Endings

When I started working in health care, I wondered how I would react to having to deal with the death of a patient, and how I would feel about touching a dead body. As it turned out, I found it to be a deeply moving experience. This is an essay I wrote a year or so ago, after my first such experience.

Tom died today.

His name wasn't really "Tom". That's just what his friends called him, probably because his real name was one of those that kids get teased for having. He was a little man who seemed even littler because both his legs had been amputated. He routinely refused baths and showers, so his hair was a matted, grizzly mess, and he always needed a shave. He wore a pair of grey cigarette-burned sweat pants that dangled loosely below his amputations, and a big flannel hunting jacket of indeterminate color. At any hour of the day or night you would find him cruising the halls of the nursing home on his motorized scooter, its front basket filled with tissues, cigarettes, empty soda cans, magazines, and, oddly, an emesis basin.

Abraham Maslow said that human beings have five types of needs that must be satisfied in order for them to be whole. "Unwhole" people, he said, are people who haven't had those needs met. According to Maslow's Hierarchy, physiological needs come first, then safety and security, followed by love.

As a CNA (certified nursing assistant), my job description requires me to provide levels one and two for the patients in my care. But I think to truly be a caregiver in every sense of the word requires that I enter into that third level as well. And I'm finding that although levels one and two are basically just a lot of hard work, love is kind of magical. It's not something to be earned; rather it's a gift to be given. And somehow, the giving of it blesses the giver as much as it does the receiver. Maybe even more.

It's not always an easy thing to love someone. Some people, like Tom, can be pretty hard to love. From snatches of conversation I've heard, his own family didn't love him. Maybe he didn't love them, either; I don't know. As I cared for him each day, I made a conscious effort to treat him with respect and kindness; to touch him without shrinking away from the dirt. And I quickly found that beneath that gruff nicotine-stained exterior there was a human being, with a heart and a sense of humor. Pretty soon, loving Tom wasn't such an effort any more. He still wouldn't submit to a bath. He didn't get any cleaner, or smell any better. In fact, he didn't change a bit. But I did.

Today my coworker Thad and I finally got to give Tom that long-overdue bath. Thad shaved him while I soaked his hands and scrubbed off the nicotine stains, then cleaned and trimmed his fingernails. As we worked I wondered about his path through life, and how it had brought him here -- from a cute cuddly baby in his mother's arms to this wizened, tattooed, scarred, broken little body. What made him the man he was? What kept him from being the man he might have been?

When we finished giving Tom his final bath, we changed the linens on his bed, then dressed him in a clean hospital gown. We put a soft pillow under his head, spread a colorful afghan over his blanket, and tidied his room. This is what we're taught to do when someone dies, for the sake of the family. I don't know if Tom's family even came, though. It wasn't duty, or his family, that Thad and I were thinking of as we worked. We did it for Tom.

I felt something powerful in that room today, just me and Thad and what was left of what used to be Tom. We found ourselves talking to him just like we would have if he were still alive - "Okay, Tommy, we're going to roll over this way now..." We always talk to our patients as we work, to let them know what we're doing, and I guess it doesn't change just because there's no one there to hear us any more. Love is something you give, even when you don't expect anything in return. That's what makes it love.