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A Clear Small Voice

Beall, Linda RN, CHPN

AJN The American Journal of Nursing: September 2019 - Volume 119 - Issue 9 - p 72
doi: 10.1097/01.NAJ.0000580300.70116.e6
Reflections
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One woman's truly life-changing experience of caring for a mother with cancer.

One woman's truly life-changing experience of caring for a mother with cancer.

Linda Beall works at Visiting Nurse Home and Hospice, Portsmouth, RI. Contact author: bealls2@yahoo.com. Reflections is coordinated by Madeleine Mysko, MA, RN: mmysko@comcast.net. Illustration by Eric Collins / ecol-art.com.

Figure.

Figure.

The wife sits at her kitchen table, with discharge paperwork from the hospital spread out in front of her. She has a deer-in-the-headlights look that I recognize: “He never was sick before now. I don't remember what they told me to do with these new medicines…” I am here to do a home hospice admission for her husband, who was just diagnosed with advanced metastatic cancer at a relatively young age. He is too ill to talk much with me, and she is too shattered by this news to think clearly.

I write these words on what would have been my mother's 76th birthday. It is December, and the holiday season festivities are in full swing. She was 57 when she died of metastatic melanoma. I am now the same age; it is strange to imagine myself in her place and think about dying at a time in my life when I feel so vital.

Our family was mostly unfamiliar with hospitals and sickness. We had been lucky to remain healthy while I was growing up. But on a summer night 18 years ago, I received a tearful call from my brother: “Mom's in the hospital—she has cancer.” I lived 1,500 miles away; I dropped everything and flew home within the next couple of days.

My mother remained in the hospital for 10 days. We learned later that she had been suffering for much longer than we knew, but she was a person who never went to the doctor, never complained about anything. She went to work no matter what. But on that night, her body had finally given out. Severe abdominal pain prompted her to call an ambulance. She was taken in for emergency surgery and much of her stomach was removed—perforated by extensive metastases from a mole.

I recall helping her into the car at the time of her discharge. She had difficulty taking even a few steps. Huge staples laddered down the front of her body from sternum to pelvis. She had a drain to be emptied. I had a handful of prescriptions that I took to the pharmacy, not really knowing what the meds were. Now I remember so little of that time, and it bothers me. I was not a nurse then. Her prognosis must have been poor, but I don't remember being told this by any of the physicians who saw her—or did I just not hear it? I wish I would have asked more questions, or even known how to articulate what to ask.

For about a week, I was my mother's nurse. A visiting nurse came eventually, but in the interim, we had to figure things out ourselves. I helped her walk the few slow steps from the bed to the bathroom, helped her with toileting, assisted in cleaning her surgical wound. She ate so little, just bites and sips. She developed what I now recognize was thrush on her tongue. And she was in pain, though usually she didn't admit it. I wish I had known more about pain management.

I know now that life-changing journeys can start from the smallest moments. My mother and I had always been comfortable around one another, but I was helping her with intimate care to an extent that I had never done before. One day—and I remember distinctly that all I was doing was setting up her pills and preparing a few bites of food that I hoped she'd eat—a clear small voice inside me said, “You could do this for other people.” I was startled, but in the busyness of the moment, I didn't stop to examine this message.

Three weeks from the day after she went into the hospital, my mother died.

The initial days and weeks afterward passed in a blur, but eventually I remembered that inner voice. Though I had some brief hospice volunteer experience, I had never thought about working in health care; I had a master's in English literature and was doing other work. But the pull to nursing became too strong to ignore. I applied to nursing school, graduated at age 47, and now work in hospice care, which was always my goal.

When I meet with families for the first time, I always remember the helplessness I felt as a new caregiver. More often than not, the caregivers and loved ones need my support as much in their confusion and grief as the patient does. Now and then, I care for a patient who reminds me of my mom—no nonsense, practical, funny, stubborn. Part of me has always felt sad that she never knew I became a nurse, but another part of me thinks she still speaks to me through them. In my 10th year of nursing, I know I'm in the right place.

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