Easing the Pain

Carol McCormick spends her days with the dying. She listens to their complaints and fears, eases their pain and watches them die.

Occasionally she cries, but mostly McCormick finds the experience a testament to human nobility. She is a hospice nurse.

“You just see so many courageous things that people do, [and] I get to see people doing really good things for people,” she said. “To me, it’s not depressing at all.”

She remembers the woman who left her home in Mexico to care for her dying sister. And the husband who helped his dying wife hold their 5-month-old twins in her weak arms. And the 69-year-old woman who endured great pain so she could keep painting until her final days.

Patients of the Livingston Memorial Visiting Nurse Assn. program, the Ventura hospice where McCormick works, have six months or less to live and have stopped seeking treatment for their diseases. This makes the role of the nurses particularly challenging, said Director Anne Moore.

“Most people become nurses because they want to help people. In hospice, we help people, but the difference is they don’t get better. They die. You’re always dealing with loss,” Moore said.

Some people associate hospice care with giving up hope, but McCormick doesn’t see it that way. It’s just another chapter in life when it’s particularly important to be comfortable, retain your dignity and continue doing what you enjoy, she said.

“[We’re] not focusing on the dying. [We’re] focusing on making this part of their living the best,” said McCormick, who learned to accept death in a positive way after losing her father and sister 20 years ago and her mother six years ago.

McCormick, 50, of Ojai has been a nurse for 17 years, but began working in hospice care five years ago. After 12 years as a manager in a hospital, McCormick said, she became frustrated by the focus on making money that limited the time she could spend with patients. She decided to work instead for a nonprofit agency and applied at Livingston.

Livingston was founded in 1947 to provide in-home care to the sick and frail in Ventura County. It now provides numerous services, ranging from physical therapy for rehabilitation patients to support groups for children facing the loss of a family member. The hospice program, which became Medicare-certified in 1987, provides physical, emotional and spiritual help for about 500 terminally ill patients and their families through a team of nurses, home health aides, volunteers and a chaplain.

McCormick, the mother of four and grandmother of four, said the emphasis at Livingston--where patients pay on a sliding scale based on what they can afford--is not on money, but on patient care. She earns $40,000 a year working a reduced schedule of four days a week and serves eight to 10 patients at a time. She can give them all the attention, medication and equipment she feels they need, whether they live in a trailer or a mansion, she said.

One recent morning, McCormick drove to the homey Ventura beach cottage of Patricia Tavernelli, whom she has been visiting since May. It was too hot for McCormick to wear her regulation white coat over a blue sweater and white pants. She pulled a backpack loaded with medical supplies and a briefcase filled with papers from her trunk.

She found Tavernelli, 69, painting small wooden birds at a table in the craft room at the front of her house.

Cancer had spread throughout Tavernelli’s body, leaving painful tumors everywhere. She sat in a wheelchair, having lost one leg to the disease. Breathing was a struggle and tubes carried oxygen to her nose.

Tavernelli was willing to tolerate more pain than many patients so she can be alert enough to continue her crafts, which had been selling. On a scale of 1 to 5, with 5 being the worst, Tavernelli can withstand what she considers level 2 or 3 pain, McCormick said. She refused pain killers that would diminish her ability to paint.

“Everybody has to go through this in their own way, and I’m there to support them in it,” McCormick said.

The veteran nurse is particularly skilled at this part of her job, Moore said.

“She accepts patients for who and how they are, and she doesn’t judge them, but helps them go where they want to go within their abilities,” Moore said.

McCormick sat down and discussed Tavernelli’s breathing, fatigue level and new sores. Then she took her patient’s blood pressure.

With the medical portion of the visit out of the way, McCormick leaned her tanned face close to Tavernelli’s and the two talked softly about Tavernelli’s crafts and how much better Tavernelli feels when she can get out of bed and work on them.

McCormick picked up a quilt hanging over a rocking chair and asked about it. Tavernelli explained that each of the women in her quilting group made her a square when she had her leg amputated and she sewed them together.

McCormick considers listening to such stories as important as any of her medical duties. Listening is the aspect of the job she enjoys most.

“Everybody has a different story to tell, and telling it is very important. That’s kind of what feeds my soul--connecting,” McCormick said.

She remembers one patient who each time she saw him repeated the story about the day his doctor looked at his X-rays and told him he was going to die. She figured he needed to keep telling the story until it finally sank in, so she listened attentively each time.

“Some people are angry. Some people are just not going to deal with it. That’s how they deal with it,” McCormick said. “I think the trick is to just meet people where they are.”

During her 20-year struggle with cancer, Tavernelli saw numerous doctors, specialists and nurses, but she never received such caring, individualized treatment until she contacted the local hospice, said her daughter, Cynthia Winstead, who moved in with her mother to care for her.

“She’s great,” Tavernelli said of McCormick. “I look forward to her coming, whether I’m in pain or not.”

McCormick hugged and thanked Tavernelli and then drove across town to visit Louise Hernandez. Hernandez, 87, was suffering from myeloma, a bone marrow tumor. She was new to hospice, and her grandson, Edward Hernandez, thought she was improving and perhaps should be pursuing treatment instead.

Louise Hernandez had been so exhausted that McCormick spent very little time with her. She began this visit by sitting with Edward Hernandez at a small dining table, on which sat a book called “Disease-Fighting Foods” and information on myeloma.

The doting grandson, who had a monitor attached to his back pocket so he could hear his grandmother at all times, reviewed the detailed log he had been keeping of his grandmother’s diet, activity and care.

McCormick walked down the hallway and found the bedridden Hernandez dressed in a pink nightgown, with a pink blanket and flowered sheets pulled up over her chest. McCormick greeted her patient, who automatically stuck out her arm for the blood pressure monitor.

The nurse asked Hernandez if she would like to go outside and see her tomato garden, which her grandson had been tending to during her illness. But the grandmother replied it would be too much. McCormick said her thank-yous and left.

Each visit takes a toll on McCormick.

“When I’m with a patient I feel like I’m giving my whole self to that patient. That’s exhausting,” she said.

In addition to her regular schedule, she works weekends once a month and is on call one night a week.

After an on-the-job auto accident in January, McCormick cut back her work hours and now swims each morning. During her August vacation, she spent five days at a Zen retreat and then a weekend in Las Vegas.

Taking more time for herself gives McCormick the strength to face each workday, whether it brings the joy of getting to know someone new or the sadness of losing a friend.

Three weeks after the visit with Hernandez, when McCormick encouraged her to look at the garden, the woman died. Hernandez’s grandson, who has since been assured by doctors that treatment was no longer possible, has come to accept that his grandmother was nearing the end.

And four days after the uplifting visit with Tavernelli, McCormick arrived at the woman’s home to find her patient couldn’t get out of bed. It took every ounce of Tavernelli’s energy just to open her eyes and whisper a few words. A weekend hospice nurse returned through Sunday, when Tavernelli died with her three daughters at her side.

McCormick heard the news the next morning when she called into the office. She attended the funeral, something she does about 12 times a year to help achieve closure when she feels a special bond with a patient.

“I feel sad, but I feel kind of relieved, because I know she was having a hard time the last day I saw her,” McCormick said. “But she pretty much lived until she died.

“It was a successful hospice case.”

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About This Series

“On the Job” is an occasional series about working people in Ventura County and how their lives have been shaped, challenged and enriched by what they do. This installment focuses on the work experiences of Ojai’s Carol McCormick, a hospice nurse.