Her name was Helen. She was a 72 year old woman dying with COPD. I was her Hospice nurse. One thing I've always loved about doing hospice nursing is the opportunities I've had to really get to know people. It is probably appropriate to add “and provide good nursing care and support at the end of life”. And I have done that; I have provided good nursing care to dying people. But that is a given I think. Good nurses provide good nursing care, at every stage of life. In hospice, however, the boundaries that define giver and receiver often fog; it is not always so clear who's providing what for who. I've always seen it as a dance, with no assigned steps; the only given rule I knew would be: the patient always gets to lead.

During the time I had getting to know Helen she invited me into her heart. She told me stories of her life, sharing memories and dreams with me. I was her hospice nurse for six months. In acute care settings these kinds of conversations don't always take place. ER visits, hospital admissions for the administration of the latest life saving drugs and treatments, and the focus on “fighting the good fight” is the focus there. But in Hospice, once comfort needs are met, there is time to be spent reflecting on life, its purpose and meaning.

In one of my early conversations with Helen we talked about what death meant to her. She told me she was a Christian woman and her Bible was a source of comfort and hope to her. Her ideas on death were grounded in her faith. Often she would share Scripture passages and inspirational stories she was reading with me when I visited her. One day she shared with me a recurring dream she was having. She kept dreaming of her father; he had died when she was very young. He had been a helicopter pilot. She had a picture of him in his aviator uniform; a young man in his twenties. He was holding the hand of an adoring little five year old girl. Helen remembered that picture being taken. You'd think the years would have lessened her memories of him, but they had not. She remembered how much she loved him, and how tender he was with her. In the dream she was having she said “My father is there. He tells me not to be afraid. He says he will come for me, and take me home, when it is time to go”. When she would awaken from this dream she said she always felt so peaceful. She told me, as “crazy” as it might sound, she believed it. She believed that when it was her time to die, her father really would be there for her.

I went to a hospice conference recently in Dublin Ireland. One of the speakers referred to an ancient Celtic practice at the time of dying. A specific role existed in which a healer was assigned to be an Anam Cara, the literal translation is “Soul Friend”, to the dying person. The Anam Cara would help the dying person make their transition by being along side them through the process, attending to their physical, emotional, and spiritual needs. He said it was this practice that provided the early roots of our modern hospice movement. Well, I was Helen's soul friend. I ministered to her physical and emotional needs during my time as her nurse. And she took me into her world telling me her stories and dreams. I never thought any of them were “crazy”. We'd made an agreement that I would remind her of that dream of her father when death was near. And I did.

Helen had the same physical deterioration process going on that I had seen in many people with COPD. Air hunger eventually narrowed her focus. Each breath became a mantra, breathing in, breathing out. The effort to breathe kept her ever present in its demand. Interesting term, air hunger, now that I reflect on it. Over the months I was her hospice nurse our conversations became less and less as she needed to conserve air more and more for breathing. It was hard to watch her labor. My job at that point was to make sure she optimized her oxygen and she did so as painless as possible. And I did, using all my hospice skills of symptom management. I often, however, found myself thinking about our earlier conversations about her dad, and her belief he would be there for her at the time of death. Seemed a long time ago that we had talked about such things. The smells and sounds and feel of death had me focus on supporting Helen's physical needs, and her, well her job was to breath. And rest.

The night Helen died I was the on-call nurse for hospice. It was about 3 am and I was awaken from a deep sleep, a distinctive sound shook me into consciousness. A whirling winded sound. I sat bolt up right abruptly, I swear this is true, awaken by the sounds of a HELECOPTER outside my window! Then the phone rang. In a daze I picked up the receiver. It was the answering service for hospice. A woman voice told me told Helen had just died. Incredulously I said, “I know”.

I've shared that story with many. Some ask me if I “seen the helicopter”? Well, I didn't run to the window, I got up and answered the phone. Others ask if I think I was perhaps dreaming that I heard a helicopter. I don't know the answer to that for sure. I just know the sound of a whirly birds wings woke me up. And when very shortly after I picked up the phone and heard that Helen had died, I felt completely at peace. Helen's death has taken me to places of reflection, and wonder, I had never been before I met her. My inner world has grown because of it. Who, I ask myself, really was the giver? Who was the receiver in this time I spent with Helen? What a dance!