I work as a primary nurse case manager at Hospicare. This role includes providing clinical and psychosocial case management for patients and families. It starts on admission with education about hospice and the benefits provided. Weekly visits are made to complete nursing assessments and manage symptoms. Visits include support to patients and families in preparation for the psychological and physical events that occur throughout the dying process. Being calm, present, and reassuring are essential. These qualities facilitate trust from the patients and families who allow me into their homes each week.

I worked in a cardiac/medical ICU in June of 2020 after not having any patient-facing nursing work in years. I saw firsthand what the COVID virus did to patients and families. Using the best evidence-based practices, I became part of a health system that tried everything to keep people alive. I began to question what I was doing in that setting. We were keeping people alive even when there wasn’t much more that could be done to heal them, and it was hard. It felt unkind. Some families kept people alive even when there were no more options, and my co-workers rumored that they did it for the financial benefits or religious reasons. I witnessed people dying alone while the country was under quarantine. Loved ones were not allowed to visit the sick and dying. Knowing that families were on the outside of the hospital, wanting nothing more than to be with their loved ones, was sad. The hospital staff could not always be in the room with the patients because they limited exposure. I would watch heart rhythms on the monitor like a TV show, waiting for the rhythm to change to a flat line showing they had passed. These kinds of events took their toll on me quickly. Therefore, I did not last long in that setting.

Now that I am working in hospice, I offer different care. Patients and families have decided to end treatments, thus making a conscious decision to use hospice benefits. There were many amazing stories of recovery in my short time working in the ICU of the people who lived, who made it out and could live a relatively “normal” life again. But the ones whom we couldn’t help, are the ones that touched me most. Nowadays, I get to spend time with patients and families in the last months, weeks, and days of their lives, be a part of the significant passage to their end, and do it in a thoughtful, kind, and compassionate way. Just being there to reassure, educate and bring presence to whatever is happening in their lives—no longer fighting against the situation that presents itself to them like in the ICU, by allowing life events to flow as naturally as possible.