Saturday, November 01, 2003

Today kicks off National Hospice Month. So, in honor, I'll share a story with you about a special lady named Jo-Jo:

It was last May, and I was on my second week in Hospice. Part of my orientation involved riding around with our then director, LaDonn, visiting patients. She briefed me on the story of Jo-Jo.

"Jo-Jo is 56, she was admitted in April. She originally had breast cancer, and it's spread to her brain. Big thing with her is pain control. We've tried everything...she's been on Oxycontin for about a week now, and it seems to be working. You should have seen her- restless, up and down, like a hyperactive kid. We've bonded over the fact that we both love Avon Products. She's special."

We drove for what seemed like hours, east bound, near the airport. We pulled up to a small townhouse, got out of the car, and knocked on the door. "Dale Earnhart Fan Lives Here" read the novelity sign at the door. A bespecled man smoking a Marlboro opened the door. His eyes immediately went to me, sizing me up.

"Buddy, this is Jenn, our new nurse. Jenn, this is Buddy, Jo-Jo's husband." As we entered the dimly lit house, I noticed the patient sitting on the hospital bed that now occupied a huge amount of space in the living room (typically hospice patients have their equipment in a certain converted open room in their house, so the medical team, and later on, the funeral mortician, can have easy access to them). She stared out at me with large eyes framed by big bifocals. Her speech was slurred. A baseball cap covered her head, left bald from a failed chemotherapy attempt a few months back. LaDonn spread some newspaper over one of the living room chairs and placed her bag on the newspaper, to keep it clean.

LaDonn assessed Jo-Jo, showed me how to do the paperwork, and reviewed Jo-Jo's many medications with Buddy, who was Jo-Jo's primary caregiver in the home. LaDonn applied Bag Balm to Jo-Jo's reddened backside, as well as talked with her about her recurrent shoulder pain, all the while chatting about Avon products to Jo-Jo. Jo-Jo didn't seem very happy to me. She made no bones about the fact that she was pissed off at the fact that she was dying, in pain, and couldn't move as well as she used to. When LaDonn finished the visit, Jo-Jo growled, "Get that shit (the bag and the newspaper) off of my chair."

LaDonn laughed it off, but I was intimidated.

After LaDonn stepped down as director, I assumed care of Jo-Jo as case manager. Usually we met twice a week. Every visit was pretty much the same. I'd get out of the car, and Ruby Dee, the couple's spaniel, would bark and bark as I knocked on the door. Buddy would answer with his trademark "How're we doin?" Jo-Jo was always sitting in her wheelchair, watching the Morning Drama Marathon on TNT (I usually made it around the time ER was on. We'd watch a bit before I had to go onto another patient). Most of my attention however, I focused on Jo-Jo's needs and wants, making sure she always had enough medicine and supplies. Buddy would hand off back issues of Entertainment Weekly to take back to the office, and would walk me to the door with the following message: "Be careful out there, and stay out of trouble."

As the months rolled by, I almost seemed to forget that Jo-Jo was a hospice patient, with a terminal illness, and whom, one day, I would help transition into the afterlife. Her visits became commonplace, almost routine. Buddy almost never called into the office with problems. Jo-Jo's dark hair began to grow in soft tufts on her head, much to the joy of everyone on the hospice team that worked with her- Othelia the aide, Georgia the LPN, me and Tim, our chaplain. Although she hated it, I would jokingly rub her head and coo over it's softness. On her birthday, I stopped off at Stony Point and bought her a costume ring that was identical to the one I wear on my left hand. I presented it to her and pronounced us as "The Bling Bling Sisters." When she immediately put it on, I knew then and there that Jo-Jo and I were bonded.

Two weeks ago, I got a call from Georgia, who had made a visit to Jo-Jo that day. "Jenn, there's been a definate change. I don't think we have much longer." Othelia had called the office with the concern that she could not get a pulse on Jo-Jo when she came to bathe her. Also, Jo-Jo had become more lethargic, had basically stopped talking. That week, we made several visits in the middle of the night, as Jo-Jo's lungs had started to fill up with fluid, and breathing had become almost impossible. By that Friday, we put Jo-Jo on our special level of care, convinced she only had hours to live. That Saturday, she sat up, asked for her dose of Oxycontin, and ate some oatmeal (Sometimes, right before they die, patients experience a surge of energy, which in hospice is called a "rally"). Her family came in to say good-bye. Coworkers prepared for the loss. I braced myself to receive The Call.

On Wednesday morning, I was sitting at my desk, preparing for team meeting, when our acting director, Leslie, came and stood in the door.
"Jenn, you'll be glad you're here. Ms. Jo-Jo just died." I stopped what I was doing, stood up, papers scattered all over, picked up my purse, and walked out the door. I drove the familiar route to the little townhouse. I realized that would probably be the last time I'd ever drive that route again.

Buddy met me at the door, his eyes reddened. He had been turning her, attempting to change her diaper, and was holding her as she drew her last breath.

"Where is my friend?" I asked him, fighting back the incrediblely strong urge to cry uncontrollably.
"She's right here." He stepped back, letting me pass over the threshold. Jo-Jo was lying in her bed. I went to her, put my arms around my neck, and embraced her lifeless body. "I'm so sorry, Sweetie." I said aloud.

When a patient dies, I usually like to give them one last bath. I consider it my final gift to them. I try to use perfumed water, preferably perfume that belonged to the patient, so that it's a natural smell. I filled up Jo-Jo's basin with warm water, and spritzed some perfume that Buddy had given to me in the water. I made it a point to wash very slowly. It still hadn't sunk in that she was gone. By washing her, drying her, and sprinkling powder on her, I was able to touch her, to allow myself to realize she was dead. I realize how powerful denial can be.

By the time I was ready to dress her, Jo-Jo's daughter and son-in-law, as well as Tim, our chaplain, had arrived. I dressed Jo-Jo in her strawberry print nightgown, I folded the bedsheets down, and folded her arms on top of the sheets. Usually, I put a flower in the patient's hands. I've found it's a nice surprise for the family when they see their loved one like this. I usually search for roses. I found a synthetic one in one of the many vases near Jo-Jo's bed. I noticed it was a novelty flower, with a little green button on it's stem that said "PRESS ME." When I pressed it, it played, "Let Me Call You Sweetheart." I smiled and placed it in Jo-Jo's hands. Tim said, "that flower. It's a little bit silly, but beautiful."

"It's so Jo-Jo." I said. We all agreed.

Tim suggested we say a prayer, and we gathered around Jo-Jo. I stood at the head of the bed, and like I had many times before, I found myself stroking her peach fuzz hair on her head throughout the entire prayer. Tim said some very nice words about how bravely Jo-Jo had fought, and now that God had taken her, she was in a better place, but there was a hole in our lives now because she was no longer with us. The funeral home arrived and removed her body. I made up the empty bed, and did the last phase of my usual ritual. I took a picture of Jo-Jo that everyone liked- pre-cancer, her head full of dark curly hair. I took the Sweethart rose, and Jo-Jo's glasses, and propped all of these things against the pillow. Jo-Jo's daughter brought a vase of red carnations in a vase and laid them against the pillow as well. I gave Buddy a big bear hug, and stepped out of the little townhouse into the sunshine.

"Stay out of trouble, and be careful out there," he called to me.

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