My 91-year-old mother, Dorothy, had been in and out of Bethesda’s Suburban Hospital all summer. One morning, an emergency room nurse told us, “It’s time to think about hospice care.”
I knew what she meant, but I didn’t want to accept it. Mom was dying. Still, that nurse was giving us two great gifts—truth and time.
That night, my three siblings and their spouses gathered for dinner in our garden. During a draining but loving evening we discussed the basic question that hospice poses. Were we more interested in quantity or quality? Did we want to keep Mom alive as long as possible? Or did we want to make her last days as comfortable as possible?
The consensus was clear: quality and comfort. My sister, Laura, even wrote that down so everyone literally would be on the same page.
Two days later we took Mom home to her airy apartment in Maplewood Park Place on Old Georgetown Road. That’s when we met Sally Roberts, the hospice nurse assigned to her case. (We are not related—my family name was Rogowsky back in Poland, and her husband’s was Rabatinni in Italy.)
Twenty-four years ago, Roberts’ father, Jim Walsh, was cross-country skiing in Vermont when he felt sick and consulted a doctor. The diagnosis was stunning—advanced liver cancer. After three weeks of chemotherapy, his family was told: Take him home, there’s nothing more we can do.
“I wasn’t a nurse at the time,” Roberts recalls, “and I remember my mom and my sisters and I were there and we knew this is what he wanted. We were thrilled to take him home—and absolutely terrified.”
A hospice nurse came regularly to help out. Walsh, an engineer, brushed her off, but his wife and three daughters were full of questions: What are we supposed to be doing? How will we know when he’s near death? What do we do when that happens?
Watching her dad die changed Roberts’ life. “I just remember being affected by that so profoundly, realizing what a privilege it is to be part of someone when they’re leaving this world,” she tells me. “And I remember thinking: I wonder what it would be like to be a nurse who does this.”
She found out. Today, Roberts is a team manager with Montgomery Hospice in Rockville, a trim, prim woman of 60 who radiates a combination of contradictory traits: steely softness and warm efficiency. The Rockville resident immediately reminds you of that insurance company commercial: “You’re in good hands.”
When her father died seven weeks after his diagnosis, she had four children between 2 and 13, no college degree, no career path and a husband who commuted to New York from their home in New Jersey. She started taking courses at a community college and working as a nurse’s aide on weekends. After she finished her degree, her husband, Tom, a writer for the National Catholic Reporter, was transferred to Kansas City. Last May they moved back East to be near their two grandchildren.
During her 10 years in the Midwest, medicine changed dramatically. “New meds are available now, particularly for cancer,” she says. “There used to be a time when a family could say to a physician, ‘Isn’t there one more thing you can do?’ and that physician would say, ‘No, there aren’t any more options.’ But that doesn’t exist anymore; the options for treatment are far more extensive than they were.”
These advances affect hospice care everywhere, but their impact is more pronounced in a place like Montgomery County, with its highly educated populace and numerous medical institutions. “I do notice, here in this area, people have done more research, and they seek out more second opinions,” Roberts says.
Local residents are more likely to know medical professionals (in my case, it was a niece and her husband, both doctors at Johns Hopkins) and try experimental therapies than patients who might have to travel several hundred miles just to reach a large hospital. So there’s a paradox: People here know more about hospice, but they also ask more questions, explore more options and often delay a decision until the very end.
“People have an idea of hospice,” Roberts says. “It’s a wonderful thing—for somebody else!”
It was a wonderful thing for us. The first time we met Roberts she told us, clearly and carefully, what to expect. Mom would gradually grow weaker. She would receive medicine to control her pain or regulate her breathing, but that was all. Eventually she would fall into a deep sleep and never wake up.
During Mom’s last days, a gentle peace descended on her apartment. No more lights in her eyes or nurses in her face. No more tests, technicians or tension.
On good days, Mom’s devoted caregivers (known in the family as “Team Jamaica”) would prop her up by a sunny window. I would hold her hand and tell her stories, and occasionally I would hear a muffled response, “That’s wonderful.”
One morning she stayed sleeping and stopped responding. The next evening, her breathing grew labored. We sang to her and kissed her and held her. And then Mom quietly died.
We called Roberts and she came right over. She contacted the doctor and the funeral home. She disposed of Mom’s medicines and medical equipment. She smoothed our path and soothed our pain. We were in good hands.
Steve Roberts’ latest book, From Every End of This Earth, is now out in paperback. He welcomes suggestions for future columns at firstname.lastname@example.org.