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one foot in heaven

Starting Tuesday, April 1, get your copy right here- One Foot In Heaven, Journey of A Hospice Nurse.

From Alicia Butcher Ehrhardt on her blog site, liebjabberings:

“A light hand with the heavy subject of Death and Dying, March 27, 2014

I’m glad I overcame my fear of the subject to read this memoir of a journey through the last steps on Earth of a group of people who had one thing in common: a gentle and caring nurse for themselves and their families. Nurse Telpner demystifies – by sharing stories of those who have gone before – the process by which hospice helps people through the final gate.

Read the rest here. (And check out her beautiful WIP.)

Thanks! Julia

Crossing the Great Divide. Cultural Differences and Hospice Care.

Just my observations after twelve years of hospice nursing. What I have to say is not gospel so don’t take it as such.

Every culture/religion/society varies in its approach to death, or acceptance/nonacceptance of death. View of death. The way we treat death. The mythology, religious beliefs and folk beliefs associated with death.

That’s just the way it is. Some things will never change. Bruce Hornsby

My Filipino families were amazing loving caregivers. But they didn’t like to have family members die at home. Scared of ghosts. I’m serious. Every Filipino family I worked with was concerned about lingering spirits. Because of this, they were reluctant to bring a loved one home from the hospital. Most hospital discharge planners with whom I coordinated care did not understand the reluctance. They didn’t understand it at all. I get it, I mean, who comes out and says- I’m afraid to take dad home. What if his ghost haunts me?

But I knew about it. Remember, I spent a lot of time with these families. I knew what they were worried about.

In one case, after the grandmother died at home, the family was so distraught over the possibility of her ghost hanging around that within a week of her death they’d sold their house for well under market value and moved clear across town. In another case, my patient, an American serviceman who had married a Filipino woman, had to constantly reassure his wife he would not haunt her after his death. That was her only hesitation about having hospice in her home. She had no fear of caring for him, no real fear of death. She was worried he’d come back to haunt her. I have this vivid memory of the two of them sitting on the couch. He held a bible in his lap and he could not stop laughing. “I am not going to haunt you,” he said. “I swear on this bible I will not haunt you.” She never really believed him. She too sold her home after he died.

Chinese families tended to be pretty pragmatic and there were always many family members around, multiple generations. However, I learned two things- if the family was Buddhist, there would be lots of prayers, incense, candles- there was a tremendous amount of spiritual support for the dying patient. Death was an amazing peaceful experience. For me too.

If the family was not Buddhist, more, you know, Americanized, while there were loads of family members present, I noticed a distinct reluctance to ever, and I do mean ever, discuss death. I was surprised by the number of times a son or daughter instructed me to never ever ever tell the patient he or she was dying. I did my best to respect those wishes, but, you know, if the patient flat out asked I had to tell him or her the truth. I had to. I’m not gonna lie to my patients. And I always made sure the family knew that. Chinese families reminded me of…

Now, I’m Jewish so I can say this. Jewish people, modern atheist/humanist/reform type Jewish people, do not like to talk about death and in fact, rarely did I have a Jewish patient. Seriously. Jewish people tend to treat an illness to death. Most Jewish people die in the hospital. Hey, I’ve had relatives put on hospice, pretty much at the very last minute, and it was like pulling teeth to convince my own family that my aunt or uncle was going to die despite every available advanced medical intervention. People die. Jews think that’s just not right. (I’ve never worked with super orthodox Jews so I don’t know how their acceptance of death differs.) I just know that a lot of the Jewish patients and families I worked with didn’t believe in an afterlife and making the decision to put a patient on hospice was a terrible guilt-ridden struggle. As they stated, and I quote from so many patients and families, they felt like they were “giving up”.

Heck, one of my aunts begged for hospice and her husband (my step uncle) refused. He insisted the doctors treat her, as in forever. He kept demanding a cure, insisting the doctors find out what was wrong with her and fix it. I remember one exasperated doctor finally saying- “What’s wrong with her is she’s dying. I can’t cure death.”

Let’s face it. Sometimes death is the cure for what ails you.

Hispanic families? No problem. They seemed to accept the fact that death is a part of life. People get old and die. Most of my Hispanic patients and their families barely needed me. They got it. They totally got it. I actually felt like my visits were a little intrusive. These were private people and they could pretty much handle anything that came up. I just made sure they had the medications and equipment they needed. Most of my Hispanic families already had a support system in place- large families, their church and a priest. These were always the easiest patients to care for. They died in the arms of their loved ones, literally.

The fun thing about caring for Hispanic patients? The food. They were always cooking great stuff. There was a sense that even if the patient could not eat, the smells of traditional Hispanic cooking made the person feel better. It’s true. It does. It did. Sure as heck made me feel better. I loved visiting these homes. The scent of that food made everything so… homey. So warm and inviting. I swear the smells coming from the kitchens were like pain control magic for my patients.

My African American patients often faced a different set of challenges. I generally found the initial response to a hospice referral to be anger, as in- why are you not pulling out all the stops to treat my mother or father? Is it because we’re Black? The anger didn’t usually come from my patients, it was usually the kids. My patients knew how sick they were. There was no fooling them. They totally knew they were dying. Once things calmed down and we were all on the same page- it was smooth sailing. Everyone rallied, called in the troops, pulled together. Some of my most cherished memories are of the hours spent with my African American patients and their families. My great grandmother was mixed race. My parents and grandparents experienced discrimination for being mixed race AND Jewish. I get it. Like my dad said, “Someone will always have a reason to hate you.” I understood the initial anger and suspicion. Hey, when I was a kid somebody painted a swastika on the side of our house in blood. Another time somebody burned a cross in our front grass. Good times…

Super religious types. Now here’s where things get interesting. One would think super religious types- those people who are constantly talking about god and heaven- would have no fear of death, might maybe even look forward to heaven. I rarely found that to be the case. It was almost as if the reality of death forced them to suddenly question their previously unquestioned beliefs and we (yes, I include myself because I was usually by their sides) experienced a major spiritual crisis near the end. Definitely not what I expected.

But it was even tougher for the super Buddhists - not the actual Buddhists but the American formerly Christians or Jews or atheists who were now Buddhists or spiritual adepts or vegans - they totally freaked out at the notion of dying. Thought they were so spiritual it would never happen to them. I’m not making this up. I once had a vegan patient say to me- “But I can’t have cancer. It’s not possible. I can’t die. I’m a vegan.” I had a Buddhist (formerly atheist) patient tell me- “But how can I be dying? I’m the most spiritual person I know. I’m not supposed to die.”

Well, as a hospice nurse I bring tidings of woe along with comfort and joy. We all gotta go sometime.

It always worked out okay in the end. I mean, they worked it out. In the end everybody works it out in his or her own way.

As I said, the above are not gospel, merely observations, things I noticed in my twelve plus years of caring for hospice patients. For me it’s all about respect. I respect the way people die.

So beginning Tuesday One Foot In Heaven, Journey of A Hospice Nurse will be available on Amazon for free for your kindle. The paperback version is free as well if you belong to Amazon Prime.

one foot in heaven

 

 

 

Dear Mom, the dead relatives stopped by for a cuppa.

(I only know what a cuppa is because of Orphan Black - Season 2 coming soon! OMG I’m shaking… Vikings is like, killer enough! You go Lagertha.)

So my mom has known me my whole life. She knew I saw ghosts way back when. The truth is, she does too, she just doesn’t like to talk about it.

And as my husband, Oscar, the ultimate skeptic, has experienced some of what I’ve experienced because he lives with me, says- It’s like this- You didn’t ask for this. You don’t go on television. You don’t try to make money off of this. You hate it. You don’t see this ability as a gift. You see it as a curse.

Right. It is a curse. I hate it. But sometimes it has its perks. Take my dead relatives, for instance. I seem to be their first stop on the road to the beyond.

So I had this cousin… We’ll call her Deidre. She was my second cousin? I’m not sure how the cousin system works. (My husband and I are distant cousins.) Deidre was my father’s first cousin. She was older than my father, as in eight, ten, or twelve years older. She always liked me. Why? Because we were both wild childs. I know childs is not a word but it sounds better than wild children. I was a difficult teenager. She had been a difficult teenager and boy oh boy did she live a colorful life. I can’t even tell you. No, really, I can’t. It’s kind of a family secret. Let’s just say it involved notorious bad guys.

Anyway, she was drop-dead movie-star gorgeous, outspoken, independent, tough as nails and she got me. She totally got me. So despite the significant difference in our ages, we were very close. She had two children, also much older than me. I was good friends with her son, not so much with her daughter.

When she was older, not old, but older, she got lung cancer. Yes, she’d smoked a whole lot and she’d always been married to one smoker or another so she had a lot of nicotine exposure. Smoking was big back in those days. I have to admit she did look cool with a cigarette in her hand. When I was fourteen I took up smoking for an entire year, trying to look as cool as Deidre.

In the end I didn’t like the way it made my hair smell so I quit. And I never managed to look as cool as Deidre.

Something weird happened to me when Deidre died. There I was in the checkout line at the grocery store, minding my own business, reading a copy of People Magazine (because what else are you supposed to do in a long checkout line) when out of the blue I couldn’t breathe. I really and truly could not breathe. I felt like I was gonna keel over and die right then and there. I must have been weaving around because the guy behind me grabbed my arm and asked, “Are you all right? Do you need to sit down?” He started waving for the manager.

But as quick as the feeling came over me, that’s how fast it left. By the time the manager reached us, I was fine, but very shaken up. I had no idea what had just happened. And by the way, there was a clock right above my head and I glanced up at it- don’t know why but I did. It read 3:15 (Pacific Standard Time).

I managed to get my groceries checked through and I headed home. Pulled into the garage, grabbed a couple bags and walked into the kitchen. There, reflected in the large window over my kitchen sink, was Deidre. No shit. Deidre. It was winter and it was cloudy outside so I could see her reflection clearly. She was leaning against my refrigerator, looking all sexy-gorgeous, arms crossed over her chest, giving me this sly knowing smile.

I looked at my refrigerator. Couldn’t see her. I looked back at the window and there she was, clear as day.

I said, “Deidre…”

She blew me a kiss and vanished.

I dropped my grocery bags onto the table and called my mom.

“Mom! What happened to Deidre?”

“She died. She just died.”

“When did she die? When?”

“Maybe fifteen minutes ago?”

“But what time? Do you know what time she died?”

“Maynard, what time was it when Diedre died? 5:15. Your father says 5:15 (Midwestern Standard Time). Why?”

(Ah, so that explains the grocery store episode.)

“Because she was here. I just saw her. She was in my kitchen and she looked fabulous.”

“Maynard… Deidre just visited Julia. And she looked fabulous. Your father wants to know if she asked about him.”

“Tell him no. She didn’t say anything but she looked great. Is (her son) there?”

“Yes.”

“Can I talk to him?”

When I told him I’d just seen his mother he was quiet for a couple heartbeats, then he said, “Well, if she was gonna come see anyone I guess it would be you. That makes sense. Thanks for letting me know.”

I never saw Deidre again. But boy, she looked amazing. God, she was gorgeous.

When my uncles died, my father’s two brothers, they both showed up as well. The first was kind of funny because he was, well, to put it nicely, he was a difficult man. He had issues. He was wild and crazy and creative and super smart and ambitious but always angry and frustrated as all hell with both his professional and personal life. And believe me, it showed. This was no secret. We all loved him but we tried to stay the hell away from him. He died young as well. It was sad but he lived such a hard life I guess it wasn’t totally unexpected.

So there I was, vacuuming up in my bedroom, and who should appear but Uncle Moonpie. Yes, he did have a nickname from the time he was a kid and while it wasn’t exactly Moonpie, that’s what we’ll call him for the purposes of this blog.

I switched off the vacuum.

First of all, he looked happy. I never ever remember this uncle looking happy in real life but now he was super happy. Maybe ecstatic is a better word. And he wanted to chat.

He said, “I’m visiting everyone, heading west first and then east. I want to let you know how much I love you and how well I’m doing.” He said, “For once I’m fine. Tell them to watch for me.” And then he vanished.

Now, I have to be honest. My sisters couldn’t stand to be around him when he was alive. So I figured I’d better warn them. I called my youngest sister first.

I said, “Uncle Moonpie is making the rounds. He’s headed west then back east so he’ll hit you later today, I guess.”

She said, “Oh crap. Did you tell him not to stop here? I don’t want him showing up here. I don’t need the aggravation.”

My middle sister, with whom he’d once had a screaming match, said, “Call him back. Tell him not to come.”

That’s not how this thing works.

In any case, I think I was the only person who saw him. Nevertheless it was important for him to make the rounds. It was something he needed to do before he moved on.

My other uncle, my father’s oldest brother, was a real sweetheart. And he was the funniest man- could keep us all in stitches. Everyone adored him. But he had a difficult time at the end of his life.

He’d been a bombadeir during WWII. I’m not sure, but I kind of think his plane was named the Daisy Mae from the Li’l Abner comic strip. His plane was shot down over occupied France. My uncle was injured when they parachuted out- hit in the head by shrapnel. The French underground managed to hide the crew for a time and they found a doctor to treat the worst of my uncle’s wounds, but eventually they were discovered by the Nazis. His pilot put up a fight and was killed. The rest of the crew were taken to a POW camp. I can’t remember which Stalag. I’m sure my dad remembers. My uncle spent two years as a POW. Weighed 90 pounds when the Russians finally liberated the camp.

At the end of his life, he suffered from some form of dementia, perhaps because of the pieces of shrapnel still scattered about in his brain. The doctors couldn’t do an MRI for obvious reasons (metal in the brain means no MRI) so nobody really knew what was going on. But he did become agitated at times, even violent. I suspect he was reliving the moments when his plane was shot down, when they all bailed out, when he was hit in the head, when his pilot was killed, and the trauma of the POW camp.

I knew my uncle was dying - my mother kept me informed of events up in Canada. What I wasn’t prepared for was his visit when he died.

It was late. I’d gone to bed, my German shepherd, Louie, lay next to me. (He was a cuddle bunny.) I was just drifting off when the bedroom door flew open, banged against the wall, and my uncle ran in. I bolted upright, heart pounding. Louie freaked and took off with his tail tucked between his legs. (Thanks loads, Louie.) I wanted to run after the dog, but I couldn’t. My uncle kept pacing back and forth, all around my bed. He was so agitated, so upset. He was mumbling to himself. Frankly, he was scaring the crap out of me. He swung his arms around like he was throwing punches, like he was fighting off invisible attackers. It was so upsetting. I was in tears.

At last he seemed to calm down and I took the opportunity to bolt out the door and find my husband. He was in his office along with the dog, who cowered beneath the desk.

I said, “Can you come upstairs with me? Uncle (we’ll call him Uncle Kewl) is in our bedroom and he’s freaking me out. I don’t want to face him alone.”

So like a good little hubby, Oscar trooped upstairs with me so Uncle Kewl and I could have our conversation. By the time we reached the bedroom, my uncle was sitting on the bed.

He asked, “What am I doing here?”

I explained to him that he must have died.

He took that in and it was like a light turning on. There was clarity. He said, “I’ve got to see my family.” And just like that, he was gone.

Gosh. So many of my relatives have come back. My grandmother comes all the time to check up on me and on my kids. My grandfather used to visit. Haven’t seen him in years. I hope he got to be reborn back into our family. I’ve even seen my mother-in-law. She’s lookin’ good, like Rita Hayworth back in the day.

So… enjoy the ghost stories. Maybe I’ll have another on Monday. My work of nonfiction, One Foot In Heaven, Journey of A Hospice Nurse, will be free beginning next Tuesday. Tell your friends! I’d give away a million copies if I could.

one foot in heaven

 

 

 

 

 

When my hospice patients try to kill me.

It’s only happened twice.

It was nothing I said or did. Sometimes hospice patients hallucinate. Might be the meds or the illness or terminal agitation. Sometimes it seems to me it has to do with memories. For instance, a number of my patients have relived their experiences in WWII. Those who saw the worst combat occasionally have a very bad time of it as death approaches.

Or… The occasional patient is prone to violent outbursts and when his usual filters break down because of a terminal illness, well, shit happens.

So I had this patient, an elderly man. He was German. As in he’d been born, raised and lived much of his life in Germany. I no longer recall when he’d emigrated to the States. His English wasn’t the greatest, but his wife was quite fluent in English, German and French. She was the sweetest thing and she baked the best sponge cakes.

Anyway…

I knew one thing about this guy, he communicated this one thing very clearly. His eyes said I was the devil incarnate. Seriously. Every time I visited I thanked my lucky stars he was weak and bed-bound. Little did I know…

He planned ahead. I’m not kidding. He hid a knife under his pillow and waited for me to arrive to do my twice weekly assessment.

So there I am at his bedside, my stethoscope in my ears, and I lean over to listen to his lungs-

That man grabbed me around the neck with one hand and tried to stab me in the chest with his other hand. I was stunned by the ferocity of his attack. I managed to grab his wrist and whack the back of his hand against the hospital bed railing until he dropped the knife, but he still had me by the throat. It took all my strength and the help of his elderly wife to pry his hand away. Man oh man, he was determined to kill me one way or another. I called his doctor and shot him up with a boatload of anti-psychotics ASAP.

We had a long staff discussion about him and our safety (and of course I had to file an incident report) and it was decided that for everyone’s sake he’d remain on anti-psychotics, but we put a big red warning sticker on his chart. Everyone involved in his care tip-toed around him like he was a vicious attack dog. I did manage to keep his behavior under control, for the most part. Things were never perfect. He had a propensity to pinch people really hard. He got along well with his wife though, so that was something. It was the rest of us he hated and feared.

wrestlingOnce upon a time I made a visit to another patient, a bed-bound stroke patient, a man who had always been quiet and cooperative, always sweet. I found him trying to strangle his wife. They were rolling around on the floor, these two frail elderly people. Oh, it was just awful. I managed to get him off of her and then he tackled me. The two of us rolled all over the living room, knocking over tables and lamps. It was an insane experience.

I was trying to keep him from biting me and bashing my head against furniture and at the same time keep him from hurting himself. Meanwhile his wife crawled to the phone and dialed 9-1-1. The longest ten minutes of my life. It took two police officers to pull him off of me and seven of us- the police officer, four paramedics and myself to strap him to a gurney and transport him to the ER so the doctors could start IV sedation.

Crazy stuff and fortunately, very rare.

You know, I always wonder why me. Maybe it’s because I saw so many hospice patients - I was super efficient, in demand, and I carried a huge load of patients - or maybe I just attract the abbynormal (Young Frankenstein). Or maybe it’s just that I can cope with the abbynormal. It’s all part of the job, babies.

I really didn’t want to get bitten.

Hey, I have many more stories. Shall I write more books? love, Julia

 

The dead man, the minister and the comfy couch.

A dead man and a minister walk into a bar…

Actually it was a living room and they sat on a couch.

I received a telephone call from an hysterical wife. Her husband was nearing the end of his life and she needed my help. Of course I helped her, that’s what I do. It was a difficult situation because her husband was actively dying and she was not coping well. She refused to enter the bedroom.

I took care of him. He was fine. Nothing dramatic happened. He died peacefully shortly after I arrived. I made him presentable and left the bedroom to fetch his wife. At first she was willing to peek through the door, look over my shoulder, but even that quickly became too much for her. I asked if I could call someone for her, a child or a neighbor. I was reluctant to call the mortuary when she was in such a state.

At last she agreed to let me call her minister and of course I offered to stay as long as she needed me. She asked me to sit with her husband until the minister arrived. Not a problem.

The funny thing was, when I entered the bedroom a second time, her husband was sitting at the bedside. Yup. Right next to his own body. Gave me a bit of a start to say the least.

Oh, sometimes ghosts are nothing more than sparkles, maybe a ball of energy, and sometimes they look just like themselves but not quite in the altogether. He looked just like himself, just not quite in the altogether. So, now I had to decide what to do. Did I sit there and chat him up, you know- explain to him what had happened? Did I ignore him, pretend I didn’t see him and finish my charting?

To be honest, I’m not all that fond of ghosts. And it felt especially weird to be in a room with a ghost who was sitting next to his body. But I didn’t want to be rude. Still, I looked back at the closed door and I considered leaving.

However the truth is, he seemed like a pretty nice guy, not scary at all. Not even Ghostbusters cartoonish-type scary. So I sat myself down in the rocking chair and proceeded to chart his death.

All I can say is thank god the minister finally arrived, except the dead man didn’t want a thing to do with him. The minister and the wife entered the bedroom and the dead man followed me out to the living room. He walked right through the minister.

By this time I really wanted to go home, but of course I had to wait. Couldn’t call the mortuary until the wife gave me permission so I kept my eye on the ghost. He plopped himself down on a yellow sofa, spread his arms along the back and crossed his legs. Made himself just as comfy as he could be. He had this big grin on his face, and he winked, you know, like the joke was on me.

I took the arm chair near the open entryway door. Always plan your escape routes, that’s my motto. But actually the ghost did seem like a nice person.

At last the minister came out of the bedroom, walked down the hallway, entered the living room and sat down on the couch, right on top of the ghost. And I’m like waving my arms around and stuttering- “Hey. No. Wait. Uh, don’t uh, sit, uh, um, uh… Don’t sit there.”

And he, the minister, shot me a look like- What is your problem?

The ghost was cracking up. I’m looking at the ghost and he’s doubled over with laughter, and he’s got this minister superimposed over him. And it was so totally freaky.

And then the minister asked me to close the front door because he felt a cold draft. Yeah, ya think? You’re sitting on a dead man, dummy.

And now, Winston Saves the Day!

My hero.

Winston is a huge green parrot. He’s 35 years old and we’ve been his foster family for over 20 years. His owner is now in her eighties and I consulted with her two years ago when her husband had a stroke. It ended up being a hospice situation.

In any case, Winston has spent a lot of time with us over the years because his family has traveled to places like Mongolia and Siberia and Japan and Antarctica and they’ve left for months and months.

Winston speaks. Not only does he speak, he says what he means and he means what he says. He knows our names. He knows our pets’ names- and he never gets confused. As I said, he says what he means and he means what he says. And his rendition of the Star Spangled Banner is beautiful. He could sing it at a baseball game. Hits all the high notes.

Normally Winston carries on conversations with whomever happens to be near his cage. The dog, my kids, me, the cat. He’ll even talk to our birds although he’s kind of a snob when it comes to birds. He doesn’t know he’s a bird. Winston thinks he’s a person in feathers. He turns his beak up at bird food. He prefers croissants. And omelets.

When he visits us his cage stays downstairs next to the big picture window overlooking the basketball court so he can watch all the activity both inside and outdoors. He’s not far from the laundry room. Maybe 10-12 feet from the laundry room door.

One day when he was here I was busy with chores. I had several loads of laundry to do, dishes to wash, sheets to change and loads of ironing. I spent a lot of time running up and down the stairs, the dog running with me, while Winston chatted us up every chance he got.

I was upstairs, ironing, when I heard bloodcurdling screams coming from Winston. Seriously- my blood ran cold. Then I heard Winston yell — “Help! Fire! Help! Fire!”

I flew down the stairs and, hell yeah, there were flames shooting out of my laundry room. The dryer had caught fire and my sheets were burning. I slammed the laundry room door shut, dialed 9-1-1, and got all the pets outside. I wheeled Winston’s entire cage out the back door.

The firemen managed to contain the fire. Fortunately it didn’t spread beyond the laundry room. We lost the washer, dryer and the floor beneath and had smoke damage on the walls and ceiling.

Winston saved our lives and our home. The firemen were so impressed they all wanted to meet him. Winston, of course, tried to bite them.

He’s one cool parrot dude.