By Peggy Hendry
When I was a hospice social worker I went to a lot of funerals, but I cried only at one.
It’s acceptable for hospice staff to have tears in our eyes sometimes. It shows that we have compassion for our patients and their families. People can sense a lack of compassion and that, I believe, does them harm. But, to survive, we also have to find a way to stay calm amid all the suffering we see. Healthy detachment is as necessary as healthy compassion.
At Ruth’s graveside, I lost the balance between the two and broke down in sobs. That was not OK, not OK at all. In fact, crying like that was unethical because it took attention away from the grieving family. I was supposed be there to support them, not for them to support me.
Ruth isn’t her real name. I choose to call her Ruth because of her faithfulness, and her willingness to give her all for the people she loved.
When I met Ruth, the cancer that had started in the left corner of her mouth had eaten her face in a half-inch radius around that spot, exposing her teeth and gums.
That day she said to me, “I’m the same person I always was.”
So, I focused my time with her on reinforcing that she was the same person and much more than her current appearance.
During my weekly visits, Ruth told me the story of her life. As a child she was a tomboy. She played ball with the guys and joined in their Halloween pranks. When she grew up, she became a nurse. She enlisted in the Army during World War II, despite—or maybe because of—knowing that she would leave nursing, marry, and have children when her fiancé came home from combat. But the next time she saw her beloved, he was a patient in the Army hospital where she worked, and was horribly injured and significantly disabled. Everyone—her parents, her friends, even the man himself—said she should break off the engagement, but she was adamant. He was the man she loved and she was “by God, going to marry him.”
The couple set up housekeeping in Tucson. Because her husband’s injuries prevented them from having children of their own, they fostered troubled boys. Ruth kept on fostering even after her husband’s death in his 40s. The stubbornness of her loving heart kept her gathering in boys until she was no longer physically able. Some of the young men went on to have healthy, happy lives and some didn’t, as is the way with human beings, but she gave each of them the best start she could.
It was Ruth’s lifelong habit of taking in strangers that resulted in her cancer going untreated until it was too late to save her. Because of her kind and trusting nature, when she got old she allowed a homeless man to live in her house. He not only exploited her financially but also failed to take her to the doctor even after her facial erosion became undeniable. I don’t know exactly how Ruth was rescued from him and taken for medical treatment, but I believe that the Roman Catholic Diocese got involved.
Ruth was a devout Charismatic Catholic and believed that any illness would be cured if she just had enough faith. Throughout her decline she refused to believe she was sick. It’s possible, though I can’t know for sure, that this might partly have been due to the cancer invading her brain. At any rate, whenever her cancer cost her something she loved— like being banned from the public swimming pool because of her open wound—she would ask me why and I would say it was because she was sick. Every time this happened, she would look at me with her sweet brown eyes, still the same above the ruin of her face, and say, “Am I sick?”
One of the things I did to reinforce Ruth’s personhood was to kiss her goodbye each week on the steadily-decreasing skin above the growing vacancy where her cheek used to be. I wanted her to experience some physical contact that was not happening because of hands-on personal care.
Those kisses on her cheek would have cost me my social work license if anyone had reported them. Such physical contact is considered unethical, too.
I believed that providing Ruth with a moment of physical affection made her feel like a whole person. I could see her blossom when I did it. So, I chose to ignore the social work ethic that outlaws skin-to-skin contact.
As the cancer ate more and more of Ruth’s face, her speech became much more difficult to understand. Because I saw her every week, because she told the same stories over and over, and because I listened for a living, we could still have conversations as her vocal deterioration worsened.
The last time I saw her alive, she said, “Ehl ee aow ee,” which meant, “Tell me about me.” I told her every story she had ever told me, while she sat in her wheelchair, rocked with laughter, and hit the arm of the chair in glee.
“I will remember you,” I said. “I will never forget.”
One of Ruth’s foster sons and his bride had come back to Tucson to be her caregivers when the homeless man was evicted. After her death they threw an old-fashioned Irish wake, with her closed coffin in the living room.
It wasn’t until they played “Taps” at Ruth’s graveside service that I broke down, not into tears alone, but into the kind of sobs that close your body in around your heart and make you almost double over. I was horrified, but I couldn’t stop. I thought of bolting for my car but decided that would make the situation even more about me.
So, I stood there and cried. I cried for the tomboy who spent the end of her life in a wheelchair. I cried for the destruction of her face, and because she had been banned from the swimming pool. I cried for the wartime nurse, the faithful fiancée, the mother to every boy who found his way to her door. I cried for her stubbornness and her loyalty and her unswerving devotion. I cried because I loved her.
I had never cried at a patient’s funeral before and I never cried at a patient’s funeral again. Only for Ruth. Only for her.
Was I an unethical social worker? Did kissing Ruth’s cheek do her some kind of psychological damage? Did crying at her graveside harm her son and daughter-in-law? I don’t think so. I would have preferred not to make a scene at her funeral, but I don’t regret giving my love to someone who had given her love to so many.
With Ruth, as with any other hospice patient, I used whatever action I believed would do the most good and cause the least harm. And the people who made the rule banning physical contact were not (as is so often the case) the ones doing the work, so they had no way to understand that sometimes human touch is the intervention that is most needed by people in pain.