The Longest Hospice Patient

When my father was dying, I wanted to practice a “charnel ground” meditation, or the closest version I could offer. I didn’t leave his bedside. I interviewed him for three mornings, taking notes so that I could write his obituary. I stayed as close to his body as possible by setting up his dialysis exchanges four times a day. On the final morning, I was in his bedroom at five a.m., draining liquid out of his abdomen. As the liter of sterile replacement solution flowed into his abdomen, I yoked my breath to his. Every time he breathed in, I breathed in. Every time he breathed out, I breathed out, sighing—“ahh”—as if to confirm that he had lived a long, satisfactory life.

When the dialysis exchange was finished, I went back to bed, meditated for a few minutes, then dozed. An hour later, my sister woke me up. Our father was dead.

I had always thought of funeral homes as places that put the bereaved family on a conveyor belt of how-everyone-does-a-funeral. But after talking with many hospice-trained friends, my understanding of the possibilities had widened considerably. I had the confidence to keep my father’s body at home for eight hours after death. I asked my family if I could dress the body, and surprisingly, my evangelical brother showed up to help me. That’s when the two of us realized that the physical form on the gurney was not our father; it just looked like him. The next day, we gave our eulogies, dry-eyed.

After the funeral, I stayed at the graveside while everyone else went on to the luncheon at the church I grew up in. I watched the gravediggers peel off the fake green grass carpet, lower the casket, and back a dump truck of earth up to the grave. Plop. My father, who had owned a construction company, was six feet under a big pile of dirt.

When I was 45, some five years before my dad died, I trained to become a hospice volunteer. I sat with lonely old ladies in nursing homes. One woman kept her eyes closed during my visit, perhaps because she didn’t want to be bothered by a stranger. I simply sat beside her bed in the nursing home and thought, “I too am of the nature to become ill and feel poorly and not want to be bothered.” The Buddha recommends five subjects for frequent reflection, and over time the recollections, slowly and subtly, have taken on a life of their own in my practice. When I go to visit a hospice client, I look at the wrinkled face and think, “I too am of the nature to grow old.” In them, I am seeing a preview of my own coming attractions.

Visiting a friend’s mother in the hospice room of the local nursing home, I could see that she was close to the end; my friend, an only child, looked the worse for wear. Though she knew her mother’s death was coming, she still nourished the hope, the mini-denial, that I have had myself: Not yet. Later. I looked at the mother, with her eyes closed, and thought, “I too am of the nature to die. Death is unavoidable.”

I visited another eyes-closed nursing home client just three times. I had been told she just needed someone to hold her hand. I moved a chair close to the bed, but soon she had drawn me halfway into bed with her, only my toes remaining on the floor. She had a single bottle of body lotion sitting on her bedside table. “Everything I cherish will change and vanish,” I thought, “until I have only a bottle of lotion left.”

In October 2005, the hospice volunteer coordinator assigned me to visit a terminally ill patient named Peg because “she needs someone to talk to.” I walked into Peg’s home the first time to meet a woman who was my age but who looked as if she were older than my mother. I was shocked. I was polite. I was repulsed. I aimed my mind toward compassion. After all, that’s the reason I volunteer for hospice. It was much easier to feel gratitude for my own good health.

Peg had been a drinker and a smoker. Now she had chronic obstructive pulmonary disease (COPD) and an additional respiratory infection. The COPD caused her severe anxiety about her breathing. The idea that I might have to do something with the oxygen machine while Peg’s husband was out of the house caused me some anxiety as well, even though I had a sheet of instructions. Peg’s husband, Sam, had taken care of his dying mother, his dying father, his dying uncle, and now he was caring for his wife. He had recently retired after 35 years with the post office. He had the patience of Job. Sam would not leave Peg alone. Perhaps it would be more accurate to say that Peg did not want to be left alone; she was overcome by the “what ifs” while Sam was gone.

After six months of weekly visits, I tiptoed into the first of the Five Daily Recollections with Peg: “I am of the nature to grow old. Aging is unavoidable.” To tell the truth, I needed the contemplation myself in order to look at Peg and her seven remaining snaggleteeth. Her naturally wavy gray hair could be very becoming, but she could not lean over the sink for Sam to wash it without having an anxiety attack about breathing. She wouldn’t wear her false teeth or do the walking exercises assigned by the physical therapist. She could not stand up by herself. She whined. She asked Sam to heat up her tea, to refresh her water bottle, to bring her a tissue. She was completely homebound and sofa-bound, except for occasional doctors’ appointments.

Peg knew that I taught meditation classes, and she clearly thought I was trying out these contemplations on her to prepare for my class. She had taken many classes at the community college, but never earned an associate’s degree. This belief that she was helping me seemed to give her a sense of purpose. I thought I was helping her, but she thought she was helping me. After a month of doing the aging contemplation on every visit, I added the next reflection: “I am of the nature to become sick. Illness is unavoidable.”

The third month I added the contemplation on death. “I am of the nature to die. Death is unavoidable.” I personalized this contemplation to fit Peg’s situation. Her many cats had disappeared, one by one until only two remained.

Just like my cats, I am of the nature to die.
Just like my grandparents, I am of the nature to die.
Just like my aunts and uncles, I am of the nature to die.
Just like my mother, I too am of the nature to die.
Like my brother, I too am of the nature to die.

Over her sofa hung a picture of Jesus knocking on a door. So I closed this contemplation with, “Just like Jesus, I too am of the nature to die.”

After two and a half years, Peg weighed 79 pounds and looked like she was 90. She was now “seeing” her dead brother every day, and she was happy about these visitations. When I left for my annual one-month retreat, I assumed I would not see her again; yet when I returned home, there she was, still alive.

Peg’s COPD-induced anxiety was extreme. She was terrified to get into the car to go to a doctor’s appointment because that involved a changeover from her main oxygen tank to her small, portable one. Bladder surgery had left her incontinent and unsure of when she would have to “go.” When one of her infrequent appointments fell on a Tuesday afternoon, the time of my regular visit, I talked her though the transition from wheelchair to car. “Notice sitting in your wheelchair.” “Notice that Sam is changing over your oxygen tanks.” “Notice that Sam is helping you stand up.” As Sam ran around and packed the wheelchair into the trunk, I sat on a sliver of car seat beside Peg, directing her to notice her body and her sensations, how anxiety felt in her body, how worry felt.

During my third year with Peg, she was taken off one of her 10 prescriptions, and she began to gain weight. Within a few months, she hit 120 pounds. At our team meeting, another volunteer who visited Peg began to agitate for less frequent visits. “This woman is not dying,” she said. So the four volunteers assigned to Peg began to visit every other week.

By this time, Peg had settled on the body scan as her favorite meditation. After chatting for about half an hour, she would ask if I had time to do the body scan. I always did. Since Peg lived on an old, faded blue sofa 24 hours a day, she simply put her feet up, tucked a stuffed animal under her arm, and closed her eyes while I guided her through the body scan. She usually fell into a fitful sleep. If she woke up before I left, she felt quite relaxed and refreshed. I made a CD of the body scan for Peg, but she never listened to it.

Guiding these body scans was really what made these visits interesting for me. Trudy, a volunteer who held Peg’s hand for two hours while she slept with the TV on, burned out after four years. But the body scans nourished me and were obviously serving Peg by reducing her anxiety about breathing and reducing the pain of her fibromyalgia. Her quick breath slowed as I spoke. If she awoke while I was still there, she always smiled and thanked me profusely.

After more than six years of my visits with Peg, the end came surprisingly quickly. One night in January, after my afternoon visit, EMS was called to take Peg to the hospital. Two days later, I received a call that she was still there and would not be going home. I arrived at the ICU room that Friday afternoon to find Peg lying, open-mouthed and comatose, on the bed. Sitting with her were her husband, Sam, a large group of family members, a minister, and three hospice volunteers, all engaged in conversation. I went around to the less crowded side of the bed and began to whisper a body scan into Peg’s ear. “Notice your body lying on the bed. Allow your head to really sink into the pillow. Your back. Your arms. Your legs.” Her monitor began to beep. “Cheryl, you are definitely having an effect on her,” said the minister. Peg’s vital signs were slowing down, so Sam asked that the monitor be turned off. A hospice choir arrived and sang several songs before I said good-bye and left the packed room.

The next morning was snowy, and driving was slow; I arrived at the hospital mid-morning. Sam, Peg’s daughter, and the daughter’s half-sister were in the family waiting room, so I sat alone with Peg and put my hand on hers. Once again, I led her through the body scan, although I did not really expect that she could still feel her body. “Perhaps your body feels the same as the bed,” I said. “Perhaps the body is just a bunch of twinkling lights in space. Why, look at that!”

As I went through the 20-minute body scan, I could hear a monitor beeping at the nursing station outside Peg’s room. I kissed her good-bye and bade farewell to Sam and to Peg’s daughter.

Peg died 40 minutes later.