Hospice Temp

Posted on January 20, 2007

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Its been an odd series of months. Those interested in the sundry can read accounts in this blog and in hyphenatedrepublic.blogspot.com, its predecessor. Others that know me probably already know the whole story. I guess at the point that I’m at in my life, I need a bounty of good experiences, but I’ve more or less gotten the opposite–one after the other, one on top of the other. Not the worst things in the world; just a steady stream of unapetizing episodes, which linked one to the other as they have been, have pecked away at my lust for life. I thought that I could escape my fate by riding the New Year’s transition and all the hope of change that it brings, but I discovered that wanting things to change is not enough. Life gives what its going to give, whether or not you’re ready to open your heart to positive experiences, and often when you want the curve of reality to prove that mostly good things happen to those willing to welcome them, you are instead shown that life is incomprensibly cruel and nonsensical.

As time passes, just as I think that my current tolerance is at its limit, I seem to be exposed to more terrible realities. There is a range of joylessness, and, at the risk of paraphrasing a character from the Matrix trilogy, levels of survival I am willing to accept. I can deal with being depressed for a long period, of reorganizing my mind to deal with previously unthinkable situations and unwanted realities, and thus becoming a different, perhaps better person. But what if it doesn’t stop? And what if, in turn my ability to redirect those experiences reaches its apogee, and I become bitter and reclusive? What if this life molds me into the kind of person we all fear to be most? The old man peaking ruefully out from between the blinds, with nothing but bitterness to enjoin to the world, unable to find where it was he came from, unable to love, unable to trust happiness. We all think of those people as somehow being predestined to end up like that, but we rarely stop and wonder what pushed them to the edge. Could they have been different, joyful people if life had dealt them another hand of cards?

This is what’s been on my mind and why I haven’t posted for awhile. I also wanted to give some time to the memorial post out of respect for the tragic death of Helen Hill. But a few days after I heard about Helen’s death, something odd happened that has changed the way I’ve viewed fate–or life, or reality, this moment in time–whatever you want to call it. One of the things I did at the end of the year to shake up my luck was quit my old job. I really didn’t like it there, and when you spend half your life doing something you don’t respect surrounded by people that leave you non-plussed, it can weaken your outlook. I was jobless for a couple of weeks, and I had a productive novel writing period, but time does not stand still and neither does the rent and the Pg&E and it was time to go back to work. The temp agency I work for called me up and offered me a relatively high paying position at a well-known health care provider, and I went without asking too many questions.

I was to replace an employee who was going on maternity leave in a few months, but it didn’t become clear what the place was for a day or two. I suppose I should have noticed somewhat earlier, but I was in a bit of a fog–I had hoped to get a little more time off work to finish my book, but the California Unemployment Insurance program had other plans, and I was saddled with a previous and woefully paltry benefit. I was looking at a long term assignment–a will-numbing, what’s-the-point-office-gig, that would squander the best creative hours of the day, leaving me a drained wreck with enough time for a beer, a quick meal preparation and unsatisfying wank before I slept the rest of my non-working life away. What was worse is that the job was complex, involving the mastery of medical terminology, working knowledge of medication names, dosages and administrations, and the generation of detail-oriented reports for use for care of patients by doctors and nurses.

The woman I was to replace was 7 months pregnant and had the worst case of chronic dispepsia and nausea that I have ever seen. One of the first instructions that she gave me was to leave ample space between my chair and the trash can, for at any moment she might vomit, and often there was not enough time to reach the women’s bathroom. One morning she was an hour and a half late because she had vomited all over her car and herself as she drove her daughter to school. She did her best to train me, but to be honest, I generally spaced out anytime she opened her mouth; I just didn’t want to learn the job or be there.

A few days after I began working there, she called in sick a few days in a row, and then announced that she would claim disability until her maternity leave kicked in; she would not be back and I had not been paying enough attention to know the first thing about the job. It was then that I became aware exactly what I was involved in. I had heard the name hospice bandied about, but hadn’t given it much thought, thinking perhaps that this was an accounting or business office. But this was the adminsitrative office of a home hospice program, where the nurses, caregivers, and support staff like myself, did the paperwork to keep it running.

The first step for a patient admitted into this program is to sign a certificate stating that they have a terminal illness. This CTI is a legal declaration that no means are meant to be taken to resuscitate the individual if they are dying or dead. Then the nurse assigned to the patient fills out the forms which show the diagnosis and medications to be administered. Part of my new job is to enter this data into the patient’s chart; eventually I got the hang of the process and in turn, it was this new-found facility that made me acutely aware of what I had become involved in. Only pain relieving medication, mostly opiates, are prescribed for the patients; there are no anti-biotics, no anti-cancer drugs, no treatments. The diagnosis are startling–one patient, a sort of median of illness, had as her primary diagnosis cervical cancer. Her secondary diagnosis was a list of all the other organs–literally all of them–in which it was metastisizing. Often by the time I had received and entered this data, I was already being asked to mark their file as ‘expired’, the ironic and trusted euphemism for the cessation of both human life and file records. The database I manage is an evershifting portrait of lives being lost, one after the other. It was a startling thing to realize. I am just a temp and the last job that I had was at a company that makes Ipod vending machines. Here the task was literally of life and death importance.

The facts of life and death, were highlighted to me just a few days ago. One of my duties is to be the main contact between the patients, or more often their family members, and the nurses– who do not give their cell phones to the patients as a practical matter. The daughter of a patient called in. She had a thick russian accent and I knew that she must be the relative of a patient I had just entered who had a very classic Eastern Europe name. The record had been one of the first, the one on which I basically learned the job through trial and error. She needed to speak to the nurse, her father was asking how to die. I asked her to give me her phone number so that I could be sure that we had it. She was flustered, she couldn’t remember it, and I said that I would find it in the database and read it back to her to make sure that we had it. She began to cry, she cried in that way that people cry about death when they can’t stop, they can’t think, their entire body folds into it, from the gut up. The database was frozen, of course, or it seemed to be; the whole exchange may have lasted only a few minutes, but it seemed like a lifetime. All I could say was that I understood, that if she could only give me a minute or two, we could go on about the business at hand. And finally she remembered the number, just as I found it in the database, and I told her that I would contact the nurse as soon as possible. I was told later that the time of death was a few minutes after I hung up.

I’ve been upset about a lot of things, as I said. Its not life isn’t going my way; I’ve been accustomed to that since my first day of grammar school. Its more that every year has revealed a new way for the world to be hideous, and sometimes I wonder if it is just being revealed to me alone; I seem to have this weird luck for being caught at the periphery of misfortune, just close enough to witness something that’s destined to change me, things my friends and family don’t see and that seem to alienate me from them. The next day on the way to work, I remembered that conversation with the man’s daughter, that unrelenting weeping and sadness and the reality that was being witnessed by the person on the other side of the phone and I could literally see that scene, as if I had really been there. This image led to others, the details of deaths that I had never thought about and I was suddenly living them. I saw Helen Hill, murdered and dying in the arms of her husband Paul, and I saw Celeste Victoria, paniced, dying at the Windows of the World on September 11th, and I saw my friend Hassan, slip beneath the sea and his surprise at drowning. I remembered all the people that I’ve known that have died and I began to cry. I hid in an abandoned portico of a storefront, with my back to Market Street and I cried, and I couldn’t stop and I was half an hour late for work.

I realize that my essays tend to end in the following way, which seems to make their arcs unreal. There is a climactic event, our hero learns a valuable life lesson. I suppose I wouldn’t write about anything if I didn’t somehow see things that way, and perhaps, more than ever, I need to see things that way. And so this is the lesson that I have learned, or chosen to take away, at least:

sometimes life (and in this case, death) gives you what you have been asking for, but not when you’ve asked for it or how.

I have lived these past few years after my private war, in a state of oversensitized, rationalized grief. I haven’t let one death go unthought of in my head, because my deepest fear is not feeling it, of not grieving, of being unperturbed by this cycle. And then I would have to admit what I’ve suspected all along–that I am a bad person, barely human. I think and think, and wonder how I’m supposed to feel, and in a way I never really let go because there is no answer, no rationalization.

At last, because of this hospice temp job, I felt unmitigated grief; I could not stop what I was seeing in my head, it was beyond reasoning with, It came from my ankles, it rose from my belly and I wanted to vomit, I wanted to pound my head against the glass. And I thus came to terms with this barest and simplest truth; that we are all going to die, its happening everywhere all the time. It is only the end of the world when it happens to us or to those around us. We are most likely going to experience tragedies before we die and they will not make any sense. But somehow, God or evolution or whatever is running things, has given us a way to make sense of life. Not with our minds, because that’s impossible; either because it is beyond logic, or perhaps because it so logical that our sensibilities cannot accept it. We can’t grieve rationally, because we can’t accept death as a rational part of life, and if we could, there wouldn’t be much to grieve about.

But with our bodies, our visceral response, we have everything we need to process the unthinkable, and thus continue to live despite the irrationality of living. And if we are so wisely equipped, then there is at least something rational about it all.