Lena, an 82-year-old unaffiliated Jewish woman, was surrounded by numerous people in the cardiac ICU that Thursday morning. Her room was brightly lit, had several balloons and some photographs hanging on the wall. After I introduced myself, Lena introduced me to the people in her room; most of whom were family, and some friends. I was able to get a sense of how valued and beloved Lena was by all. I felt an immediate connection to this woman whom I had just met.

Lena proceeded to tell me that she has congestive heart failure and was awaiting a risky procedure for the next day. I sensed an underlying and understandable fear in her voice. It was a voice of “trying to be strong for others,” while not feeling strong at all. I also knew that having a private conversation with Lena in that moment would not be feasible and mentioned to her that I was available whenever and for whatever she needed. She looked into my eyes, reached for my hand and said, “Just keep me in mind in your prayers.”

On Tuesday the following week, I was quite surprised when I saw my patient list for the day. Lena’s name appeared on the hospice floor. As I began to walk toward her room, room 306, I saw Steve, Lena’s son, in the hallway. Steve recognized and greeted me immediately.

“My mother decided not to go through with the surgery last week,” he said. “From what the doctors were saying, it seems like it would only buy her a few more weeks and performing the surgery in itself is a major risk with potential complications. My mother did not want it. We tried to convince her otherwise. She refused. She wanted to come to hospice where she would no longer be in pain and be able to live her remaining days as peacefully as possible. I get the sense that she could use someone to speak with now. Please go in. No one is with her.”

I gently knocked on the door, entered the room and re-introduced myself. Lena looked comfortable, though appeared much more pale and gaunt compared to the previous week.

“Wow!” she said, with a smile on her face, “It’s hard to get rest here. So many people coming in, constantly.” Lena sounded extremely short of breath; only able to speak a few words at a time without struggling for another breath of air.

“People like me are constantly barging in, huh?” I half joked. “There is a sign that we can put on the outside of your room that asks visitors to check with the nurse before entering the room. Would that be helpful?”

“No, no. It’s ok. Please stay. Sit down. I need to talk,” she said. “I have had so many friends and family coming to visit over the past few days. And then I have the doctors, the nurses, the social workers, the music therapist. The cleaning crew. The lady who takes my meal requests. The volunteers. And now you are back! Everyone here has been amazing. So kind. So compassionate. And they do an excellent job here of keeping my pain under control.”

“I am so glad to hear that, Lena.” I said.

“But I have one question I need to have answered.” She took my hand and looked me straight in the eye. Silence for several seconds.

“How long will this take?” she said.

“This … meaning?” I asked.

“Dying. How long will it take? I want your complete honesty,” Lena said.

“Lena, you know, I am not a doctor and I don’t know the specifics of your medical condition. But quite honestly, there are times when the doctor will say that the patient will live a few hours, and the person lives a few days. And then sometimes they say a few days, and it’s only a few hours. I have seen it both ways. They can only tell you based on what they have seen in their experience. I believe that it is completely in God’s control. I do know that the doctor and nurses will do the best they can to keep your pain under control and keep you comfortable until the very end,” I said.

“Thank you for your honesty. I pray to God that this goes fast; really fast. I have been praying for that everyday. I could never tell my children what I just told you. They would get so angry and upset with me if they heard me say that. But it is the truth and I had to tell someone. Thank you for letting me share that with you.”

She said this with great sincerity and tears coming down her eyes. She reached for my hand and squeezed it. I immediately sensed her body relax from unburdening this feeling that she had longed to unload to someone. There was silence for several seconds as she held my hand.

“I have taken care of a lot of matters already and said what needed to be said to my family and friends. My daughter is supposed to be arriving from Florida later this afternoon,” Lena said.

“Maybe God is keeping you here so that you can see your daughter,” I remarked.

“Maybe… I spoke to her on the phone. It’s ok. I am ready. I really…”

Right at that moment, Lena’s son walked in the room.

“Hi Mom!” he said with a cheerful look, obviously unaware that he had disrupted an intimate, serious conversation.

Lena looked at me and I looked at her. There was an immediate understanding between the two of us. It was an extremely powerful moment. Lena had verbalized to me feelings that she could not share with her closest of family members at this time in her life. We shared a secret. A bond. And now, words did not need to be spoken, but I knew, our private conversation was over.

As I carefully observed Lena’s face, I noticed a look of calm, relief and peace. Though I knew there was more that needed to be said, I also recognized that a huge weight had just been lifted from Lena’s heart.

After a few minutes of light conversation between the three of us, I decided to exit the room; wanting to give the family their privacy. I had wanted to offer to say the “Vidui” prayer (Prayer for the Dying), but at the time it did not seem right. Tomorrow, I figured.

Upon my arrival to the hospital the next day, I received my patient list. Lena’s name was still on my census and her room number had remained unchanged. As I usually see my patients on the palliative/hospice floor first, I knew that Lena would be my first stop.

Lena’s door was closed. I noticed a sign on the outside of the door. The exact sign that I had mentioned to Lena to get the day before! “She decided to listen to me,” I thought to myself. Being that the sign is more for “outside visitors,” I took the liberty to knock and enter the room. Lena was lying on the bed in the dimly lit room. She did not look alive, though I couldn’t be sure. I went out to find Jesse, the secretary on the floor.

“Lena?” I asked. “In room 306?”

“She just passed three hours ago.” Jesse said.

I had forgotten that “the sign” is also placed on the room door if a patient has passed away…

Lena’s prayer was answered. We were just having a conversation less than 24 hours ago and now she was gone. My heart dropped. I had missed the opportunity to say the Vidui prayer with Lena, thinking that I would have a tomorrow…

Back at the nurse’s station, I received the phone number for Lena’s son in order to call him and express my condolences. Though obviously upset, Steve was so appreciative, grateful and impressed at the entire team for the wonderful and compassionate care that his mother received until the very last minute of her life.

As I saw several members of the hospice team at the nurses station (including a couple of the nurses, the music thanatologist and the social worker) we informally took a few moments to debrief and reflect on the special woman that Lena was. Each of us was able to shed light on a different side of Lena, due to our varying roles. It was clear that each team member brought their own skills and abilities to meet Lena’s needs to ensure excellent care.

Upon reflection, l was reminded of many things from Lena’s story. The very strong physical and emotional effects that unloading to another person (not necessarily family!) can have. The strength of a collaborative team. The value of debriefing with colleagues. Taking advantage of today and not delaying until tomorrow. The power of prayer.

Someone had once told me that my patients will always be my best teachers. They always seem to be. “From all those who have taught me, I have learned understanding.” (Psalms 119:99)

By Debby Pfeiffer

Debby Pfeiffer is a board-certified chaplain working at Morristown Medical Center through its affiliation with the Jewish Federation of Greater MetroWest NJ. She resides in Bergenfield, New Jersey, with her husband and children. She can be reached at [email protected].