“ But He’s Non-responsive”
It was after 8 p.m.. The elevator slid open and I was facing the empty hallway between the elevator and the empty nursing station. I was feeling a little uncomfortable about this late visit, so the quiet felt both comforting and kind of eerie. I knew that a couple of dozen people lived here. I had seen them at meal times, or sitting silently in the T.V. room or waiting to be allowed off the ward to go to BINGO or out for a drive. Yet, at an hour when most people are socializing, or working at hobbies, or getting ready for the next day, all of the residents, and the staff who looked after them, had disappeared into the bedrooms - the last homes the residents would ever know.
I had come to visit a new Hospice client. He had been here for a while, quietly living out his last days. At last someone had decided that he had become palliative, and so our Hospice Volunteer Coordinator, Wendy, had been called. I was the volunteer assigned to meet our client for the first time.
Wendy had been able to give me the client’s name, age, and room number, but aside from that the details were vague. She had felt that there was some urgency, which was why I was making this evening visit instead of waiting until the next day. I was uncertain where the room was and would have liked more information from the staff before I went in. I went into the nursing station to get the Hospice binder, to see if there was anything that would help me. There was nothing new there, and I was just about to go hunting for the client’s room when the nurse in charge appeared.
I asked her if the client had any family with him or if anyone was expected. I was told no, his daughter had been in to see him in the afternoon and would probably come back the next day. I asked if the nurse felt confident that the family had all the information they needed to make a decision about whether they wanted to be there, and was told that since the client’s daughter was a nurse that she was perfectly well aware of the situation. Having been put in my place, I said that I would just go along to see the client, then. The nurse gave me a puzzled look and said, “But he’s non-responsive.” I wasn’t sure what to make of this. For a fleeting second I felt foolish and considered leaving, but then I wondered how I would tell Wendy that I hadn’t met the client. Instead, I mumbled “We should get along really well, then”, or something like that, and went to the client’s room.
The hallway outside the room was semi-dark and absolutely quiet. No music, no voices, no sounds of television came from any of the rooms. The door to the client’s room was ajar, and I could see that there was a light inside. Pushing the door open, I spoke softly from the doorway, saying hello to the client, introducing myself, and saying I would like to come in and visit for a while.
Inside, the air felt warm and heavy. There were pictures on the walls showing a vigorous older man with a woman, with other people his age, with younger people. Some people wore kilts, and there were military and Scottish themes repeated in knick knacks and photos. The room was neat and orderly, as was the bathroom, where someone had posted several notes about how some of “Dad’s” possessions seemed to be missing and that this was not acceptable, because these were costly items and not easily replaced. Someone was very concerned about “Dad’s” stuff. I thought I would like to meet this person, so that I could learn more about her concerns about “Dad”.
Only the head of the client was visible. The rest of his body was tucked neatly under a sheet and light blanket. It looked like he hadn’t moved a muscle since he had last been positioned in the bed, so it was hard to tell when someone had last looked in on him. The head of the bed was raised, so his upper torso was almost in a sitting position.
The face of the man in the bed was recognizable as the man in the photos, but much thinner. His cheek bones and nose stood out sharply, with the skin stretched and thin looking, like parchment paper. His eyes were closed, but his mouth was open wide and his breath came in short, shallow, rapid breaths. His mouth and tongue were dry and caked with thick, yellowish, hard mucus.
I looked frantically for mouth swabs, and finally found some in the drawer of the night stand. I found a clean glass and filled it with water from the bathroom sink. I said, “Frank, your mouth looks very dry. I am going to put a wet mouth swab in your mouth. If you are thirsty you can suck on it.” The instant the mouth swab touched his tongue, he clamped his mouth closed and sucked. I said, “O.K. Frank, I am going to make the swab wet again and put it back in your mouth. Please open your mouth.” And he did. We repeated this a few times, until his mouth looked cleaner and more moist. He seemed to be more comfortable. So much for non-responsive, I thought.
I spotted a cassette player with a cassette in it. "Oh, why not?" I thought, and pressed play. Instantly the gentle bellow of a scottish marching band filled the room. I slammed the off button, but the client seemed to be oblivious. It seemed reasonable to think that this had been, and perhaps still was something that he enjoyed, so I turned the volume down and pressed play again.
Normally I would hold a client’s hand while I either sat quietly with them or talked or read to them. With no hands visible I wasn’t sure how I could touch this client. “Frank,” I said, “I would like to stroke your forehead. Try to let me know if that is o.k.” I gently laid my fingers on his forehead . Instantly, with his eyes still closed, his eyebrows shot up making deep wrinkles in his forehead that felt like they were grasping my fingers. His breathing became slower and deeper, and suddenly it seemed like the invisible body under the blankets relaxed.
We stayed like that for a couple of hours. I felt that this might be the last night of our client’s life, and I wondered if I could stay all night. Finally, exhausted, I had to leave to go home to sleep. I said good night to Frank and went to make some notes in the Hospice binder. I found the nurse in charge in the nursing station, filling out a shift’s worth of paperwork. I asked again when the client’s family would be coming, and again she said she wasn’t sure, but thought the next afternoon. I said that I felt that they might want to come sooner, and that I would like to be sure that someone was going to check on him at least once an hour. “We’ll see” she said. Feeling somewhat defeated, yet glad I had spent time with the non-responsive Frank, I went home.
The next morning Wendy called. Frank had died in the night..
Of course I have mixed feelings about what happened that night. I wish I had stayed all night, but I didn't so I try to focus on the things I am happy about. The credit for those things goes mainly to Wendy, who passes her passion and wisdom in dealing with the dying on to everyone who cares to listen. She made me brave enough to act on instinct, and I’m glad for that. On those occasions, however, when instinct is not enough, there are the reports of professionals to support our actions. I have attached one of those papers, which I picked up at the Hospice Conference in 2010. Enjoy, and think about what they say the next time you have a non-responsive client.
