Maybe this is the most obvious thing I’ve ever written, but hospice is sad, y’all. I’ve started working in hospice as a chaplain. It is so cool to learn a new context for my skills and to build a more well-rounded skillset with every job I take. I thought I was pretty well prepared to spend so much time with death. Having done my internship and residency in a level one trauma center during Covid, getting a divorce after a 17 year marriage, and then doing a fellowship in palliative care at the VA (often a precursor to hospice), I kind of thought I was pretty comfortable around death. Turns out, I am. I have come to see death as a friend. I have totally upended my life in light of my experiences around death these last four years in chaplaincy. So much of the life that I am building now is in light of the fact that all of us are temporary.
The part that I hadn’t counted on with hospice is how incredibly vulnerable my patients are. A lot of people I’m working with live in facilities. Some have no family. And I know they’re getting good care because I know their team and their caregivers. But a lot of my patients are non-verbal. They are physically very weak. If they fell down, they would not be able to get up on their own. Their skin is like paper. Often purple paper. I don’t know that I have ever known a more vulnerable population than the dying.
I often compare birthing with dying, as I have experience with birthing. The liminal space, the solitary nature of it, the transition from one way of being to another…there are comparisons to be made, for sure. The vulnerability is part of it. But most birthing parents can speak. Many of my patients do not or when they do, it comes out in what we call “word salad,” which means they say words but they are random and not necessarily following a pattern another person can understand. It is the act of talking that they are practicing. What they are saying is less relevant to the connection than the fact that they want to talk to you.
As my chaplaincy has unfolded, after a long season of theological deconstruction and reconstruction, what I have come to find as my theological grounding is that every person actually matters. Deeply and truly. That the way our society marginalizes some over others is not at all true about who we are. Every person actually matters.
In hospice, I am getting to walk out this theology in ways I haven’t had the chance to practice, or certainly not with such frequency, as I am being able to practice it now. I watched today as a colleague offered a sip of water, a squeeze of the hand, and moments of silence to just be together. These moments matter, even though they look like maybe they don’t, in our world of efficiency and over-functioning.
I cried today with my spiritual director. The source of my tears was the vulnerability of my patients. They are simply defenseless. And being in relationship with people who are as vulnerable as anyone could possibly be just brings tears to my eyes. It’s not strictly sadness, though that is a profound feeling I am having in patient care. It is beauty. It is being moved. It is the simplicity of it. It is the rawness. The tenderness that I feel towards them and knowing one day I probably will be them is profound.
There is also this human part of me that whispers, “if I don’t do good work with them, no one will know.” There is certainly an opportunity to “phone it in” so to speak. The integrity that it takes to provide good care to someone who relates in much subtler ways than a fully cognizant person does is real. I wanted to name that voice because I think it is a reflection of how vulnerable my patients are. Essentially, people are working with them simply for the gift of doing so. And those that see the profound gift that it is are exactly the ones who should be doing it.
I feel so much tenderness for these new people in my world.