Every Monday, at about 4:30 p.m., I depart from my law office in Rincon Center for Laguna Honda Hospital, where I serve the evening shift as a volunteer in Ward C-2, the hospice. As I reach the crest of Market Street, as it turns into Portola, I pass through a veil into a world of heightened awareness, consciousness and caring.
Laguna Honda is a public hospital, serving San Francisco's impoverished, dispossessed and disenfranchised - those who have outlived their families, the homeless and recent immigrants, legal or not.
In C-2, there is a tremendous sense of community amongst the staff, volunteers, the 26 residents, their families and friends. Ours is highly transient community. Our residents generally survive for only weeks, sometimes months, and occasionally, for years. In all of this transience, there remains an environment of caring and reverence, for both life and death. It imbues C-2 with a sense of openness, awareness, resilience and love.
About two years into my service, I knew that I wanted to integrate the extraordinary C-2 environment into the rest of my life. While I had entered into the hospice service to better understand death and care for others, I was receiving an extraordinary gift of insight and awareness about everyday life from my volunteer service that I wanted to share with the "outside world."
In 2006, I began writing stories about the residents whom I had served. Based on those stories, in early 2007, I began speaking to people in the legal and business communities on "Lessons for the Living." I revealed what my hospice experience had taught me about change, control, perception, discovery and human relationships, and how those lessons were invigorating and enriching my life and the lives of those around me.
I also would tell audiences how these lessons had changed the way I practice law. This often was met with skeptical looks and requests for elaboration. Just two weeks ago, I received a forceful reminder of this connection. I thought that it might be worthy of sharing with you.
Victor had arrived that Monday afternoon, shortly before me, from San Francisco General Hospital, where he was being treated for complications arising from end stage AIDS. Victor was a Mexican immigrant to California. He appeared to be in his early 50s. We were informed that Victor was extremely restless and already had thrown himself out of his bed twice. The nursing staff requested that the volunteers sit by his bedside to secure him from injury. It was not unusual to see new arrivals, agitated and confused. We often would sit with them as they acclimated to their new surroundings. Victor had been prescribed a sedative to reduce his anxiety, but it could not be administered until after his evening meal. As volunteers, we have no directive as to whom we attend during our shift. But, upon hearing of Victor's plight, I offered my evening to him.
As I approached his bedside, I saw his suffering. The head of his hospital bed was raised at a 30 degree angle, but Victor was uncomfortably slouched at the bottom of the incline. Victor's body presented a Hieronymus Bosch-like image from The Last Judgment. An orange sweatshirt with hood was fitted too tightly around his neck. The garment body was twisted tightly to the left of his upper torso. His exposed abdomen was distended by the gases and accumulated fluids caused by his rapidly failing internal organs. His sheets and blankets were twisted amongst themselves and again around Victor's upper body, waist and legs. His diaper rested uselessly up on his upper thighs, exposing his buttocks and genitals, as he convulsed on his bed.
I considered our prime directive to prevent Victor from throwing himself on the floor. But I also considered what more that I could do at his bedside. I would attempt to disentangle him from the knotted mess of clothing, sheets and blankets. Once I disentangled him, I would try to get him warm. Then, I could ask a CNA (certified Nurse Assistant) to fit him with a new diaper. Maybe I could provide him some small respite from his arduous day.
But, all didn't go "according to plan." As I tried to disentangle Victor, he rolled around, while attempting to move his legs over the edge of his bed. I simply couldn't keep him on the bed, while attempting to disentangle him. Victor wasn't all that large, but even a small person carries considerable weight and power. As time dragged on, I found myself more wrestling with, rather than attending to, Victor.
I stopped a passing CNA to ask her about his sedative. She advised that Victor had refused his medication. I asked her if she would ask the ward nurse to join me at his bedside. The nurse joined me and again offered Victor his sedative, which despite his turmoil, he clearly refused. She rolled her eyes and said "Well, I can't make him take it." As the nurse left, I knew that I was in for a long evening.
For a few moments I just sat with Victor. I stopped wrestling with his legs. I watched him and quieted myself down. I began to see that I had not served him well. I had taken someone else's interpretation of his behavior as true. Maybe Victor was not attempting to get out of bed to escape the ward. His agitation might be arising from elsewhere.
As I sat with Victor, ignoring his thrashing legs, I began to see his great difficulty in breathing. I could hear his lung congestion and almost feel Victor's exertion as he tried to gather the oxygen needed to carry on. A few moments into my non-intervention, Victor was able to force himself up to a seated position. I moved my chair directly in front of him, bracing my inner knees against his outer thighs and gently resting my right hand over his heart, as he weaved in his now precarious seated position. An amazing thing happened. He did not resist my support, he welcomed it. He used his right arm to further brace himself, holding the bed's railing. As we sat, Victor relaxed. His agitation subsided. His breathing became more measured.
Breathing was what Victor's restlessness had been about. He was not "throwing himself out of bed," he was trying to sit up to gain more oxygen into his highly congested lungs. Alone, Victor did not have the stamina to remain upright. Consequently, he fell. We all had had the story wrong! I supported the upright Victor for about a half hour. When the nurse next went by, I asked her if we could move Victor to a Gerichair, a reclining padded chair, with a restraint device that would allow Victor to sit upright, but not stand. The nurse saw how Victor's restlessness had subsided. She told me she would need a doctor's order for the move, but advised that she would have it within a few minutes. Shortly, the Gerichair arrived. Victor was changed into more comfortable clothes and a clean diaper. He then was fitted with a crane-like device which lifted him from the bed to the Gerichair, which then was wheeled down to outside the nurse's station.
It had been a hard afternoon for Victor, as he struggled with his breathing. But he now was comfortable. I sat with him a while longer as he further relaxed and eventually slept.
I was exhausted. But, I couldn't help but consider the lesson I had been taught that evening - a lesson which applies to my law practice and my life, in general. Sometimes we are asked to undertake an action based on faulty premises. If I am not fully aware of myself, my surroundings and the events transpiring before me, I assume what I have been told is the "truth". I forego the opportunity to test that "truth," to create solutions more consistent with my observations and experience. I make mistakes. In such circumstances, I must slow my mind, make space for new information coming my way, and check what that information is telling me. Sometimes it will confirm what I've been asked to do. Sometimes it won't.
Few of us operate at all times from adequate spaciousness and awareness. Regrettably, we often are so filled with reactive behavior that we fail to make important inquiries. I almost failed Victor. But, I caught myself. He died three days later. I was honored that, in a small way, I was able to help him.
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