Seems like every September at least one golden afternoon takes me across the river to travel Highway 14 in Washington. Today was one of those days. I didn't have to work and decided to hike Wind Mountain - something I've wanted to do for ages. It was a perfect day for a hike and I had a wonderful time, but what I really want to tell you about is why I love driving Highway 14 in September when the wheel has turned just slightly towards autumn and the light has changed.
His name was Carl and all I knew about him was that he had congestive heart failure and was being admitted to hospice from a nursing home. The weekend on-call nurse processed the admission and I made arrangements to visit him on Monday morning.
Carl lived in a single-wide by the train tracks on the Washington side of the river. He no longer drove, but he was able to get around his house. A nearby nephew helped him with groceries and transportation. He was on hospice because he told the doctors and the nursing home to go fuck themselves and discharged himself, against medical advice, to go home and die on his own terms. But I'm getting ahead of myself.
I met Carl that Monday and he was a delight - a little rough around the edges, but I liked him immediately. We talked, I did the usual assessments, coordinated his medications and arranged a home health aid, chaplain and social worker. As I recall, he politely refused the chaplain and warned me the social worker would be useless, but he was cautiously willing to meet everyone else. I don't think he quite knew what to make of us.
Then the reports and medical records started trickling in and a strikingly different image of Carl began to emerge. One he freely confirmed as the weeks progressed. How should I put this? He was, on paper, a nasty, mean son-of-a-bitch who did battle with everyone he ever met. Every record documented non-compliance and anger management issues. He claimed to have killed someone in a drunk driving accident and to have done time in prison. He was a huge man and I sincerely doubt he ever lost a fight. We knew none of this when we met him. He was just a nice, old man in need of hospice care and we treated him as such.
Every time I, or the home health aid, visited (and sometimes we coordinated our visits just for the fun of it) he would wonder out loud, "Why do you pretty, young girls come here to see me? I don't know what I did to deserve this!" Most of our visits consisted of chatting and him telling his stories - and he didn't hold back the ornery ones. He let us see who he was. I still cringe over the tale of euthanizing a stray cat with a shotgun in the abandoned bathtub in his back yard. But by then we liked him and I'm pretty sure he liked us back
We spent just a couple months with Carl in a season that spanned bridge crossings to Highway 14 on golden, September afternoons. Watching him soften and sink down into the time he had left was humbling. It wasn't something we talked about - that would have just gotten in the way. It was enough to be a witness.
On the day I found Carl dead, in his own bed, on his own terms, I brought with me a Tupperware container of home-made ice cream. Hospice care that day would have consisted of a few good stories shared over a couple bowls of ice cream. I would have documented 'improved appetite' on his dietary assessment and Medicare would never have known they'd been party to a party.
It's been about eight years now. Of all the patients I worked with, Carl has stuck with me - and he always comes back in September. I hope I never forget what he taught me. It was simply this - kindness, love and respect trump everything.
Thank you, Carl. I remember you. And I hope there is good ice cream wherever you are.
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