A Strong Dose of Empathy
The window shades are drawn against the afternoon sun, filling the house on Woodley with evening light. A china cabinet in the kitchen dining area is Scotch-taped with photos of the infant great-grandson, and on the table three bananas and a pear ripen in an aluminum pie plate.
From the bedroom down the hall comes the soft whimpering of the dying woman. They are the only responses she can manage to questions about the few remaining issues in her 77-year-long life--the level of pain, the inability to breathe comfortably, the need to be turned in bed.
The questioner is Shirley Toews. She is a soft-spoken woman of 25 who has found her place in life, and it is cheek-to-cheek with death.
Her surname rhymes with “saves.” As a nurse working for Tender Loving Care Home Hospice, she helps the end-stage terminally ill preserve what dignity they can as, in the familiar setting of home, they make their exits. She strives also to salvage, from the flood of anguish that often swamps the families of the dying, a calm acceptance of what must be.
As they emerge from the bedroom, Toews is telling the woman’s 77-year-old husband, “I’m going to call and get oxygen sent here today because of her trouble breathing. Also, you need to remember at 2:30 that it’s time to turn her again.”
The man, who is tall and bald and stricken by what’s befallen his wife in the five weeks since pancreatic and liver cancer sentenced her to her bed, nods and repeats, “two-thirty.” They have been married 48 years.
“I look in on her every 20 or 30 minutes, just to see if there’s anything I can possibly do for her,” the husband confides. He and his son, who’s come in from New Jersey, are frequently at a loss in their urgent desire to help. “I think we suffer terribly because of it,” he says. “I don’t know how to cope. Sometimes I just have to take off and walk out to the garage.”
The night before, he made soup for her but couldn’t get her to eat it. And this morning he was unable to get her to open her mouth to take some of the ice chips she usually welcomes.
“I know she understands and hears what I’m saying, but I think she’s rejecting the help I’m trying to give,” he says. “I was hoping she’d pull out of this and we could get everything back to where it was. I can see now it’s not going to happen, and it’s devastating.”
Toews embraces the man and takes her leave, reminding him to page her if he has any questions. Tender Loving Care nurses are on-call around the clock for telephone consultations and emergency visits to their patients. At present, Toews has nine patients, whom she visits twice a week, unless she’s needed more often. On days she doesn’t call, her patients are seen by TLC hospice volunteers and social workers.
“This family is hard for me” she admits, driving her old gray Taurus north toward another appointment in Mission Hills. “I’m getting attached to them. She’s a wonderful woman, and it was just a few days ago that she stopped communicating. And it wasn’t until last week that her husband realized that she isn’t going to make it.”
It’s curious, Toews says, how often the dying will linger until they’re sure the people they love are ready. “The family very often has to give them permission to die.”
In her 2 1/2 years as a nurse, Toews has worked in urgent care and at a convalescent center. She became a hospice nurse just three months ago, and believes she’s found her professional niche, where a premium is placed on calm demeanor and natural empathy.
From the score or so of her hospice patients who have died, Toews has gleaned a few lessons. “It’s taught me a lot about the importance of family and togetherness and of making decisions ahead of time, so that when you’re in a crisis you can make it through together. It’s really brought me close to my family. I talk to my parents now every day.”
Toews pulls her car to a stop in front of the home of Henry Rubanowitz. Here Rubanowitz’s sister, 83-year-old Frieda Schwartz, is passing her last days amid an unbroken flow of relatives and friends.
Schwartz, feet up in an easy chair, is a tiny woman with the false tan of jaundice and the eye-shine of wit. A payroll clerk for Warner Bros., long retired, she wears a flowery blue shift and small white terry cloth slippers.
Her pancreatic cancer was diagnosed in July and she is becoming more of an invalid by the day. Having eschewed treatment, she is accepting of her fate. She is even eager for it.
“I’m almost 84 years old--how much longer can you live?” she says in a high, strained voice, flipping her hand dismissively. “I’ve had 84 good years and to go on and on and on like I am now doesn’t excite me. So, I am ready to go. My climax will be to go off into the blue yonder. To curl up and leave this world very calmly.”
Toews examines Schwartz and questions her about her pain and her appetite, caressing her narrow ankle as she talks.
“I’m sure glad you’re here,” Schwartz says, then turning to her visitors, adds: “She’s the only one who understands me. She looks like a goddess when she comes into my room.”
Schwartz’s great-nephew, Dan Rubanowitz, and his wife, Teri, are visiting. They are expecting a son, their first child, within the month.
“The baby’s coming in a couple of weeks, Aunt Frieda,” Teri reminds.
“I’ll be here,” Schwartz nods.
“Yes, you’ll be here.”
“I want to meet him--so then I can get out of here.”
While Toews is completing her examination, she gets an emergency call from the house on Woodley.
The woman there has stopped breathing. Toews must return immediately.
In a few minutes, she is heading south on the 405 Freeway, gathering herself to be a compassionate, steadying force, in case the family is coming undone with grief.
Of course, the woman may be having only a spell of apnea, a temporary cessation of breathing. One could hope. “But if she has died,” Toews says, “she wanted to be home as long as possible, so she got her wish.”
Toews shoulders her blue backpack, hurries up the front walkway, and enters the house.
The family is sad but calm. The woman isn’t there anymore.