The house was small, run down with more paint off than on. Tall dry weeds blocked the cement walkway to the door. The barking of a small dog intensified as I walked closer to the front screen. I knocked loudly on the aluminum screen door as the barking intensified and called out, “Hello.” A raspy irritated voice yelled back, “Come in damn it.”

Thus began my relationship with Frank. I was called out to his home for an emergency visit as Frank was new to Hospice. Prior to my arrival I spoke with his Doctor who stated this patient was in urgent need of medical assistance and had maybe a week or less to live. Furthermore he lives alone with no support, no family or friends. As the MD hung up the phone he said “Good Luck!” What does that mean?

As I entered the house I found Frank hunched over in his recliner chair. He was gray, pasty and extremely short of breath. He suffered from years of emphysema that was now laced with Lung Cancer. He was alone with just his mangy dog – Max. He was so short of breath he had difficulty speaking. His oxygen was in place but the tubing was kinked and crimped. As I straightened it out I noted in the dim light that his lips were dusky and his words short and scattered. It was difficult to discern if his disjointed speech and angry demeanor was from his disease process, the lack of oxygen or him. I tended to think the later.

As I proceeded slowly to assess him he was visibly guarded. I explained who I was and that his Doctor asked me to check in on him. He would push my arm away as I tried to listen to his chest for breath sounds. He finally allowed me to open his shirt so I could listen better. As I unbuttoned the few intact buttons I was met with a large faded swastika in the center of his chest. It was HUGE. There were smaller ones to the lower right with the initial WP…White Power?

Frank saw that I observed his markings and barked, “You have a problem with that or are you a darkie lover?” Oh man, what have I stepped into now. I tried to downplay my surprise and reaction and simply asked, “How long have you had these?” I asked trying to engage in some sort of conversation. “I was born with them,” he said as he attempted to brush my arm away to button his shirt but he was too weak. As I found myself kneeling on the floor almost face to face with this dying man I tried desperately to hide my judgments and concerns over what I had just seen and heard.

As the visit progressed I discovered that he had been sitting in the chair for almost 3 days. He had soiled his clothes and the chair. He smelled of urine and feces. There was no food to be found except for a few Jimmy Dean sausages in the refrigerator and a few cans of Coke. “When was the last time you ate?” I asked. “Can’t remember” he mumbles and starts talking about how everybody keeps bothering him and just won’t let him be. “Can’t a man die in peace?” he asks. “I don’t think you’re dying today so let me arrange to get you something to eat and help get you cleaned up a bit. Is that OK?” Frank nodded the affirmative.

I immediately called the Social Worker who rallied up her resources and had Meal on Wheels scheduled to deliver some food in the next few hours. I received orders from his Doctor for medications to help with his breathing and discomfort in his chest. I gathered supplies from my car including the wash basin to begin the unsavory task of bathing him.

Once the dog settled I began collecting a change of clothes. “Don’t be stealing anything.” Frank growled. Are you kidding me? I found a pair of old raggedy navy sweat pants, a button down faded red checked flannel shirt and some underwear. I questioned the cleanliness but they were better than what he had on. I tried to lighten his suspicious mood by making wise cracks like “I bet you don’t get bathed too often by women you just met?” Or, “When was the last time some stranger asked you to take off your clothes?” Neither of my techniques worked so I stopped with those types of remarks. I quickly ran warm water into the basin I supplied, opened my liquid all purpose body soap and grabbed a not so clean beach towel that was hanging over the bathroom door and began.

Clothes were removed with great effort and all that remained was his soiled underwear and socks. I started with his feet. They were covered in worn socks. As I peeled them off his feet revealed dry, cracked flaky skin with a few open sores. I decided his feet were in desperate need of a good soak so in the plastic basin they went. “Ahhhhh,” he purred. I continued to be quiet and lightly washed his legs while his feet were soaking. “Where were you born?” I began. His eyes remained closed and he whispered North Carolina, Durham. “Oh, are you a Tar Heel fan?” I was referring to the North Carolina University sports team. “A long time ago…,” he was drifting.

I had to move quickly if I wanted him to help remove his soiled pants. The soothing relief of the warm water and the morphine I had administered to him earlier for his labored breathing was all taking effect. I pushed, pulled and shimmied until somehow we managed to clean both his front and back side. I was able to maneuver pulling on and up the sweat pants…forget the underwear.

I gave him a few minutes to settle before I proceeded further. “Do you have any family or friends you want me to call?” I asked. He gave me a foggy and distant look, “No, no one, no how,” he said flatly. “Does anybody other than your Doctor know the extent of your disease?” I continued. “No one knows and no one needs to know.” He glared and spoke clear and firm this time. As he settled back he closed his eyes and started to speak softly, “I have done a lot of things in my day. Things I will surely have to pay for.” Silence as Frank fell into a deep sleep.

As he slept my thoughts raced. Who was this frail dying man in front of me? What actions in his life brought him to this point of being alone, suffering and now here with a complete stranger during his final hours? What are those things that he did that he feels he will have to pay for?

I have witnessed the final hours of many dying patients who have great emotional and spiritual demons that they battle during their final vigil. A person who has accumulated years of hate is a complex and difficult patient to comfort and palliate towards the end. Emotions are mixed by both the patient and the caregiver resulting in an often unsettling result. Any act of kindness provided by the caregiver is met with disdain by the patient for they feel they don’t deserve it. Any helping hand is pushed away as they have knocked so many hands down and feel unworthy or ridiculed. The caregiver typically recedes and withdraws and is often left with feelings of resentment and that the patient deserves what they get which is typically not much.

As I coordinated nurses for the next few days I requested specific nurses. I selected this group because they were mentally strong, clinically astute and…African American. He was suffering and I am sure some of the demons he kept referring to were connected to his chest insignias that have sprung up to haunt him. I felt it was an opportunity to heal…or maybe it was just my dark side trying to engage in some justice for his past deeds, real or not real. Whatever it was the first nurse scheduled to come would be at his home in less than an hour.

As the next two days unfolded he continued to ebb and flow with wakefulness, delirium, hallucinations and great anxiety. He was at the edge of the unknown and afraid of the final cataclysmic event. Spiritual counselors and social workers were provided along with appropriate medications. On his last day he had calmed. He allowed his African American nurse to bathe and comfort him. I even heard him utter a coherent thank you as she finished. As I said good bye to Frank I whispered into his ear. “Let it go Frank, whatever it is let it go. You don’t need it anymore.” Frank died two hours later.

There are more times than not when I walk into situations and I am completely unsure of what emotional actions I should take to help comfort the patient. This was not one of those times. Frank brought out in me boldness. Desperate situations do at times require desperate measures. Maybe that was Frank’s final parting gift to me in order to help him.