Pallavi Tatapudy
South Kortright, New York, USA

“You have arrived.” The Google Maps navigator tells me I have reached my destination. I look around, doubting if indeed this is the right location. This looks like a vibrant suburban neighborhood with life all around and surely not what I imagined. There is no external sign that a hospice patient may be struggling beyond these sturdy walls. Everything seems so… normal. Benign. Non-emergent.

I park the car, waiting for the hospice nurse to come. I peer down at my white coat, wondering if wearing it will have implications. Will I out this family to the rest of their neighbors by hinting that something is “off”? Will donning my white coat reveal that someone here requires medical attention? I find no easy answer to the many questions whirling through my mind. I settle on saving my questions for when the experienced hospice nurse arrives.

The nurse pulls up to the house and introduces himself as “Dave, the hospice nurse from Good Shepherd Hospice.” He responds to my question by encouraging me to read the situation and be myself, whether wearing a white coat or not. I decide to wear it, with the flexible option to take it off inside if I change my mind or if the white coat starts to impact the interaction negatively. Dave and I walk together to the front steps. A sign reads: “Welcome, Yankees fans! Please enter through the front door! If you’re a Sox fan, the only entrance is the rear door.” I chuckle to myself, already feeling like I am getting to know this seventy-year-old patient and his family. Dave unlocks the key box with the code he was given. As soon as I step into the living room, the energetic family dog runs to my feet. She sniffs me and gives me the “go ahead” signal to enter her special territory.

I follow Dave to the back of the house where Mr. Yankees must be. An emaciated, elderly-looking man is positioned supine on a mobile hospital bed. He is near the window, but the blinds are drawn. The room is dark. I survey the room and catch a glimpse of two photos of a younger, healthier-looking couple embracing each other. The love is palpable. I see college gear hung on the walls and artwork from when the kids were younger. By the head of Mr. Yankees’ hospital bed is a pile of untouched mail, collecting dust and ready to topple over with the stacking of another unpaid bill.

Dave introduces himself to Mr. Yankees and gestures for me to introduce myself. I thank Mr. Yankees for giving me the chance to come into his home. I state my goals for the visit and explain that I am looking forward to spending some time with him to get to know him better. Dave begins recording vital signs and asking the patient how the past week has been for him since the paracentesis last week that drained eight liters of peritoneal fluid from his belly. Mr. Yankees describes the frustration of the fluid that keeps filling him up “like a balloon” and the constipation from being on high-dose pain medications. We address his clinical needs and discuss the next steps. Mr. Yankees sighs and looks away, as if defeated.

After a few minutes, Dave informs Mr. Yankees that I have a few questions for him to answer if he feels up to it. He agrees but does not crack a smile. Every response he gives echoes the same sentiment: “I want to stay alive. I am not ready to die. I am too young.” I can sense the pain and helplessness he feels looking at me. I am the same age as his children. I start to wonder if my presence is doing more harm than good. In a way, I feel like I am a reminder of the struggle he inevitably has to face in the coming days, weeks, or months—leaving behind his college-age children and a legacy that was not supposed to end here. A premature legacy.

Mr. Yankees becomes tired and I end the conversation so he can rest. I leave the room behind Dave. At the kitchen table, Dave starts ordering the medications that will be home-delivered by the end of the day. He calls Mr. Yankees’ primary caregiver, his wife, to update her on the details of the visit and clarify the changes that will be made. When Dave finishes the phone call, I ask him a few questions about hospice care. He explains that the average hospice program lasts eleven days. Hearing this shakes me to my core. Only eleven days to work with a patient, family members, and a multidisciplinary team to coordinate care! I am curious about the perspective that allows hospice health workers to keep pushing forward, knowing full well that their patients are most likely going to pass away during their time together. Dave replies, “Success for a cardiologist may be performing a cardiac ablation on a patient that goes well with no post-operative complications. For hospice health workers like myself, we enter the room knowing we will lose this patient in an unspecified time frame. Success in this field is defined as supporting our patients until they reach a comfortable end that aligns with their goals and empowers them to leave this world with their dignity intact.” I am taken aback by this explanation. It is clear that this line of thinking leaves room for both empathy and efficiency, support and straightforwardness, respect and reality.

The conversation continues. I ask Dave about the steps in his personal journey that led him to this field. While Dave was working as a palliative care nurse in a nearby hospital, he received the unexpected diagnosis of Hodgkin’s lymphoma. He became the recipient of a palliative care consult in the very hospital where he worked. Each day, he would speak with his primary care provider and oncologists, discussing the best- and worst-case scenarios. After six months of chemotherapy and over twenty-five rounds of radiation, Dave could declare with confidence his status as a cancer survivor. Dave proudly says to me, “I have been in remission for the past three years.” Before this point, I was looking upon this man as Dave, the hospice nurse. Listening to and truly hearing his story now allowed me to transcend my one-sided view of his identity and see him as much more than that.

As Dave finishes the note for Mr. Yankees on the electronic medical record, I observe several clippings hanging on the walls from the sports sections of newspapers. The Yankees and Bob Dylan seem to be the celebrities of this home, or maybe even part of the family. I also see several statues of Jesus Christ and religious symbols neatly arranged in every corner of the house. Across the kitchen table, I notice a cross made out of wood. The following words are imprinted on it: “When you saw only one set of footprints, it was then that I carried you.” I smile and reflect on the power of this familiar phrase, the final line of a poem that has given me strength and support over the years in times of struggle and doubt. I often think of this poem as my own personal prayer, forgetting that this same poem may be providing relief to thousands of others who are facing difficulties. I want to capture this moment. I offer a prayer in my mind and send positivity to all those nearing major transitions, such as losing a loved one or walking alone through the inevitable door of death. I thank Good Shepherd Hospice for this unique opportunity to learn, grow, and be still. When I open my eyes again, I look up to see another biblical quote on the wall next to a large-scale photo of Derek Jeter’s smirking face after hitting a homerun. The plaque reads:

“As a shepherd looks after his scattered flock, so God will look after His sheep.

-The Good Shepherd.”

Yes, Good Shepherd. Yes. May love and peace prevail. May peace be unto all.