Dan Heath: Hi, folks. Dan here. Just a quick heads-up before we begin. As you might expect from the episode title, there is a lot of discussion of death in this episode. Some of it can get pretty intense, so use your discretion if you have young people listening with you.

Heather Meyerend was a hospice nurse for just over 30 years. She retired in 2021. One of the first things she did when she met with a new patient in their home was to figure out how well they understood the situation they were in.

Heather Meyerend: I usually ask, you know, "What has the doctor told you?" That will give me a sense of where their head is. There are some patients who have not been given the whole story, or some patients are in denial, or they hear what they want to hear. In other cases, they will say, "Well, the doctor told me there's nothing more that can be done, so go home and be comfortable."

Dan: So there's sometimes a tension between what the patient knows and what the family knows, and that leaves the hospice nurse in a difficult situation. Heather once took care of a Russian man in his 50s. He was dying of cancer, but his wife...

Heather: She didn't want us to speak the word "cancer." We couldn't even say the word "cancer" in his presence. And so there was this hovering, this sense of, okay, I'm just gonna sit here and, you know, make sure that you're not saying anything that you...

Dan: Make sure to censor anything that comes out of your mouth, right?

Heather: Exactly. And then you always feel like you're on guard, you know, not able to address certain things, or even the folder that says "hospice" on it, you have to hide it someplace or cover that word. The philosophy of hospice is to not be secretive, not to withhold information. So it's sort of a tricky situation, 'cause we want to respect the family member, but also at the same time, that patient has a right to know what's going on with their body and, "Why are they feeling this way and why am I not getting better?” So, in some cases, there are lots of obstacles to getting to the patient emotionally to begin to prepare them for what's coming ahead.

Dan: I'm Dan Heath, and this is What It's Like To Be. In every episode, we walk in the shoes of someone from a different profession, an Olympic bobsledder, a life insurance salesman, a summer camp director. We wanna know, what do they do all day at work? Today, we'll ask Heather Meyerend what it's like to be a hospice nurse. We'll hear what hospice patients want to talk to her about, the strange phenomenon of patients who will wait until family members leave the room to take their final breath, and how she can tell when someone is close to dying. Stay with us.

Heather's mornings as a hospice nurse began by checking her messages to see if anything urgent had happened the night before. On a typical day, Heather would see three or four patients, occasionally five if it was a busy day. Each visit would last at least 30 minutes, but often go longer.

Heather: I'm a lingerer, so usually if my visit is half an hour, that would be amazing. But they're usually longer than that and sometimes it can be two hours. And in fact, I was reading a letter that a patient wrote me and she said, "Heather, you were there four hours." And I said, "Four hours? How did I manage to do that?" So sometimes it, you know, depends on what's going on in the patient's home that day.

Dan: Leaving aside the dynamic about the news and, and the diagnosis, is there a common dynamic where what the patient wants is different from what the family wants for them? Like when it comes to anything from what medications they're on to, you know, can they have a milkshake for lunch? Like, is that something you have to navigate?

Heather: Yes. Let's talk about food first. The patient is... Frequently there's a huge, you know, loss of appetite and they get very picky and, um, "I don't want this, I don't want that." But for the family, food is life and, "If you're not eating, that means, um, you're going to die and I'm doing a terrible job." So we have to sort of negotiate food and what does it mean to respect the patient's right to not want to eat, or, "I want to eat. I don't care if I'm diabetic, I want a milkshake or I want to eat this slice of cake." And to say, "Just let him eat, let her eat, let her enjoy." We're not mindful too much about our elevated blood sugar at this time.

Dan: Right.

Heather: And one of the things I tell my patients, "You're not going to win the food battle. You can't force someone to eat. And if you do that, they're just going to bring it back up." So I try to address that very, you know, upfront, "That's a battle that you will not win."

Dan: How much of your work is attending to the emotions of, of the patients or the families?

Heather: Typically, you know, after I make a visit, you know, I deal... The first thing I do, I just sit down and I ask my patient, "How are you doing? How was your night?" Before I, you know, get into the vital signs and, you know, doing all of those physical things, I try to get a sense of what's going on, you know, with them. If we're into the relationship enough, meaning it's not a first visit or a second visit, but we've established enough of a relationship that I can begin to ask those questions, you know, like, "How have you been coping?" You know, "What are you thinking about when you're, you know, alone?" Or, “Are you sleeping? If you're not sleeping, you know, what's on your mind? What are you thinking about?” And sometimes, you know, the issues of fear comes up. “I'm afraid of falling asleep at night because I'm afraid I might not wake up.” And then we talk about how to just be at peace. Uh, sometimes I'll have to make a referral to the, um, pastoral care or the social worker. Or sometimes I'll just jump in there and talk about whatever, and then just staying to talk a little bit, you'll find things coming out.

Dan: What do patients wanna talk to you about? I mean, is it big end of life stuff, or is it more mundane stuff or memories or...?

Heather: Sometimes it's memories, and sometimes it's big stuff, too. Um, like estrangement from a loved one. You know, I remember this one patient in particular. She had ALS, and she was estranged from her daughter. And that became, like, a huge topic of conversation for us 'cause she was a patient that I had developed a relationship with. We would just sit in the kitchen and we would talk, and then it came out that she was, um, estranged from her daughter. And she said, "I don't want my daughter at my funeral," and I'm thinking, "Well, you won't even be there at your funeral." But she was saying whatever happened, you know, something went down, and, uh, she could never forgive her daughter for what she did. And this was a Catholic woman, who, you know, uh, was trying to practice her Catholicism and do the best that she could in life. And so, we got to talking about that, and I, I read to her. There's a, a prayer in the Bible, the Lord's Prayer, maybe you're familiar with that...

Dan: Mm-hmm

Heather: ... where it says, you know, "And forgive us our trespasses as we forgive those who trespass against us." And it's as almost like she never saw that scripture before, 'cause I'm saying, you know, there's a sense where if you withhold forgiveness, then you're also withholding forgiveness from yourself, you know, in terms of receiving from God. And somehow that struck her in a way maybe that she hadn't heard before, and she really thought about it. And so I said, "Why don't you, you know, try to reach out to your daughter and, you know, bridge this gap? Just offer, you know, the forgiveness, whatever it is that she may have done." And I don't know if I was very hopeful that she was going to do that, but the next visit, which was about a week later, she said, "Heather, I called my daughter, and we made it up, and it's okay." I was kinda shocked...

Dan: Wow.

Heather: ... because, you know, sometimes you throw these things out, and you don't know if it's going to be advice that's taken, or, "Oh, that's fine for you to say, but I'm going to, you know, keep in this path." But that was one of those stories, or that patient, that stayed with me, 'cause I picture her now, just us, you know, sitting together, and she seemed more at peace after that. So sometimes, you know, the unfinished business can add to the restlessness at night, the thoughts that come. And I think if you're not dealing with that, then it impacts the physical, um, comfort.

Dan: I wanted to ask you about those kind of end of life regrets or, or anxieties. It sounds like troubled relationships or a feeling that you've been wronged, or maybe even that you've wronged someone are among those common regrets. Is that right?

Heather: Yes. I think that comes up. We have a saying that, you know, "How you live kind of feeds into how you're going to die." So sometimes when we see so much agitation, restlessness, no matter how much medication you're giving, there's no peace, no rest. And sometimes you find that there's been so much turmoil in that life, so much, you know, messy relationships that it impacts even how, you know, the patient dies. And so sometimes there are regrets, and sometimes, you know, these conversations are not had, you know, with the family members. And often we'll ask the pastoral counselor, the priest, the rabbi, and the social worker to come in and to see what can be done to help, you know, unravel some of these knotty threads that just keep patients from having, you know, a peaceful end of life.

Dan: And what do you feel like is the line between what you're responsible for, what you can do, and what maybe you can't or shouldn't do? Like, I thought it was wonderful and wise, the advice you gave to the woman who had been split from her daughter for so long. But it sounds like in other situations, you feel like, you know, maybe a minister or pastor would be better suited to provide for them. Like, what is that line between a hospice nurse and perhaps a spiritual advisor?

Heather: Yeah. You know, sometimes the hospice nurse becomes the social worker, becomes the confessor, becomes the, you know, the everything, because we're there in that moment when things are being poured out. So it's like, uh, for me, it's like catching the moment, 'cause sometimes whether it's a Jewish person, Christian, whatever it may be, sometimes there is just the need in the moment. And you can't say... It's not like I can say, "Oh, hold that emotional, um, pain right now. Let me, you know, get in touch with the social worker."

Dan: Right.

Heather: So it's being present there and in that moment. And if there is a follow-up that's needed, then I'll reach out, you know, to our other team members and say, "Can you follow up to, you know, to see what's going on?"

Dan: There's just a certain inherent… Gravity to this work and a seriousness about it. And, and we've talked about a lot of those issues and the emotions associated. I wonder, like, on a day-to-day basis, are there also moments of lightness and, and joy and, and even humor?

Heather: Oh, definitely. I had this patient in particular. Her- the wife, I, I... And not that I can tell you all the jokes that she would give, but I just remember laughing in that home when I'm with her. I mean, her husband was there, and he had a little bit of dementia. And sometimes he would say these crazy things and she would just, you know, give some off-the-cuff remark. And before you know it, we were all laughing together. So there is this sense where, yeah, sometimes, uh, you know, you have to laugh. Otherwise, you're going to be in tears, you know, continually. So, I try to bring that kind of... Sometimes there's just a lightness that's needed in the, in the midst of this, you know, heaviness of preparing, you know, to die, preparing to say goodbye to your loved ones.

Dan: What patient, looking back, gave you the greatest joy in your work?

Heather: Wow, so many. There's one patient in particular. I'll just call her Violet without, you know, giving... But she was a woman who seemed to have such a sense of dignity and peace. She was someone who would come to a place where she recognized, and she was very vocal about her dying. And the reason for that, she said, I said, "You know, I would say, wow, you are in a in a place where, you know, you're not fazed by what's coming, that you know you don't have a lot of time." And she said she had a near-death experience where she literally felt like she died and went to heaven. And, you know, we, we hear those stories, but she told this to me that, "No, we're not ready for you yet. You have to go back." And for some reason, that just was a comfort to her. And so she could live with a sense of joyfulness that there was a time and she would be ready when that time comes. And she has such a rich family support around her. And a lot of the visits, you know, centered around, you know, talking about her children or, you know, many of the generous things. She was such a generous giver that she would, um... Uh, you know, I was born in Jamaica and she happened to be from Jamaica, and one of the things that they would do is, um, pack a barrel, one of those huge barrels, and fill them with goodies and clothes and food and, and she would just send those, um, barrels back to Jamaica for those who were in need. And I got to really love her, because I just saw a woman who was such a quality woman. And just to learn these acts of, you know, from these acts of generosity and just appreciation of life, and that when her time comes, she was quite ready.

Dan: That's kind of beautiful to be confronted with these situations where you see such a range of, of abilities to deal with what's coming. You know, ranging from anxiety and, and bitterness to comfort and peace. What was it like to be in the presence of people whose approach you admired? Did it change anything about your life or the way you want to approach the end someday?

Heather: Yeah. I would say to her, "I want to be like you when I grow up." You know? And I'm a woman of advanced age. So, the s- the... Just the sense of, it's never too late to become more than you are. And your own life becomes more expanded, so that you can say, "Wow, Heather, you don't have to wait until you are on your deathbed to do the things that you want to do, or to be more generous, or to be more patient, or to be more kind. You can begin now to do those, uh, things that you admire in other people."

Dan: Hey, folks. Dan here. A quick casting call. We are hunting for two roles. First is a pharmacy tech, and the second, and I know this one may be a bit of a stretch, a customer service rep. If you know people that do those jobs and love their work, send them to us. Step one is to leave us a voicemail message, and that phone number is always in the show notes. Let me say this, multiple guests on the show have been booked after leaving us a voicemail, so this process works. Send us your recommendations. And now, let's get back to the show.

Dan: How often are you present when a patient passes away?

Heather: Quite a bit. I mean, several times. I mean, I've attended multiple deaths. So it's been instructive in many ways. And also, the families that I've, you know, been able to be with at that time, they've always been so appreciative. Says, "Nurse, I don't know what we would have done if you hadn't come," or, "I'm so glad you're here. I feel so much comfort." Sometimes, you know, the experience can be, for the family members, it can be frightening at times because of the... Sometimes there's a lot of agitation, and then the breathing, the gurgling. Sometimes it's not pretty, if I could use that word. So to be able to walk them through the physical, the physiological part of it, you know, they're always appreciative. Because it can be very frightening, and some people don't want to be alone, you know, when their loved one is dying. So, if I get a call that says, "Mom isn't breathing right," or something, I will go. I will drop what I'm doing and go. Because usually if there's breathing issues, something more serious might be going on. So, you know, I prioritize that.

Dan: How often do you feel like your patients are, are ready to go?

Heather: It's kinda hard 'cause it's so, you know, here and there. A lot of times, actually, when it comes to maybe weeks or days before I will begin to hear that statement, "Nurse, I'm tired. I'm really tired, but my family, they don't want to let go." And sometimes they'll get very graphic with, "I'm ready. I have said goodbye to who I want to say goodbye to, and I'm ready." And especially when they start using those words, "I'm tired, nurse. I'm tired."

Dan: You know, you hear stories sometimes of people who wait to die until someone is there, or, or sometimes wait to die until someone is not there. Have you encountered situations like that where there almost seems to be a strategy to the timing of when someone passes?

Heather: Yes. That is the weirdest thing in hospice. I think it's anecdotal that, you know, patients choose who they want to be with as they're dying. But I have seen it happen where I will tell the family, "Okay, it's just a matter of time right now, you know, maybe hours or whatever," and I'll, you know, either get the call that she's gone, and I'll say, "How was it?" Say, "Well, nurse, I wasn't there. I went to the supermarket just to pick up something," or, "I went upstairs, you know, to the, just to take a quick shower and I came back and she was gone." And, uh, sometimes I try to warn the patients to say, you know, uh, "You might not be there," or, "Just be aware that, you know, your, your mom or your husband," or whatever, "might choose to go when you're not there." And even when I say that, it can still happen because you have to go to the bathroom. You have to, you know, do something. So it's, it's amazing how, um, often that happened.

Dan: But witnessing death day in, day out, takes its toll. Heather told me about one day in particular when three patients were close to death.

Heather: This day was so hard. I had to write something in my journal from time to time. Not always about my patients, but I remember just writing this day. Because I pretty much started, saying, "Yesterday was a disturbing day. I felt overwhelmed by my senses and it's a rare day when I don't want to do anything with, I don't want to have to do with death and dying. I just want to go home, watch a movie, or just eat ice cream or whatever it may be. And I just want to not be there." And that day, can I describe that day to you?

Dan: Of course.

Heather: So I remember I had this patient that I had to go evaluate in the emergency room. It wasn't my patient, but she was in the throes of dying. The arms were flailing. She was, you know, crying out. She had a oxygen mask. And then I wrote, "She had this wild-eyed agitation. Her eyes would momentarily focus on me and then, in that moment, I would say, 'I'm here. Just be at peace.'" And, you know, just trying to, you know, lock in with her. And then there was this son, you know, at the bedside. Very... He was distraught, um, and his expression was just, you know, discomfort, pain. And I said, "Why don't you come over and hold her hand?" And this is what the son said to me. "No. I don't want to hold her hand." He just didn't want to hold her hand, didn't want to have any physical contact. Only to find out that, you know, he had been estranged from his mom. I don't know what their relationship was, but he says, "I'm here now. That's all I can say. I'm here now." But even then, he wasn't there, you know, to be able to just hold her hand and say, "Mom, I'm here."

So my senses are all just overwhelmed with all that's going on because normally, you know, when you're with your patients, you're in a home, it's quiet, you can, you know, kind of lean into your patient and be able to, you know, deal with that. But I'm seeing in the emergency room and I wrote, "Tumult and noise in the emergency room, sickness and dying spilling over into the hallways. Cubicles with drawn curtains, the somber looks, the masked faces. The patient is desaturating. Increase the oxygen, give morphine." And then there's just this noise, this overwhelming, so not hospice, you know? That was my sense. “This is not hospice.”

Dan: As a nurse in the ER gave this first woman morphine, Heather had to go see another hospice patient in the same hospital, but not in the ER. It was an elderly woman named Elaine who'd been taken off a respirator. Heather described the scene.

Heather: I could see her edentulous mouth, her slack jaw, the wet breathing. You know, her legs drawn up and extending, and you know, and then every now and then her eyes would connect with me and I would just say, "Elaine, peace. Be still." I'm always praying for my patients, honestly. I think that's how I get through my work by just saying, "God, I need your presence here with me now and this one is suffering. God, please, you know, help." And so, you know, just seeing her and just asking, "Nurse, please, can you give her some morphine? Give her some medication." "Oh, well, I can't right now because the doctor wrote the order, but somehow the computer kicked the medication, the order out." And so, you know, she was not able to be taken care of immediately. And, and so again, just this, um, not... I call it “not hospice”. This being in a hospital bed, side rails up, um, flailing arms and the exten- you know, the legs going up and down. Just a picture of misery. I said, "Oh my God, this is just not good." And then you... I feel so powerless, you know, because here I am, the hospice nurse, but this is not my setting. It's not my environment.

Dan: Heather was then called away to another patient at her home. This woman wasn't a patient of Heather's, so she hadn't seen her before.

Heather: So I ring the doorbell and her mom answers the door, and, uh, the mom is wearing a mask. And so, you know, I go in to the patient and see that she is actively dying. I could tell just by a first glance, this lady's not gonna last long. She doesn't have much time. And the mom, it kind of a funny... Uh, and it's not even funny, but it was so telling. The mom is wearing a mask and she said, "Oh, I have a cold. I'm wearing a mask and I don't want my daughter to get a cold." And I'm saying, "A cold? If that was all that she... If she could get a cold at this time, that would be wonderful. She doesn't have enough time to get a cold." You know, I'm thinking of that. But it's, it’s how oblivious the mother was as to what was actually happening. And so, you know, her name was Christine and she's just lying in bed. And again… a picture of discomfort. You know, her arms are just going up and down and shallow breathing. You know, the open-mouth breathing. I know sometimes, you know, you think of people dying as a nice, clean, neat event, but sometimes it's a sight to behold, let me say that. There's this, you know, labored breathing. There is, you know, just a gasping, trying to get enough air in. And sometimes rapid breathing. She was actually in the throes of dying. She was actually imminent. And the mom couldn't stay with me in the room, and so I'm saying to her, "She's dying." You know, "She's going." And I kept saying, "Mom, just come and be with her. Just come." And she couldn't. She just kept coming in and she would go out, and then she'd be on the phone calling family and, you know, trying to tell them what's going on. It was just a moment where I'm trying to get some family just to sit with her, just be with her. And because of the- the shock, maybe not expecting that she would be, you know, going so soon. And I- I just remember, um, I'm saying, "She's going. She's- she's dying." I say, "Come, just be with her." And then I'm praying, I say, "God, I speak life and not death." I'm- I'm talking to God at the same time. I'm saying, "God, she's only 48. Why is she dying," you know? And then here I am, a stranger, dying, a stranger, as I hold her and pray. Mom is making phone calls. A tearful person looks in and leaves. Another one with wide-eyed shock. And then it says, “Here I am, a stranger, holding Christine's hand, stroking her face, smoothing back her hair.” And then, and even when that was happening, I'm saying, "Oh," because she had died by that time and the family was still out there, doing, you know, whatever, and nobody to just sit with her and hold her hand and just express those words, those final words.

Heather: And so, um, I- I just sit and I wait and the family bustles about. Um, I confirm the time of death. And then I just wrote, "I will clean this body as one last task, one last act of kindness from a stranger." And sometimes we do that, you know, when the patient, um, dies. I feel a little bit emotional just talking about it sometimes, because, you know, you realize, um, the family, sometimes they don't know how to cope. So, I just sit there in that case, and my last act is to just bathe the body. Sometimes they're soiling after a patient dies, and, um, I will do that, and, you know, ask them to, you know, bring clean clothes and just to make sure that the patient is clean, and then assist the family with, you know, calling the funeral home, making arrangements.

Dan: I can't believe everything you just talked about happened in one day.

Heather: One day, yes.

Dan: I mean, how did you come back to work the next day?

Heather: You know, back in the days, I mean, I've been a hospice nurse for many... More than 25 years, I think. And in the early days of hospice, you know, after a patient dies, you would be able to get, uh... “Go home, Heather. You know, just relax, do whatever.” But in this newer hospice, it's not a kinder, gentler hospice, if I could put it that way. It's more like, "Yes, your patient has died, but you know, there's somebody else who needs you right now," and you know, they'll provide some degree of support. But in the early days, I would be able to get the rest of the day off or, you know, have some time.

Dan: What kind of personality do you think you need to be good at this work?

Heather: I think number one, you need to be a compassionate person. You have to be able to say, "If I were in that position, how would I want to be treated? How would I want the nurse to be, you know, with me?" And I think somebody also who is patient. Hospice is not an efficient work where you, you know, you go in, "Okay, I have to start this IV. I have to give this medication. Um, I have to make this bed or do whatever," and, you know, that's it. Because when you go in, there might be a huge disruption to your schedule, that you need to just sit, you know, with the patient and listen, or the family. I mean, so many times, I'm... You know, I've had my visit, I've done everything. You know, packed up my stuff, have my hand on the doorknob, ready to go out, and the family member said, "Nurse… I have this question for you. Our nurse..." And before I know, I'm there another half an hour, just talking to that, I call it my “doorknob” moments, where I think I'm done, and then here comes a deep question or an issue. I can't just ignore it. And so sometimes my days are longer than I want it to be, or, um, I just have to defer another visit, you know, defer my visit to another, another visit to another day.

Dan: Well, Heather, this is probably the most awkward transition that I've ever, uh, had on an interview. But we always end-

Heather: And I haven't told you the half of it.

Dan: Uh, I- I have never been more remorseful about starting the lightning round. But, uh, Heather, we always end our show with a, a quick lightning round of questions. Uh, let me, uh, let me start here. What is a word or phrase that only someone from your profession would be likely to know, and what does it mean?

Heather: Okay. So, um, transitioning.

Dan: Transitioning.

Heather: Meaning when that patient has begun to die. Basically, they have... Their skin color changes. They're mottling. You might see some purplish-red discoloration, you know, to the feet and to the lower extremities. Um, there might be some tingeing of blue to the nail beds. Breathing might be shallow, minimal responsiveness, and so that patient is now transitioning into the actively dying stage.

Dan: What is the most insulting thing you could say about a hospice nurse's work?

Heather: Oh. Once someone said, "A nurse is nothing but a glorified maid." I said, "Oh, no-"

Dan: Ugh

Heather: "... she did not say that."

Dan: Oh. Oh, man.

Heather: Four years of nursing and, uh, doing all this wonderful work, and that's what you have to say.

Dan: I hope they got, at a minimum, a proper tongue lashing for that.

Heather: Yes. I did not appreciate that.

Dan: What's a tool specific to your profession that you really like using?

Heather: My hands. My hands are like a tool that I can assess, I can press on a belly. I can soothe. I can touch a forehead. I can detect if there's a fever. I can comfort with just holding a hand. I can disimpact a patient with that same hand. That's when a patient is severely constipated and you have to... I know it's kinda gross, but that hand can do so much to bring comfort.

Dan: What phrase or sentence strikes fear in the heart of a hospice nurse?

Heather: Oh. I think when they say, "Oh, the state is here. We're being audited."

Heather: Then you know that, you know, your... Every paper, you have to make sure that you have nothing left out and it's just a time-consuming... Although if you're doing good documentation, you know, all throughout, then there shouldn't be any fear. But usually, there is this hyper, you know, alertness and, "Oh, my gosh. The state is here. Let's make sure all our, you know, um, T's are, are crossed and our I's are dotted."

Dan: It's just so funny to me every day you're dealing with death, and what you really fear is the auditing.

Heather: Isn't that something? Yep.

Dan: What's a sound specific to your profession that you're likely to hear?

Heather: Um, I think more often than not, it's that gurgling sound. I think in, um, lay terms, uh, people say the death rattle.

Dan: I've heard that term, the, the death rattle. What... Biologically, what, what's going on with that?

Heather: Yeah. It's really a mucus just building up in the airway. Like in the bronchus, there's just... Or in the upper, you know, the upper airways congested and the, because of the patient is so weak, they're unable to cough and to release the mucus. So it's just that noise of the mucus, you know, moving around in the, in the airway and in the chest.

Dan: What's the first question people usually ask you when they hear what you do for a living?

Heather: "How could you do that?" Or somebody will say, "I guess somebody has to do it." But no, I feel I was called into this work, and I let them know. No, there's a certain sense of satisfaction, of... I wanna say joy, but that... Maybe that's not quite the word. But there's a sense of having accomplished something together with another human being who is facing, you know, this journey, and who has come to this time where you need someone with you to say, "Okay, don't be afraid. This is what's going to happen." So, some people are there to attend a birth. I'm there, you know, to attend the dying. And this is, you know, how I see my purpose in bringing comfort, in just being there, you know, to help someone through this most difficult of journeys.

Dan: Heather Meyerend was a hospice nurse for more than 30 years. She's a contributing author to a book called Resilient Faith: Dare to Believe. We'll link to the book in the show notes, and also a profile of Heather that was done in The New Yorker from 2016. It's excellent.

If you're feeling a little emotionally exhausted right now, let me just ask you to imagine doing what Heather did for 30-plus years.

The word that keeps coming to mind for me about Heather is brave. Brave. Because her work happened in situations dominated by fear and uncertainty. You know, how long does the patient have left? How much will they suffer? Will there be time to resolve the conflicts that still trouble them?

Situations like these can make people timid and fearful. I can't stop thinking about that one mother who couldn't bring herself to just sit with her daughter as she approached the end. But Heather was there, and that's what I mean by the bravery of this role, the strength to not look away from what's happening, to be clear-eyed and confident and compassionate.

Navigating end of life regrets and frayed relationships, tracking vital signs and monitoring medications, providing support and advice for fearful families, and being a reliable source of comfort as patients transition. Folks, that's what it's like to be a hospice nurse.

A shout-out to recent Apple Podcast reviewers and Spotify commenters. We read every one of them. Here's a recent one from Jenny in Seattle, who wrote this: "I didn't know I'd be moved by hearing a beer salesman or a welder talk about their jobs, but I was. I've learned something from each post and love the way you allow your guests to speak for themselves." Thanks, Jenny.

And keep those reviews coming. This episode was produced by Matt Purdy. I'm Dan Heath. See you next time.