Ruth Herne - Winter's End

“It’s comfortable for Dad.” Face taut, he headed into the kitchen. Kayla followed as he tugged the collar of a black turtleneck layered beneath a green plaid flannel. The inside temperature was a little much for his mode of dress.

Kayla understood. End-stage patients often suffered effects of temperature. Extremities chilled, causing discomfort. She glanced around the kitchen.

The room lay spare, like the entry, but neat other than some breakfast clutter. Old-style, glass-fronted cabinets marched in formation around the upper level, offset by wood-fronted, thicker partners below. The cupboards wore a soft shade of green, faded with time. A chipped but uncluttered laminate counter met a backsplash of ivory tile. The effect appeared old and utilitarian, but cared for.

A man’s house.

Kayla glanced up at the disgruntled man nearby. A big guy, about six feet and one-eighty, she wondered if he meant to intimidate her. If so, he was doing a good job. She hoisted her work case, determined to make nice. “Would you like to talk first, or introduce me to your father?”

His facial shadows deepened. A muscle in his right cheek twitched. He worked his jaw, then grimaced. “Dad’s through here.”

Thank you, Mr. Congeniality. Kayla followed him through a dining room into a small bedroom beyond.

A hospital bed dominated the space. The patient opened his eyes as they approached. His look darted, confused. Sighing, he settled into the pillow.

Dreaming, Kayla decided. Normal sleep or drug-induced, she couldn’t quite tell, but the startle-awake reflex was not unlike a newborn. Cradle to grave, full circle.

“Your nurse is here.” The son’s tone left no doubt she wasn’t here by his grace.

Kayla bit back a smart remark and focused on the sick man. She approached the right side of his bed, cheerful. “Mr. DeHollander?”

He nodded. His eyes cleared somewhat. “Yes.”

She broadened her smile. “I’m Kayla Doherty from Visiting Nurse Service. Dr. Pentrow requested our services. Did he explain that to you?”

The older man glanced Marc’s way. “He told us, didn’t he, Marc?”

Gone was the look of antagonism that greeted Kayla’s arrival. Marc leaned down and brushed a thin lock from his father’s brow, his big hands gentle against his father’s pale skin. “He did. And a home health aide to help out.”

“Having people come to the house could get expensive.” The dying man sent a look of concern his son’s way. The bottom line had obviously ruled his decision making a long time, a concept Kayla comprehended.

“Your insurance covers both, Mr. DeHollander.”

“Does it?” His frown deepened, trying to reason things out.

“Have you had pills this morning?” Kayla inquired. She angled her head and waited for his response.

“Yes,” Marc answered, but didn’t meet her eye. “Around five-thirty. I gave him two of these.” He reached across his father’s bed to hand her a bottle.

“You started this yesterday?”

Mr. DeHollander frowned.

Marc nodded. “I picked it up around four when I went into town to get my sister,” he explained. This time he looked at her. “Is it the right stuff?”

“Yes,” she confirmed. “It’s a hydrocodone and acetaminophen mix,” she continued, including both men in her explanation. Successful hospice care meant developing a strong working relationship with the caregivers and the patient. At some point the patient would likely lose the ability to participate in his/her own care. A satisfying hospice experience blossomed from establishing good rapport all around.

Kayla was good at working both sides of the bed, and that made her an effective hospice nurse, a fact she’d realized during her first years in the North Country. One of her hospital patients had brought her to faith, to hope, and eventually to her present gig.

She raised the container. “Effective for moderate pain. Side effects generally ease after a few days.”

“Side effects like…?” Marc’s look sharpened. He glanced at his father, then back to her.

Kayla addressed her patient. “Sleepiness. Confusion. Dreams.”

Her list relaxed Pete DeHollander’s features. “All of the above.”

Glad to have relieved his mind, Kayla offered a proposal. “Since you just started this, I’d like to see if the side effects level out. They usually do as the body acclimates. Can we try that, Mr. DeHollander?” She posed the question with a look of inquiry. “I don’t want you to think this is an automatic trade-off. Less pain for a state of confusion. We have lots of things at our disposal. Your care will be based on what works for you. Adjustments in meds are common.”

He contemplated her words, then looked at Marc. “I’m not thinking too clear,” he admitted. He fiddled with the uppermost blanket, nervous. “What do you think?”

Kayla met Marc’s eyes across the bed. She read the look in them. His expression offered resignation and little else. He’d do what he had to do, but it was plain he didn’t like the choices. Whether his unease stemmed from the question or the situation, she had no idea. His gaze narrowed. “If we keep Dad on this medicine, the side effects might clear up?”

“Yes. If they don’t, I’ll call the doctor and we’ll modify the meds. Our goal is to provide sufficient pain relief with minimal side effects.”

“And it can be done?”

She scrunched her face and offered Marc a firm nod. “Absolutely.” She hoisted her tote onto a side table. “I have an amazing bag of tricks, gentlemen.”

The old man smiled. When he did, his gray-green eyes sparked with life. For just a moment, Kayla envisioned the man he’d been before his long battle with cancer.

Her throat tightened. She controlled the impulse to sympathize too much by dragging a chair alongside the bed. “You boys could at least ask a girl to sit down.”

The old man looked affronted by his carelessness. “I don’t know where our manners have gone,” he exclaimed, surprised.

Marc’s look hardened. He kept his eyes trained on Kayla, studying her. Fighting the rise of negative emotion, she addressed them both. “We should talk. I want you to know what to expect of me, what kind of care I’ll be giving and what choices you have.”

“Do those choices include a nurse who isn’t afraid to get dirty and knows enough to wear sensible shoes midwinter?” Condescending, Marc swept her pert, polished nails and well-fitted blazer a look of disdain, his expression intimating she didn’t have enough muscle to get the job done.

Ouch. The young farmer’s cutting appraisal hit home. Striving to remember why peaceful conflict resolution was a good thing, Kayla faked a look of calm. She’d dealt with antagonistic families before. His anger wasn’t all that unusual. Death managed to bring out the best in some people, but that wasn’t a universal reaction.

She kept her voice confident, but didn’t negate the hint of challenge in her reply. “We have a group of hospice nurses, male and female. We work individually, concentrating on specific cases. But—” she added, strengthening the note of reassurance “—someone is always on call so there’s no lapse in service.” She addressed her words to the older DeHollander. “If your nurse is off or away, you’ll still have help regardless of the day or the hour.”

“Makes sense,” the older man agreed, his expression serious but accepting.

“Of course you can request a different nurse,” Kayla continued. Her gaze encompassed father and son. “That’s not a problem, because your nurse acts as your case coordinator, overseeing all aspects of your care.” She turned and met Marc’s eyes, unflinching. “Facing the loss of a loved one is difficult enough without personality clashes making it worse. Our job is to make things easier for you, Mr. DeHollander.” She shook her head. “Not rougher.”