Bob Sh’mal Ellenberg
11329 8th Ave. NE Apt 106
Seattle, Wa 98125
HESTER’S LAST SMILE
AND CAN OF ROLLING TOBACCO
In the nursing home where I work people dying is going on regularly; it’s nothing new to me, but now people are being admitted, in their forties and fifties, who are terminally ill with one critical illnesses or another. All are destitute; that’s why they’re in the nursing home where work, because we’ll take in America’s poorest of the poor. Don’t get misled though, we aren’t taking them because of some idealist humanitarian concern, the fact is we are the oldest, least sought after home in town, so those who other nursing homes won’t accept, we do. And although we’re very close to a major southern university, with scores of students waiting on our corner for the bus, crack addicts, hookers are passing by our doors every day and sometimes come in and visit.
In many cases what brought these younger folks into a nursing home is some of their own doing. We could lay their problem on poor decision making. Sure we’re told we all have free will. But when life doesn’t get us off in the right direction, many times, life can go astray, and never get back on track. We tend to blame the person for living a poor lifestyle, making wrong decisions. Ha! Not ha, funny, but a laugh of derision for the inequities that life thrusts on so many. Maybe, in their entire lives, they never had the opportunity to know what right decision making was. Sure, we’re all responsible for our own lives, but what if some one was never able to get a decent life going because of abuse, how they were raised, poverty, mental instability, etc. And now they are too far gone for me or anyone to shake them and tell them to wake up and get their lives on track, because now the only track is chronic illness, which may be leading them to death. So here they are, at an early, end of life stage.
As the social worker, I’m given the opportunity to offer some last ditch effort of help. But help with what? Getting the social services is usually easy, sometimes tricky, considering the Draconian system that has been devised for all those in need, but that kind of help I’m really good at. But now I’ve been thrust into an environment where I can help people die: if that is something any of us can really do for another.
I have been learning to give emotional love and support. I try and access those energies during my breathing practices, meditation and prayers, from all the seen and unseen beings who I think (who really knows for sure?) are with me, helping me receive and send love: the primary healing ingredient. This is what I try and send out to those whose lives are now connected with mine at this stage of our lives.
Hester in her mid fifties is dying of cancer. She was more or less a street woman; had a place to stay off and on, but knew people at the local shelter (not far from the nursing home) where she was known for needing a meal or a place to stay occasionally. As a younger woman, she worked, had a marriage and children. Now she only knows one 18 year old daughter who has been coming to visit. I asked Hester about the other three; “when did you see them last?” She tries to whisper something to me, then can’t get the words out because her tracheotomy is clogged with mucous. She puts up 10 thin fingers, makes a fist and holds them up again. “Twenty years?” I ask her and she smiles and nods. As I’m saying to her, “that’s a long time not to know where your children are.“ She tells me the Hospice social worker is going to try and track down the other children. I think to myself that the chances are slim, given such short notice, and not much information about where they are.
I’ve taken to Hester because she reminds me of a woman I went with many years ago as a young man. Both were alcoholics. The woman I knew died at 50, of general dissipation, Hester has throat cancer, now metastasizing throughout her abdomen putting her in excruciating pain that is being helped some by strong doses of pain medications ordered by her Hospice nurse and doctor. None of it seems enough to deaden the pain, but maybe by tomorrow she will have i.v. morphine ordered by Hospice that she will be able to administer with a self regulating pump. It will most likely be enough to deaden all her pain and eventually relieve her of this life.
Hester is tiny; 90 pounds. I walk to her room, which happens to be right next to my office and find her, sitting on her bed, head down towards her stomach, legs crunched up under her as she tries to find a position that is comfortable; that lessens the pain. Of all the dying people I have worked with, I don’t think I have wanted to help any one as much as I want to ease Hester’s dying process. I can do a little; touch her hand, rub her head or neck, invite a student massage therapist to very, very gently work on her. It’s more human work, than social work.
I take her hand and cup it in mine. I sit with her, on her bed, as she tries to explain something to me. The tracheotomy is constantly dripping thick, stringy, yellow mucous that she wipes with tissues that collect on her bed, or gather in a pile on the floor till some one picks them up. The Hospice nurse calls it bronchitis that antibiotics will help lessen. When she can’t talk due to the mucous, she asks for her notebook and she tries to write messages with her uneducated spelling. Her own phonetic language: some words almost unintelligible. But she writes, she even seems to like the writing. I think of suggesting she do more, except now, with only a few weeks to go, she is barely able to hold the pen.
This is her second time coming to the nursing home. She was previously with us a few months ago for only a few weeks then returned to her apartment trying to make a go of it on her own and with friends helping. She walked in the second time as she did the first. But this time, after two weeks, she was only able to walk holding on to the back of a wheelchair for support, pushing it where she wanted to go. And than, sooner then any one thought, after only a few days more, she needed to sit in the wheelchair and be pushed onto the patio so she could have another cigarette.
She came into the home carrying two large cans of a cheap rolling tobacco, one tucked under each arm. This was a picture, which is only in my head. I pointed at her coming down the hall and gave her a friendly welcome laugh; she laughing back knowing she was a different kind of picture. Due to her confusion of coming into the nursing home and her weakened condition, she misplaced one can the second day back. I happened to find it in the staff break room and she agreed for me to secure her security in my office.
What am I to do for her? Get down on my hands and knees and pray that she doesn’t have too much pain. The morphine will take care of that. Should I ask God to help her go fast, or that she be miraculously be healed. I don’t think that’s what’s up for her. She’s on her way from this life. She told me a few times she’s ready to die, especially with all the pain. I don’t want her to have the pain. I don’t want her to suffer. I want her to have a chance, but I’m not sure a chance at what. A chance that when she dies and she sees a hundred hungry and deceitful demons she confronted in life and who will be pursuing her in death, she can allow them to pass her by so she can see some of the light and she can make amends and come back around with some opportunity to live a decent life.
Is that what I want for her? This isn’t what she believes. I’m not sure if it’s what I believe. What do I really know about dying except what I read of the Buddhists teachings, the Jewish teachers, the Christian teachings and others. I have no clue in my own memories. I wonder at time, were those really mystical teachings that were passed on, or did those mystics make stuff up.
And what is this decent life that I’m supposing she will have, or didn’t have? This is about her and what she wants for herself. I try and keep myself out of it and only reflect back to her what clues she gives me. I intuit a latent spirituality, so I bring up God and she tries to explain something, but then reaches for the notebook and writes about God, and how three years ago found herself seeking. She looks in my eyes, shrugs her bony, thin-skinned shoulders. Her nightgown comes away exposing her flattened, wrinkled breasts. When I cover her she smiles, shrugs, knowing it makes no difference. Maybe she’s lived a fulfilled life and doesn’t have to come back for any more turns in human existence. I suggest that if she sees the light, after, she should try and go with it. She nods understanding a little. Maybe one needn’t be a saintly person, maybe she experienced more of life then any one need to see and she learned and knows something about life that can carry her to the light. My work: I try and draw something out of her that can give her solace as she prepares to enter the other side of life.
I wonder if I’ll ever see her smile again. Her head was hanging low, down to her abdomen as she nodded, eyes closed, in a stupor on the strong pain meds. She was sitting outside on the patio with the other smokers limply holding a long ashed cigarette in her emaciated fingers. Her breathing gargled through her tracheotomy. I looked at her too much wrinkled face, like her breasts, more of a 70 year-old then someone in her fifties.
Her few teeth, what are left, black and rotten. Still, her smile, it was bright and frequent and I wonder: will I ever see it again? I’ve gotten attached to her. I can’t breath any more life into her then what I have and it won’t be enough. It will be slow and painful. I’m promised by the Hospice nurse Hester will soon be on the morphine pump and she’ll be able to give herself as much as she can take. It won’t constant, due to its censor, which gives ten minute breaks, so she can’t overdose, but it will be enough to deaden much of the pain.
The Hospice social worker and I agreed we should make arrangements with a local mortuary for her requested cremation. It won’t cost Hester anything. I asked her if she wants me to spread her out on the Paynes Prairie; the 1000s of acres of natural, pristine Florida, with many birds, alligators, giant turtles, herons, mushrooms, deer, transplanted buffalo, wild horses, right down the road from the nursing home. She nodded she did. I think about her turning to ash, which is more like gritty rough sand. Unburned bone. Now here she sits in front of me, but some time soon, all that will be left of her physical being, will be, unburned bone.
I laugh to myself: Am I a crazed man, waiting and helping and being with her. In less then three years I have already been with dozens of dying. My work. Creator’s work given to me. My choice to do this for Creator since Life, I have reckoned, is Me, and Me is Life, and Hester, is also a part of That, and I am going to dispose of what is left of her body when she can no longer breath in the life force.
What do I know that she doesn’t? All my praying and studying and meditating makes me someone much different then who she is, but we are all part of that One and we were brought together so I can do something for her, to help her along. I still wonder if any one really needs to be helped along in their dying. Oh yes, according to the “Tibetan Book of Living and Dying” there is work to be done with helping the dying along, but will she get any of it that I have learned? Just being with her and supporting her, praying for her, and letting her know she won’t be alone. I don’t want her to be alone and I even told her that today. I wondered how will I know when she is about to die. What if I’m home? I could tell the staff to call me if they have a feel for her last hour, her last moments. Sometimes we know. I’ve known.
Frequently, the staff gets sensitive to that moment; tell one another; it gets passed around so those who care can go in the room and spend a few last sacred moments with some one they worked with, helped along, in and out of bed, administered medication, changed dressings, spoon fed, cleaned up, the shit and piss, vomit, mucous.
The thought of a madman: I’m sitting on her bed doing like I’ve seen junkies do; tying off my arm and melting down heroin and taking a syringe and watching the white grey liquid going up into it and clenching my fist so a nice vein pops up real good and shooting up with her as she pumped the morphine into her and nodding off together. I thought of the two bottles of vodka in my office desk that I took out of Hester’s dresser after a nurse told me about them. I asked Hester about them and she told me to take them, that they weren’t her’s but belonged to a friend. What am I supposed to believe? so I ask her, “are you going through any alcohol withdrawal, do you needs these bottles close to you?” She looks at me surprised that I would question her about this, and denies that alcohol was the problem, as she brings two fingers to her mouth mimicking taking a puff of a cigarette.
She’s has done her share of drinking. Her good friend, Jo Ann, comes to see her regularly to give Hester a bath. Only two weeks ago, Hester was getting into Jo Ann’s pick-up and going back to her apartment to complete some things there. Jo Ann tells me Hester really enjoyed the vodka, even putting some in her coffee in the morning to get her day going. Jo Ann who knows Hester for two years, tells me that Hester owes nothing to live, that she lived it fully. I know nothing about vodka, but I think of Hester’s bottles, wondering if her friend, if there really is a friend, doesn’t come for the bottles, should I indulge myself and drink up the innocent looking, throat burning liquid, in commemoration to Hester after she dies. Odd thinking this way. Heroin and vodka. It’s never been my way, but never have I felt this way about some one.
Will she be the last dying person I care for in the nursing home? Will I quit after this is over with Hester, and agree with myself that this has been enough; I’ve done the Work that had been given to me; enough is enough and let me get on with some work that is fun. Let me have another lighter way to go for the remainder of my work days. I don’t keep track how many times I have had this thought. Six decades of life, more then half of them as a social worker. What more is there for me to do? How many lives must I help along the Way, in trying to bring an easier path. Easier then what? Then my own life? Have I been cheating, not suffering as much as the many who I have helped? Is this, some kind of personal, or universal guilt trip my life has been on, atoning for known and unknown malevolence in this life of ours.
My life though, has been mostly benevolent living. For what ever the reason, I was brought to do the Work of being a giver and a helper. One day a few years ago, while riding to work to see an abused, emotionally disturbed adolescent girl I had been working with for a couple of years, I realized I was like a modern day Shaman, going from home to home, town to town, program to program, agency to agency, visiting with, and ministering in the guise of a social worker. Odd thinking of all the times I spent berating myself for not making more money, not being something else, or doing this or that, not being successful, while all along, I was doing the Great Work. Who knew? No one told me when I began on this Path, that I was even on one, that it would be my Life’s Path. It was the Great Work, not a business, with all the scheming and conniving. I used to think that business was the hardball league, one I didn’t fit into. So feeling more comfortable helping others, I chose that path of helper. It always made or felt like more sense, slow pitching, not having to try and compete or get over on some one as in a business arrangement. Traveling the Shaman path, going out listening, talking, being with, and trying to figure out how to make some one else’s life trip less traumatic, easing pain, softening the burdens, but accepting there may never be solutions. I understood that from my own life; life was relentless, constantly coming at you, working through it all was part of the trip, it is the life. As a middle aged retarded man told me, “life is life.” Through his small vision of life there was a bit of simple, but grand wisdom. There is no getting away from it.
For now, I am still there with Hester. A few days later, she’s very morphined out. She can barely sit up, barely taking anything to drink; hasn’t really eaten much in the four weeks she’s been with us, her eyes closed most of the time, occasional tremors, grimaces on her face, no smiles, except a very slight, corner of the mouth smile, when the Hospice nurse got real close to her face and made a joke.
A homeless waif, Carolyn, that knew Hester in the St. Francis House homeless shelter is sitting next to the bed as the Hospice nurse and I talk with Hester. Carolyn, has been coming in and spending her days with Hester. She bargains with the nursing home staff; a couple of nights of sleep on an empty bed next to Hester and some meals. But soon she began demanding from us: regular meals, a nightly bed. We had to let her know she can’t be spending nights there and we don’t feed people. She quickly became an irritant to the staff, as she wanted to know how come we don’t have a feeding tube in Hester and how come we’re not trying to feed her more and how can we save her, how come this, how come that. The Hospice staff and myself have gone over and over it with her, but she doesn’t seem to get it that Hester can’t make it at this point. It’s obvious to the staff that Carolyn has some serious emotional problems, and her own needs may be more the priority then Hester’s. I am hoping that she will understand we are doing our best to make it right for Hester.
But Carolyn doesn’t get what’s going on with Hester, and has been whispering to Hester that she should have a feeding tube and i’v. liquids so she will live. When I come into work one morning, a nurse tells me she had to call Hospice to tell them that Hester wants those heroic measures. None of us can believe that Hester really would do that, but we would have to if that’s what she asks for. I go into Hester’s room and Carolyn is sitting there. She won’t look at me, or answer when I say good morning. Later she completely ignored me when I asked her how she was doing. I make my own call to the Hospice nurse leaving a message that she has to come in and have a talk with Hester. Late in the morning she comes in and I discuss with her the situation. I allow her to go in alone and see Hester. Carolyn walks out going past my doorway still ignoring me when I call her name. Later I hear she threatened to call the state elder abuse hot line to report the nursing home. It’s like a little extra drama added to an already delicate situation.
Hester’s 18 year old daughter, Leola, is in the room with Hester. She has been spending a lot of time with Hester the past two days. She had signed the “do not resuscitate order” two days earlier, at the behest of Hester. If her heart stops she does not want cpr. Leola is very much out of her element; nursing home; dying mother; signing papers, trying to have power of attorney over Hester’s measly bank account, problems with Carolyn. She is though a strong young woman, dealing with things, maybe making up for time they didn’t spend together. I talked with her a day earlier needing to know about the relationship she had with her mother. She tells me she was taken away from her Hester by the state and put in foster homes when she was 11 because of Hester’s drinking. She spent some time with her father after the foster homes, but never lived with Hester again. Actually, they had only seen each other a few times in the ensuing years, but are really into loving each other from what I can see of the attention they are sharing. Leola also has a two year old son who Hester is enjoying having around her room.
The Hospice nurse is in the room for about 20 minutes before I go to see how things are going. I caught the tail end of the nurse explaining to Hester and Leola, that because of her very weak condition if the feeding tubes were put in, her body might react by the lungs getting clogged with liquids and she would aspirate. She also said that because of her weak condition a doctor wouldn’t want to put her under anesthesia and that the feeding tube surgery may be too much for her. There didn’t seem to be any benefit for those procedures. Fortunately, Hester has been more alert this morning then all week. I was really surprised earlier that some one had left her sitting in a wheelchair outside my office. When I asked her if she wanted to go out onto the patio, she nodded, yes, so I pushed her out there where she sat for a while, surprisingly, with no cigarette. Now, with the nurse explaining, she was understanding, shaking her head, “no,” about the feeding tubes
For two days in a row, Hester has been more alert, sitting up. enjoying the time with Leola and her grandson. Her body getting used to the morphine. I was able to joke with her about missing her own Baptism. It happened while she was mostly in a sleepy, drugged state, after being introduced to the morphine pump that she was constantly pressing. She had previously indicated she wanted to be Baptized and a Catholic priest came in and performed the sacred ritual, answering all the questions he put to Hester himself. I had never seen this ritual before but wondered how he can answer for someone else about whether they are rejecting Satan, and accepting God. It was later explained to me that’s how it’s done, so even people in coma can be saved. I am satisfied with myself that I don’t judge too harshly.
Hester’s only drinking a bit of the nutritional supplements we keep offering to her, and a bit of water now and then. She can’t go on for too long. Each day when I spend time with her, she keeps asking me, “when, how much longer?” and I tell her what I told another friend who was dying, “you just have to wait your turn. There’s others ahead of you.” I was a bit surprised as she looked deeply into my eyes, nodding that she understood. The eye connection we are having is leaving a deep, and I know, forever, lasting impression on me. I can feel the imprinting going on as we do it. And now, in this moment, I have this realization, that so many of those that I work with in the nursing home, and have been with, and for all of us, whoever we are with, becomes us, we them, as our life is literally transformed from each and every experience we are having in this life and we’re becoming all that has been in our lives.
I would spend more time with Hester if I had it, but there are 90 other residents in this nursing home and I’m the only social worker. I walk out of Hester’s room and talk with Judy, 58, who is going through a long, slow cancerous process;. Nelson, 56, out on the back patio smoking as usual. I’ve appreciated myself for what I have done for this once homeless man, helping him get on disability and Medicaid, then cataract surgery, dentures and a spinal operation after all his limbs were becoming numb. I hesitate, hoping I’m not jumping ahead of things, but as we’re talking, I offer him the last can of Hester’s rolling tobacco I’ve kept in my office. I tell him to come to my office later.
I sat in Hester’s room yesterday watching her twitch and wiggle around a bit. She looked very pitifully weak and done with this life. Off and on she would open her eyes a crack, and look at me, but she wasn’t able, nor was it necessary for her to acknowledge my presence. I patted her on the hand, rested my hand on her forehead for a few moment, brushed back her hair with my fingers, whispered to her that it didn’t look like it was going to be much longer. There was no response, except when I asked her if she wanted a blanket or sheet on her and she mouthed, “sheet.” I covered her, almost feeling I needed to cover her face; that she was getting that close. I wished her the best, hoping she didn’t have to continue the ordeal much longer.
When I came to work this morning, 15 minutes late, the mortician was wheeling her past my office. Just in time to say one last good-bye. Leola, will be taking her remains to a place that Hester would have liked. I take the vodka to a party and don’t drink a drop.