The Hummingbird

DEDICATION

In memory of Melissa Millan

CONTENTS

CHAPTER 1

ALL I KNEW
at the beginning was that the first two nurses assigned to the Professor had not lasted twelve days, and now it was my turn.

When I drove to Central Office that morning to collect his medical records and case-management plan, I also checked the staffing file to see who had bailed on the old guy so quickly. Or maybe he had bailed on them.

Timmy Clamber was first, and a short stint for him was no great surprise. Sure, Timmy was the most medically skilled person on the agency’s home-care team. A lightning-fast diagnostician, he had worked for years as an EMT before deciding that hospice was his calling. But Timmy was also flamboyantly gay, his manner almost aggressively feminine. Some clients loved it: the perfect physique, the bitchy humor. Clackamas County’s wealthy women, when their time came, knew to ask for him by name. Once I was standing in the hallway and overheard him promising a client that he would not let anyone into her room at the end until he’d arranged her wig perfectly.

“Darling, I will take it as a personal failure if every person who sees you does not shrivel with envy.”

The woman in the bed, a sixty-nine-year-old with the wispy locks of post-chemo regrowth, gazed at Timmy with unconcealed adoration.

Obviously that style would not suit everyone. I opened the file to Timmy’s notes, the hasty scribbles of a man who hated paperwork because it took time away from providing care. The patient was Barclay Reed, white male, seventy-eight, primary diagnosis of kidney cancer, with advanced metastatic tumors in liver, right femur, and right lung.

“Ouch,” I said aloud. But I glanced around, and no one else had come into the cubicles yet that morning.

From the one wall of Central Office that was all windows, I saw a beautiful Monday in June, glorious sun after three days of drenching rain. Only a woman eager to get out of the house would arrive at the office this early on such a day. Someone who found work a welcome escape from difficulties at home. Someone like me.

The file said eight days, so the Professor’s decision to fire Timmy had not been immediate. Maybe it hadn’t been a culture clash at all. Whatever the reason, why the office sent Sara Schilling next was a mystery.

It’s not that I didn’t respect Sara. On the contrary, when my time comes—may it be many decades from now—I hope someone just like her is at my bedside. She was the embodiment of devotion and care. But like all saints, Sara was an innocent. I would have said that such an attitude would be impossible to sustain in our line of work. Seeing mortality confirmed on a daily basis will make a realist of anyone. But Sara had somehow managed to work in hospice for ten years and remain unmarred.

Years back I spent six months on central staff, trying to win a promotion to management by handling the necessary but dull work of resource planning. Every day of it I missed the patients and families, their pains and predicaments. Finally I quit seeking advancement and went back to doing what I loved. But in those office-bound days, Sara came in each morning humming a little tune. She’d switch on her computer, and while it booted up, she would turn to me—even if it was the tenth consecutive day of funereally depressing Oregon downpours—clasp her hands together and declare, “What a beautiful day to be alive.”

Sara had a pink cover for her cell phone. She decorated her cubicle with posters of cats hanging from tree limbs. At home the woman had six pet birds, named after each of the Seven Dwarves except Grumpy.

Of course there will be clients who find this sort of personality cloying. Where it matters though, in caregiving situations, Sara was more patient and comforting than I could ever hope to be.

Once I was called in to help with a difficult case, Alan, who had tumors the length of his spine. As they grew, they were cracking his vertebrae. Suffering on that order I would not wish on an enemy.

Managing Alan’s pain was challenging for Sara, which is why Central Office asked me to assist. I guess that’s my strong suit—reducing pain, I mean—which reveals more about me than I might immediately care to admit.

No surprise, Alan’s decline was driving his family into conflict. They were all loud, big people, the women bosomy and round faced, the men bearded and grim. They shouted for conversation, let their cell phones ring and ring before answering, left the TV turned up too high.

But of course the hearts of people like this break just like anyone else’s. Their father was nearing his final hour, as we were titrating morphine to see if we could mute the pain without making him unconscious. Meanwhile, we could hear everyone bickering in the living room at full volume. Someone in the kitchen slammed a drawer, and I saw Alan wince.

“I’m tempted to go out there and slap sense into someone,” I muttered. Whatever my skills, I was still plenty capable of running out of patience.

Sara smiled at me, her freckled face drawn in at the cheeks. “I know you don’t mean that,” she said. “But I can see how you would feel frustrated.”

Ah, the forbearance of the hospice worker, wonderful and annoying.

Sara went to the doorway, hands clasped just like at her desk in the morning, and cooed, “Excuse me? Excuse me, everyone?” It was like a dove flying into a den of bears; I was ready to see the feathers fly.

But she spoke so softly, everyone had to hush just to hear. “I’d like to invite you all in now. He’s ready for visitors. I invite you to honor your father by joining hands around his bed. Perhaps there is a song he likes that you all might gently sing.”

I could never get away with being so directive. In a crowd like that, I doubt I would even get everyone’s attention. But with Sara it worked. They rose as one and moved in her direction. Temporarily at least, she had ushered them from one stage of grief into the next. Not easy.

By the time I’d packed my gear, they were sardined into Alan’s bedroom, holding hands or draping meaty arms over each other’s brawny shoulders, and singing “You Are My Sunshine” in surprisingly good voices—to a man so riddled with illness the song probably felt like heaven already.

YET THE PROFESSOR’S FILE SHOWED
that Sara had lasted only three days. There was no mention of the cause, nor any complaint. In my opinion that woman could charm a box of rocks for three days, and he had jettisoned her like snapping his fingers.

I flipped through the file to her notes. Sara used a fine-point pen, with tiny lettering right to the margins, so that she occupied no extra space. Barclay Reed, no surviving family, tenured professor at Portland State University, nationally recognized expert on World War II.

That explained Timmy’s short stint, anyway. I pictured some gung-ho former Marine taking one gander at his male nurse’s dangling earring and “All Love Is Good Love” forearm tattoo, and requesting someone else. Likewise, maybe Sara’s sweet nature, while often effective, proved too saccharine for him.

I read deeper in the file and discovered something more: We were his third home-health agency, and there were only three in the region. He had churned through both the others before coming to us. I imagined one discarded caregiver after another. Now he’d come to the end of the line. If Barclay Reed wanted hospice care, we were his last chance.

So why me next? Everyone knew Grace Farnham was the diplomat, the champion of tough cases. A dignified African American woman with divinity school courses on top of her RN, Grace had a southern baritone so oratorical she could read a list of prescriptions and it would sound like gospel. Normally if someone can’t find a satisfactory nurse, Grace is the answer to their prayers, not me.

She must have been assigned to someone actively dying, so Central Office would not pull her from the case. Nothing is harder on a family than a caregiver’s departure after weeks or months of sharing the challenging work, with a new face arriving to learn the issues and personalities just when no one has the patience left for it. One policy of our agency’s service I respected most, even though it sometimes ruined a weekend or birthday or Christmas, was its commitment to avoiding revolving doors.

After all, the medical part is just the beginning. Getting breathing comfortable and pain under control only enables the nonclinical things to take place—offering apologies, granting forgiveness, whispering prayers, expressing love. Once a patient and family have come to trust their hospice worker, they deserve to have that person help them for the whole hard ride.

Therefore, me. In addition to pain relief, I am known for sticking. For staying. For never giving up. It wasn’t true only of patients but reflected my whole life. Especially in those days, when anyone within twenty miles knew what kind of marriage I had been dealing with since Michael came home. He wasn’t a husband; he was a hand grenade.

People were sympathetic, but they sure stopped inviting us for supper. And I dropped all the healthy habits I’d developed while he was gone: the monthly book group with plenty of wine, the Sunday-evening yoga class, and once in a great while joining my girlfriends for a night of dancing to eighties hits at a club in Portland’s southwest corner. Michael’s anxiety, in that kind of crowd and noise, would register on the Richter scale.

Not that my husband was violent. But the energy he gave off—that he was suppressing an urge for violence, resisting the temptation—was somehow scarier. If he had taken up boxing, I could have relaxed, oddly enough, knowing he was expressing his grief and rage physically. If he had gone back to working out, so that I heard the clank of metal from the basement as he lifted weights till his muscles failed, and came upstairs calm and grinning from endorphins, I would have known he was on a healing path.

But there was no boxing or lifting. Only pursed lips, a furrowed brow, and a temper about the length of a firecracker’s fuse.

In my own defense, I say only that caregiving never felt like sacrifice to me. In fact, it usually made me feel so good that I believed service was its own reward. I am not suggesting there was no limit to what I could endure with Michael. But I believe the measure of a vow does not lie in saying it, or in upholding it when things are easy. The power of a promise is proven in times of difficulty, when keeping that pledge is hard. My husband was giving me ample opportunity to prove the strength of my vows.

The office clock chimed seven, which meant Sara would arrive soon. Happy to chat, dear, but not today. I arranged the papers on my desk, weighting them in place with a name plate my husband had made for me out of bumper chrome when I’d finished school: Deborah L. Birch RN MSW. My handprint stood out on the gleaming metal, so I wiped it with my sleeve.

Then I packed my car with supplies—pain meds, an oxygen tank—and returned for the paperwork. As always, the last thing I did before leaving the office was run my thumb down the back of the hummingbird.

It was my ritual. Years ago, a patient named Ryan carved the bird while he fought end-stage emphysema, always tucking it away when I made house calls. Ryan lived with the anxiety anyone would experience if they can’t get enough oxygen, so I cringe to think how much the knife work must have cost him in hours and energy. But on the last day, there it was at his bedside—with a slip of paper that read “For Deb”—a fine carving with a four-inch wingspan, meticulous feathered details, a tiny eye on each side of its skin-smooth head.

Was my patient saying that the Grim Reaper is beautiful? Or was he mocking death, making a last carving about speed and flight? Was the hummingbird a symbol of life’s unstoppable force, because the art will outlive the artist? I’ll never know what Ryan intended.

But it almost doesn’t matter because the carving has a strong and specific meaning to me. It is a solid reminder that every patient, no matter how sick or impoverished, gives lasting gifts to the person entrusted with his care.

If that sounds grandiose, so be it. Because I sweep my thumb down the back of that bird before each new patient, and not for good luck. I do it to remind myself that I receive something meaningful from every person. I gain much more than I give.

ON THE WAY TO THE CAR
I checked Barclay Reed’s address: Lake Oswego. That was convenient. The lake sits a few miles outside Portland, not far past my house. Our house, that is, mine and Michael’s. Oswego is an interesting place. It’s clean, man-made because it’s a reservoir of some kind, and there are pleasant waterfront restaurants at one end. Pretty and friendly.

But so is the high school cheerleading captain, until you cross her. Lake Oswego is actually a closed place. Every inch of lakeshore has a home on it. They’re not mansions, in general, more like small works of architectural art. And there is no fence to keep people out. It’s more subtle than that: no boardwalk, no beach, no shady cove with public access. Any open lawn is adorned with a T
RESPAS
SERS
W
ILL
B
E
P
ROSECUTED
sign. Lake Oswego is a perfect little body of water, and perfectly private.

So even though I’d enjoyed a sunset margarita on the restaurant decks, and strolled the farmer’s market on summer Saturdays, I had never dipped one toe in that water. The patient’s address left no doubt about where his house stood: South Shore Boulevard. With a little luck, Mr. Barclay Reed had a dock. With lots of luck, he liked swimmers.