in your eyes I am complete

I walked into the establishment where Walter lived. I don’t know if I actually liked the place, or if I saw it in stark contrast to other nursing homes I had visited or even the previous building that housed this establishment. I had just visited the space this nursing home once occupied. There were few cars in a neighboring parking lot and the doors had clearly been boarded up. The outer decay of the building fit with the assumption that several people had died there. I don’t know if my positive evaluation of Walter’s new home was a result from seeing the previous building or if I was thinking about the stark white interior of other new nursing homes I had visited. Nursing homes in which daily life was so clinical and patients were left sitting in the hallway, unnoticed by nurses who busily walked past them.

Walter’s home was different.

The walls were a warm bronze color. Several dark mahogany desks welcomed visitors, under bright but inviting lights. Large leather armchairs were positioned in front of several large TVs. The man who directed me to Walter’s room asked if I had visited there before. I said that I hadn’t and asked how long they had occupied this new building and if the older one on 20th avenue was their previous establishment. The manager proudly recounted his story about the move and renovations. He smiled as he motioned toward Walter’s room. Yes, this place was different, I thought. Very different.

I entered Walter’s room and found the 80 year-old man sitting in an arm chair by his bed, a copy of the local newspaper on his lap. I introduced myself as a hospice volunteer and sat down. I had been told that Walter had a good long-term memory but often struggled remembering events from moment to moment. He began by trying to explain why he had called hospice in the first place. He provided me with his understanding about what hospice care is, not unusual for patients to open with. I’ve always found it interesting that patients seem determine to let hospice representatives know how much they understand. I quietly listened to his explanation and told him I just wanted to visit, and he didn’t have to have a reason for wanting to visit with anyone from hospice.
He paused for a moment, staring at the wall to the left of us. "Maybe I called to talk about what I'm feeling. You know not everybody talks about their feelings, especially around these parts. I had a friend who wouldn't talk. He would just go to his house, pull his car in the garage and shut the door. He forgot to turn off the car. He didn't talk to anybody, he just put his car in the garage and forgot to turn it off. I don't know how you do that." 

This moment caught me off guard but not as much as the moment that soon followed. I shook my head and said that it was a shame he didn’t have anyone to talk to about it.

“Sometimes I think about that.”

“What?”

“I had a friend I used to get coffee with. I was talking with him the other day. He said that if he ever had to go to a nursing home, he would probably put his car in the garage and forget to turn it off. I don’t know what to say about that. What do you say to someone who says he would forget to turn the car off if he had to live in a place like this?”

I was speechless. “Wow. I’m not sure what I would say.” I frantically searched my mind for something to tell him. He didn’t seem to be asking me as one person to another, seeking another perspective on existential issues, but he seemed to be asking me as if he thought I, as a representative of hospice, knew exactly how to respond. In that moment, I started to rethink all I had studied, trying to come up with something to say. How could I have studied this subject for so long and not be able to come up with a single thing to say?

“Sometimes I think about that,” he repeated.

I paused. The silence in the room was deafening. Walter looked as though he was going to say more, so I waited for him to continue. He looked around the room, and I took a moment to glance around as well. The paint and draperies I had noticed earlier as being a warm, comforting color suddenly looked dull and stuffy. The rich golds and maroons seemed heavy and depressing, and I began to realize that Walter’s perspective of the nursing home might be much different than my interpretation as an outsider. I looked back at Walter sympathetically. Apparently he was not going to offer anything more, so I asked a follow-up question.

“You do?” I thought that by repeating his questions or by asking simple exploratory questions, I could keep him talking, which I knew seemed to be cathartic for many patients.

“It would be easy-” he continued.

I held my breath.

“-but then I tell him, ‘well, I’m ready to go at any time, but I guess I just want to see what tomorrow looks like.’”

I exhaled. “That’s a great answer.” Walter chuckled and changed topics. We talked about his wife, family, younger years. We had a great conversation and after about an hour, I left and told Walter I would be back in a week.

As I was driving home, I continued to think about Walter’s question. I had never expected a patient to suggest that s/he thinks about suicide. I know it might seem odd that it had never occurred to me before, but in all my research, I had found that suicide rates were low for hospice patients. A friend’s father, an architect, once asked me for a consultation on a hospice build. He was concerned with the rooms being on the second floor with a balcony. He was worried patients would become depressed and jump. I had tried to reassure him with support from research about hospice and the basic reasons patients are even at in-house settings, but this moment with Walter made me doubt any previous knowledge I had. Gone were Walter’s friends, love of his life, well known community members. Walter was alone, except for a few visits from his daughter and phone calls with his suicidal friends. I became very concerned for Walter and decided that I would be his new friend, his constant companion.

This interaction made me think about research I’m learning in another class of mine. I’m enrolled in a graduate seminar entitled: Communication, Constructs, and Identity. In this class, we cover personal construct theory and symbolic interactionism. Symbolic interactionism posits that we can only learn about ourselves through interactions with others. We behave in a particular way and others provide us with the language to understand ourselves in the moment. In other words, our experiences become meaningful through interaction and reflection, and these experiences in turn shape how we see ourselves (Mead, 1934). Mead argues that any action an individual does is made meaningful only through an existing cultural framework. Duck (2010) offers the example of a child who touches a hot stove. When an adult reacts by saying “That's hot; and I bet it hurts”, the adult is giving linguistic terminology to the child’s material experience (p. 23). The child then learns not only what is meant by ‘hot,’ but also that others are able to interpret the her/his experience as well. Essentially the child’s sense of self develops through social interaction. Thus, I can only understand me, my feelings, my experiences, through others. I know me through others.

My interaction with Walter – how do I see death? How do I experience a place, a setting, a moment? Personal construct theory posits that we have to be able to anticipate experiences in order to form constructs about them, which forms our identities, but I could never anticipate how living in such a place, a nursing home, would be had it not been for my interaction with Walter and his inviting me into his narrative.

Still. living.

Susan did not die that day, and when I went back to visit a few days later, it was long after breakfast time. It had been a long day for me, and I didn't feel like driving 15 miles out to visit Susan. I knew I was being selfish, but I also recognized my feelings as realistic and normal. Volunteering is thought to be selfless, and I often am congratulated by others when they learn about what I study, but there are days when it becomes tiring to make time for visits. Immediately after I have these thoughts, I of course feel guilty, often thinking back to moments such as Susan's breakfast when I realize that some of the people I visit are all alone and would probably never hope to die with an untouched breakfast tray in front of them. After a few moments, I knew I needed to go see Susan, so I headed back to the nursing home.

I headed for Susan's door, as a nurse was just leaving her room. "Is Susan awake? I was just coming to visit her." "Susan just died. A hospice volunteer was here a half hour ago, and she died. She's all clean now and the windows are open for a breeze. We're calling her family, but it'll take them a while to get here if you wanted to stop in." I froze for a moment. When I had visited Susan days before, she was on final days, so I knew it wasn't going to be long. However after the weekend went by, Susan was still alive, so I suppose I wasn't expecting to hear that she had just died. I had expected to be the one sitting with her as she eased out of this life. I told the nurse I would only be a few minutes. I went into Susan's room and found her very much like she had been days before. Her eyes were barely closed and her mouth was half open. I touched her arm. Her skin still felt papery and slightly warm. When Susan was alive, her breathing was so slow that often she appeared to not be breathing at all - a look not much different than she appeared moments after her death. Since her skin was still warm, she even felt as alive as she had days before. At first glance, it was difficult to believe that Susan was actually dead. I looked at her face and then noticed her left ear had started to turn blue. I knew then that Susan was dead. I said a quick prayer, thanking God for Susan's life, and praying for her soul, and I turned to leave the room. Just before I headed out the door, I glanced back once more at Susan. Out of the corner of my eye, I saw the Yahtzee game sitting on the dresser and thought about how we had never gotten to play even one game.

The most important meal of the day...

The next morning I returned to Susan's home. When I arrived, she was still sleeping and looked much like she had the night before - eyes barely closed, mouth half opened. In front of her still body sat an untouched tray of breakfast food. I quietly took a seat to the side of her bed, whispering that I had returned and would sit with her for a while. I started to read while I listened to her less than audible breathing. I glanced up every once in a while when her breathing sounded exasperated and stared at her breakfast. I wondered how long the tray had been sitting there and whether she had even been awake to know that breakfast had been served. Her orange juice began to separate, and I imagined that the glass of milk would have tasted tepid.

I looked away from her tray and tried to focus my attention on other areas of the room. I noticed the Yahtzee game I brought her a few weeks before was in the corner on the dresser. The plastic wrap had been removed and someone had written her name on the box in permanent marker. We never had a chance to play, but I took comfort in the fact that someone must have opened it and possibly played a round with Susan. After an hour, Susan still had not woken up. I packed up my things, rubbed her arm, and whispered that I would be back to visit again shortly.

I went back home, but I could not get the image of Susan's stale breakfast out of my head. I know these details about Susan's separated orange juice and warm milk might seem extreme. Who would sit and stare at her breakfast for so long? Is this moment really meaningful at all? I thought about why I might have marked this moment as profound. I realized that although Susan was asleep, in a state which ordinarily might have seemed peaceful and calm, I found this moment to be eerie and painful. It was likely that Susan didn't even know anyone had delivered breakfast. If unaware, it was possible that Susan might die just like that - eyes barely closed, mouth half-opened, breakfast deconstructing in front of her lifeless body - like a scene you would watch on Six Feet Under and assume it was just a high dollar still shot. But here was Susan, in real life, dying in front of her untouched breakfast tray. And I mourned this moment for Susan and wondered if I could die in such a way.