Something I love about my job as a hospice nurse: there are many opportunities to be surprised. One of my daily mantras is “expect the unexpected”. As I drove down a switch-back gravel drive in the middle of nowhere, I pulled into a driveway and there in a sun-warmed grassy yard sitting perfectly still on a garden swing among buzzing bees and newly bloomed flowers was a fellow in a crisp white shirt, a matching white cowboy hat, black leather boots and a crooked smile. I stepped out of my car and told him for a moment I thought he was the garden scarecrow, until he tipped his hat. He laughed jovially and announced, “I’m Billy”.
Yes, of course, I thought, you are my patient… though you look the very picture of health and personifying, in fact, living while dying. He shooed chickens away as we went inside to talk about hospice. While we talked over the next hour, I heard some of Billy’s cancer horror story. None of us forecast hearing the word cancer during a routine check-up, and especially when the expectation is to get a prescription for a recurring infection and not be back in the doctor’s office till next year. For Billy, intertwined in the stark unfairness, chemotherapy failures, and overwhelming life changes was an underlying humor that buoyed his speech and infected the room. Just as one of the nurses who knew the family well had predicted, I was taken in. This man, and his caring hoard, would “get under my skin”.
And as I got to know him better, I couldn’t help but rail sometimes as an observer of life’s injustice. Just when you have figured some things out, just when you have changed for the better, just when the garden is ripening and life seems to be travelling in a more fulfilling, rewarding direction… Billy tells me, “When they get sick of me, I’m taking a bus to L.A.” (We laugh together when I recommended a very bad neighborhood). He and his wife joke about recent quarrels, “Who gets the walker?”
He has the most adventuresome bucket list with things like a trip across country, hunting with his brothers and fishing in Alaska planned, even though the oncologist ominously recommended “getting things in order” and answered the “how long” question with “maybe a couple of months”.
Billy is a constant reminder that attitude is everything. As I get to know Billy, I recognize some of his blustering and joking camouflages an underlying fear of what it will be like, in the end. We have some conversations about what this means for him. He worries he won’t be kind to his family or that he will be the cause of additional guilt and suffering for them. He shares one of the most common fears I hear, that he “doesn’t want to be a burden”.
Billy, like all of us, owns a story that isn’t all laughter, and he spends some time in the end sorting through some desolate memories and letting go of the regrets he wears like a jacket. His wife assures him that love will cover the messy parts of dying, and his family members are not burdened but in fact they feel privileged with sharing these final days of his life, whatever that might look like. (They were in fact some hard times for everyone.)
And in the end, what really didn’t surprise me too much was that Billy managed to complete his entire bucket list and die with his boots on, so to speak, catching everyone a little unaware, but going out with great style.