from this side of the white coat...

I'm beat. Today was my fourth day in a row. For those of you with normal jobs, you're thinking "and?" Dialysis, hell, patient care in general, is not a normal job. Between work and school I'm exhausted, burnt to the core.

So tomorrow my co-workers and I are preparing ourselves for a sad and uncommon event. We have a patient that has been on dialysis with us for literally almost as long as I've been alive. She is this divinely kind, gentle, and loving creature, and we all adore her. She's basically the night shift's grandmother. She is so full of peace and light, I've begun to wonder if she isn't an angel. I've never met another person like her. None of us have, actually. Well, for the past few months she has become sicker and sicker. For a while we thought she'd get better, then we started to worry she wouldn't. And she hasn't. She has been suffering for a long time now, and she has decided that before she gets worse, loses more quality of life and more independence, she is going to discontinue dialysis. With the exception of a very few anomalies, patients that discontinue dialysis will die, usually within a couple of weeks at the very most. Older, sicker people make it hours or days without a treatment. Tomorrow is this patient's last treatment. After nearly 20 years she won't be coming back anymore. This is such a momentous occasion we've been getting phone calls and visits from people that don't even work there anymore. It's so strange to talk with someone about their death when we both know it's only days away. She is going into it with her eyes and her heart wide open. It's bizarre, really. Most people that know roughly when they will be dying are either suicidal and as such not worth discussing or are terminally ill and are either too sick to talk to anyone or are too sad, scared, miserable. And understandably so. But my patient talked to be about it yesterday, as if we were talking about...I don't know, anything. She said that she was really going to miss everyone, that she was terribly spoiled to have all of us. I asked her is she was okay with it all, even though I knew she was. She said "I'm really looking forward to feeling better. And it's a new adventure, I've never died before!" Can you imagine? I am so accustomed to people who cling to life not because they want to, not because they have even a shred of quality of life, but because they are terrified of death. They fight it for months or years, suffering as a result. I have never encountered what I am encountering with this patient. She has a large, wonderful, totally devoted family, a life that she works to remain active and entertained in. And she succeeds. She has more than I have by far, more than I probably ever will have, and she is not clinging to it. She loves it, don't get me wrong. She loves her family very, very much and she loves life in general. But she does not want to torture herself or her family. She wants quality over quantity and she is going for it. It's like although she's very sad to be dying, she's not afraid, she's looking forward to a new adventure like she said. I don't know, I can't even explain it. It's just such a strange thing, planning for a death like this, having the chance to say everything you want to say, knowing exactly the last time you'll see a person. I've certainly never had that experience before. And to be able to speak so openly about it with the person... It's cool, it's like a rare glimpse into something you really never encounter until your number is the one that's up. *smile* She's so open, so fearless...it's incredible.

So here's my closing thought...or hers, actually. As she lay there last night in her treatment chair, obviously miserable, she smiled up at me and said "life is beautiful, isn't it?"