with the view of a bougainvillea at our hospice home. (And yes, I’ve changed every single fact, but not the truth.) There’s no guarantee of a “perfect death.” In this era of a pandemic, for so many families and staff, all aspects of dying and death have fault lines undermining the best of intentions. Regardless of a pandemic’s cruel role, some deaths are unexpectedly difficult. Nonetheless, the right combination of medications often does work. An uncomfortable patient achieves comfort; a family spends final, peaceful moments together.

And then there are times, steeped in Mystery, reflecting the enigmatic, essential bonds between two people, when what makes the most difference includes simple prayer, familiar songs, and a firm hand grasping another hand.

As a person of faith, I don’t think what the chaplain did should be deemed “a miracle.” Except that all of life, from birth and living to dying and death, seem miraculous. I also believe that everyone, the least or most “religious” of us, can settle beside another and offer a hand.

(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.)

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  1. I spoke to the son of a patient whose father died as I held his hand. it was the nurse and I, family couldn’t be there, they arrived later. Aide put on music as we spent our time with him. Wish we had a better view than an ICU

  2. I was a pastor. I was positive I did NOT want to see the chaplain. After all, what kind of theology did this “guy” have? I didn’t know him at all.

    Was I ever wrong! Because of some mix-up, the chaplain came anyway. He showed up and I was too grieving already to give a damn. And, I mean it. I did NOT give a damn.

    Yet, it was this pastoral chaplain who saved me from myself and from the crush of death. This man was the miracle. He didn’t need to be the miracle for my friend. She didn’t need a miracle. I needed the miracle. I was the ordained one who tossed Jesus out with the bath. I didn’t need anyone. I would deal with it all.

    BUT –

    I couldn’t. I won’t forget his eyes. His eyes were so kind and it was if he could see my very soul and loved me anyway. Now that’s the kind of pastor I wanted to be…be able to love anyone at any time.

    God uses some of the damnedest moments to let you know you are loved. My friend died. BUT, I didn’t. The chaplain was the breath which breathed for me and kept me alive.

    • Pat:

      Yeah, we clergy can be so stubborn (I could think of other words) when it comes to being open to support.

      Glad you had a kind, caring relationship with the chaplain.

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