“The elderly, who often experience disproportionate loneliness and loss, are especially well served by pets,” Dr. Lemle Ph.D., Chief Psychologist SFVAMC
A Nameless Vet in Hospice at the VA by Brian King
Our First Day with the Vet in Room 2110
As Toni King and I drove into the VA Dolly was sitting looking at the few scattered vets, staff, and families walking on the green grounds of this historic site. She is excited to come to work and becomes animated when our morning ritual becomes apparent to her that the day will hold for her seeing her veterans. Head up; tail up; she prances down the hall greeting all the staff and patients. We chat with all, most don’t remember our names but call Dolly’s as they see her. Making connections with all we meet, Dolly is the universal icebreaker, most will squat down and truly share love with her and her happiness is infectious. The morning paperwork is completed and we review a list of too many patients that want a visit from us today, many times more than we can possibly see.
Nurse Anne is always happy to see us, chat, and love on Dolly. Today she gets a sad look and asks if we could visit with 2110 he is new and missing his wife and dog and knows he will never leave, this is the hospice ward her statement means they have preceded him in death. Nurse-1 taps on the window of his door, the drape between the door and his bed pulled to a point of just allowing him a clear view of the window in the door as he sits on the edge of his bed. He spends his day watching the staff, ambulatory patients, and visitors walk the corridor. He smiles and waves us in. As Nurse Anne asks, “Would you like a visit with Dolly?” his arms open and Dolly jumped onto his bed him laughing the two of them nuzzling each other, she is wagging her tail with her entire body, her licking his beard, him hugging her laughing, and they seem like they have known each other since birth and that they have always been friends. She shows affection to most patients on the first visit but never the instant connection and bond that we saw that day. That is how our friendship began.
Given a different situation, he probably would have been on the floor rolling around playing with this half basset hound mutt. He shared stories of his terrier mutt that was also full of personality and had been a traveling companion before the little one had passed. He drove a truck for a living which is what he had done in Korea. On his dresser was a photo of him in his army dress uniform, a tall athletic enlisted man that could have been actor Jimmy Steward’s younger better-looking brother. His smile in the photo was real and sincere and the same as we would see each visit. That first visit we chatted and discovered connections between us in a love for the wilderness, horses, farming and ranching, music, and a similar ethos. These simple things we were to build our friendship on. Before we knew it half our time was gone and there were other patients that spent their morning waiting for us. A four-handed handshake was shared and a heartfelt thank you for the visit was given, he asked if he would see us again, we assured him, and more play and nuzzling with Dolly extended the visit a few moments longer. Tears could be seen welling in his eyes.
A week later Nurse Anne met us in the hall; we shared a few moments of our typical greetings and playful banter that we had shared for the past 7 months, then she said, “I am glad you are here, the man in 2110 has been looking forward to seeing you all morning.”
Our tap on the glass brought us a big infectious smile from the silver-bearded 80-year-old vet. As soon as we came in Dolly was on his bed and they nuzzling each other him playing with her like he was 10, not a frail 80. Markedly in a week, he was frailer, though his handshake was hardy. Each Friday we would see him first knowing that it was most important for him to have his time with Dolly and us for his wellbeing to help fill the void that the other services of the VA could not provide. Each visit he shared stories of his youth on the farm before his enlistment, poaching to help feed the family, and life in general. What should be a 15-minute visit was an hour and a half. Our exit was the same routine as before and over the weeks would not change.
Our next visit Dolly took us straight to his door and as usual we were greeted with a grand smile and hugs joined handshakes. Each visit seemed to have a different focus in our review of his life, this visit was meeting his wife, their life together, and their special moments with their 4-H club. Sometimes he had stories to share without prompting other times he wanted to hear our stories but we always used our stories to draw stories back out of him. This time was to celebrate his life. In these visits, his stories never included the early 50s; the time of his service in Korea. We thought Toni’s presence may have been the reason. One day we separated for her and Dolly to see other patients as I stayed behind in room 2110. I asked him about his MOS he told me about transporting supplies near the front lines. He got silent and said, “That is hidden in a part of my brain that I want to keep forgotten. “I saw things that a 17-year-old kid should never have seen.” That was the last we talked about those years.
The nurses would tell us on occasion that he complained of pain but when we asked he would not acknowledge that he was in any pain. I believe the fun and laughing he had with Dolly and us was great powerful medicine for him.
During our visits we would ask if there was anything he wanted or needed, once it was, “Can I have a battery for my watch, I will pay you?” The counter person at the shop Toni went to asked if she wanted a lifetime battery or the cheaper option when she responded it was for a vet in hospice he gave her the battery at no cost. The man in 2110 did not want to believe her; he did not want to be a burden to us. Another time when asked that same question a pair of new lungs was his request. We sat in silence, he said the doctor told him he only has a few days left, but he felt he had stuff he needed to get done before he died. A week ago he said, “To go home,” meaning to be with his wife and dog, to die. “I am tired of my life being in this room.” A few minutes later we were laughing about some SNAFU that either he or I were responsible for.
He during one conversation mentioned that his birthday was before we were to see him next; Toni went home and with the help of her quilting friends made a veterans birthday quilt in the few days before his birthday. She surprised him on his birthday with the quilt like she had done for others. He was moved by her kindness and asked to be buried with his quilt.
Each week Nurse Anne would share his eagerness to see us and would discuss the milestones in his progress, we were thinking maybe a week or two but when we saw a different name on the list for his room we were shocked and stared at each other. We found Nurse Anne only to learn that the person that made the list that day used his legal name, not his nickname. It was a mental check for us that death truly could happen at any time.
With each visit Nurse Anne shares his eagerness to see us and the mile markers of his progress, a progress to death. With each visit there is less muscle on his frame, his eyes are drawn in, his tendons and bone are more visible.
The Beginning of the End
When Nurse Anne and the other nurses warned us he was now on a morphine drip, we all know that means non-communication is a day or two away. Any questions by him or us needed to be asked and answered today or never. “Is there anyone you want to see or be contacted before or after? Do you want a hospice person with you when you pass?” “Is there anything you want to see, hear, or do?” “My kids did not want to see me before, I don’t want to see them now, and you are my family now.” “I want to die alone but if you are here please stop by and visit; you are welcome anytime.”
He also had many questions about why or what he was experiencing and his new limitations. We are always honest in regards to what to expect. In the last days and hours of death, everyone is different, every death is different, but there are steps that are very similar, we shared them with him, asked him of his fears.
We explained to him that his hearing would be the last sense to go and that he may be unable to open his eyes, you may be awake and still hear and understand and that we would read him books, play music and movies.
He said he would like The Red Stallion read to him, he liked the music of Jimmie Rodgers, Gene Watson, John Denver, Loretta Lynn, Dolly Parton all played for him. We surfed Pandora and YouTube two things he knew nothing of. Again we’re laughing and reflecting surfing the internet for songs and video clips. Like the kids today a lot of the songs he most enjoyed was music not recorded during his life but the music that his parents loved, many songs 10 to 15 years before his birth. All the songs had so many memories for him. He loved the music his wife liked to sing and those songs brought both happiness and tears. He also asked about the movie Son of Paleface with Bob Hope. We watched some clips on YouTube that day, He had not watched it in decades yet he remembered what was coming up next, we promised to be prepared to watch it all the way through one of our next visits.
At this stage, we come more frequently, coming when we can, not waiting for a and focus on just that one patient, on our next unscheduled visit Nurse-1 and we were glad we did. Though on the edge of his bed his head was down with his face in his hands, he did not respond when Toni tapped on the glass. He woke when we came in, though, in a fog, he was happy to see us. Dolly and he loved on each other, handshakes and hugs were shared. We played music from the song list we had prepared, conversations were limited but he enjoyed the music and listening to us chat. He was going in and out of sleep. He would be apologetic when he awoke not but two or three minutes later, believing that he was being rude to us yet he did not want us to leave. In our hearts, we all knew it was going to be the last time we were going to be able to converse but not wanting to admit to it.
Yesterday, Veterans Day Eve, in the afternoon Toni, Dolly, and I got there at 1400 hours, as usual, Dolly knew where she was going but was not excited, she walked not pranced. Nurse Karen told us he was still here but… not finishing her thought. I asked if he is still communicative, “No.” Nurse Anne looked heartbroken. Experienced nurses, even those that only work with the dying are moved when a hospice patient moves on. We are told not to get too attached, but our function is to raise their quality of life in the last few weeks of life and many need a good friend.
A look in the window and I could see he was not sitting on the edge of the bed, this was the only time he had not been sitting to greet us. Over the past four years sadly we have seen more than we can remember that get to this stage. Nurse Anne has seen thousands and we knew the signs. His mouth open gasping for air every few seconds, his eyes were shut never to open again, and his features have become the universal features of those near stepping over to the other side. We greeted him as we always had, held his hand, gone was the hardy handshake, replaced with the feelings of tendends just moving, his eyebrows went up an indication that he was trying to open his eyes. Toni helped him hold and pet Dolly, she was subdued, she licked his hand then laid down next to the side of his bed. She been to this point with many also.
We shared stories of our week to him knowing he was awake and could hear us. We told him we had his music to share with him and played the songs he requested: Jimmie Rogers “Hobo’s Meditation” “Hobo Bill’s Last Ride” “In the Jail House Now”, Gene Watson - Farewell Party, John Denver “Rocky Mountain High” and others. Though he could not move, speak or open his eyes, I could feel the tendons in his hand keeping beat to the music especially “In the Jail House Now”, he was smiling and was trying to mouth the words.
Nurse Anne came by several times, her last time of checking in with us she kissed his forehead whispered in his ear, “I Love you, goodbye.” She thanked us and walked out of his room for the last time. Toni before leaving to see her other patients did the same and told him “You are safe, you can go home to your wife and puppy, they are waiting for you.” I stayed with him playing music then finishing off our visit “watching” the Bob Hope comedy Paleface. He loved Roy Rogers and Trigger his horse dancing and I could see him smile just as that scene started. At 1730 hrs his breathing had slowed and less labored. His face was now gradations of white to blue his face had lost all expression. He was ready to go. I told him, “Thank you for the friendship; you have been a good friend.” I held my hand on his back for a few seconds and said, “You go be with your wife and puppy.” Nurse Karen came in to check his morphine drip just as I was leaving his bedside, he had 40 minutes before it needed to be replenished.
This morning, Veterans Day, Toni called to see if we should head up to the VA to sit with the man in room 2110 but he was recorded as deceased at 1830 hours, an hour after I left him. The gentleman in 2110 who will remain nameless will be missed.
To protect the nurses their names have been changed, room 2110 does not exist, the vet and our experiences with him did.