Every One

For Cynthia, who told me some of this story...

He’s going to die tonight. I know because of the smell.

I walk into the room and take a breath and…

“You smell it, don’t you?”

It’s the nurse who was on mids. I saw her clock out after shift change. But here she is anyway, in the far corner of the patient’s room, in the shadows and in street clothes.

“Do you?” I ask her.

“No,” she says. “It’s not a smell, for me.”

I got my RN license seven years ago, but I’ve only been working hospice for three. I spent the first four years as a traveling nurse, paying off my student loans and trying different places on for size. City hospital? Rural health clinic? Which would fit me best? And what department? OB? Gen Surg? Emergency?

I was working in an ER in Albuquerque when I first noticed the smell. Sweet, but not pleasant. A little medicinal, like mouthwash. In a place full of both sick bodies and medicine, the only thing unusual about a smell like that was the fact that no one else seemed to smell it. I got tired of asking what it was, what it meant, only to be met by puzzled looks. And anyway, I eventually figured out what it meant.

It meant the patient was going to die on the table.

The first time I worked in a hospice inpatient unit was as a traveling nurse. By that time I knew that I could smell death, and so I walked in expecting to smell it everywhere. But I didn’t. One thing I learned, during my stint on that hospice ward at a hospital in Newton, Massachusetts, was that the smell didn’t just mean that a person was dying, it meant that their death was imminent.

Another thing I learned was that I liked hospice work.

When I paid off my loans, I started looking for somewhere to settle down. This place, a small residential hospice unit in the suburbs of a mid-sized midwestern city, felt right from the first interview, even over Zoom. And during my site visit (they didn’t require it but I offered, I knew I wanted to land somewhere I’d be happy to stay for a while) I liked every single person I met… the receptionist, the executive director, the medical director, and the nurse who showed me around.

She was the stereotype we’re all familiar with from the TV shows. Middle-aged, a no-nonsense face but with smile lines etched around the eyes. Strong, competent, quietly buzzing with a calm, focused energy. “I’ve been working hospice for 17 years now,” she’d told me. “I wouldn’t do anything else, not anymore.”

I’d really liked her. She’d felt like someone I could learn from, maybe even become friends with.

And now here she is, off-shift, seemingly waiting for me in my patient’s room on my first solo overnight. I’ve been on the team here exactly one week.

I’m not sure what to say.

She puts a finger to her lips, nodding down at the man in the bed. He seems very sunk in, not conscious at all. But all evidence points to the fact that people can hear what’s being said around them, right up until the end. It’s just good manners to step out of the room for clinical conversations. Or, in this case, for woo-woo ones.

I follow her out into the hallway.

“Some people smell it,” she says. “Other people know other ways. Not everybody can tell when death is in the room, but if you do this long enough, you start to notice a pattern. Some people hear things, some see things. You, you smell it, right?”

“How did you know?” I ask.

“You take a deep breath every time you walk into a patient’s room. I noticed it the first time I met you, when I was showing you around. I guessed you were smelling for it. And if you are, you’ll be smelling it tonight.”

“How do you know?” I ask.

“The deer,” she says, confusing me. “The deer have come out of the forest.”

The building is u-shaped, with offices and the “quiet” room for families and the secure meds closet and the laundry facilities ranged along the outside of the U, separated by a hallway from the patients’ rooms, which line the inside. They face into a well-kept, grassy yard that backs up to a greenway.

The greenway is home to a herd of smallish, urban-adapted deer of the sort you see these days, as wild habitat shrinks. I’ve seen them, at dawn and at dusk, sometimes, stepping out of but staying close to the treeline.

Jena — that’s her name — is on her way out. “I just wanted to tell him goodbye,” she says. And then, “You’ll see, when you go back in, the deer are outside his window. They come out of the forest when someone is dying.”

“But it’s midnight,” I say.

“You’ll see,” she says again.

“Do they always…” I start to ask, but she anticipates my question.

“Every time,” she says. “Have a good night.”

And she is gone.

We have nine beds, but our census is light, tonight. Only three patients. I check on the other two first, both of whom are deep in the thing that looks like sleep, when life is winding down, but is, I think, a place of its own. A place between here and there. A place where they get ready.

I check their meds charts. I check that their monitors — basically nanny cams — are working. I very carefully do not look out their windows. I’m all alone here. Overnights are solo shifts unless the census is more than five.

There’s no laundry to be done. The dishes in the break room are clean. His room is right across the hall from my station. I leave the door open so I can hear through the computer feed from the monitors if either of my other patients becomes restless.

His name is Jay, his chart says. He’s end-stage renal, with co-morbid COPD. He’s catheterized and there’s an oxygen concentrator wheezing rhythmically next to the bed. There’s also a big, comfy couch against the wall, facing toward the windows. The lights in here are very low, just one hushed bulb in the shaded lamp on the nightstand is glowing. So it’s not hard to see the deer outside the window. Two does and what looks like a young stag.

I look at them, and they look at me. They don’t move, and so I won’t either. I sink onto the couch and we all sit vigil together.

When she says, “You don’t understand what Life is…” I have two thoughts at once: Oh shit, I must have fallen asleep and Why is Jena back?

There’s a woman sitting on the other end of the couch with me, but it’s not Jena.

“… that’s why you’re confused,” she finishes.

I wait to feel afraid, or even surprised. I don’t. That’s what surprises me. Outside the windows the deer are standing, not alert, just patient, their eyes lambent and strangely reassuring.

“Life is the bravest, hardest, most miraculous occurrence,” she says. “Every life, seen entire, at its end, is like a star, blazing. And a human life? It’s like a supernova. I can hardly see you for all the light in here right now.”

I still see the shadows draping the edges of the room, the deer made ghostly by the dim reflection of the bedside lamp in the window glass. But do I feel something, now, that I didn’t before? Can you feel light?

“You’re confused because the ordinary death of an ordinary man doesn’t seem to merit the attention, much less the reverent presence of the wild things.”

Whoa, I think, glancing toward the bed. Who is this guy?

“What is happening right now,” she says, “is that a galaxy, an entire universe, is passing out of existence. The massive intricacy, the enormous energy, the vast worlds created by each individual thought, hope, speculation… the tremendous courage and curiosity that powers every moment spent as a consciousness existing at the exquisite edge where a body made up of sensory organs meets an infinite variety of sensation…

“You are dazzling,” she says. “Dazzling. Each one of you. Each and every ordinary death.”

Jay’s breath is changing. I can hear it, even through the metronome of the concentrator. I look toward the bed and see that he is plucking at the nasal cannula. I go to him and gently ease the tips out of his nostrils. He relaxes again, the lines on his forehead smoothing out.

I watch for signs that he is laboring to breathe, but he isn’t. His breath is smooth, but irregular. Arhythmic. I turn off the concentrator and the sudden silence in the room is like a weight. A movement in the corner of my eye catches my attention. The deer are alert, now.

“I wish you could see what I see,” she says, behind me. I turn and she is standing at the foot of the bed. “What they see,” she nods toward the deer who, I swear, seem to nod, ever so slightly, back at her.

“Stars are realigning,” she says. “Planets are dying and being born. Reality is reshaping itself, because this life was, and now is ending. I see him coming to meet me and everything he was, and dreamed of being, and fell short of, every amazing, infinitely enfolded moment of his Life is trailing behind him like nebulae. He is gloriously beautiful. The light that he is shames the Sun.”

His breath is so subtle now. I place my hand on his chest to feel it. Exhale and then wait, wait, wait… just when I think he’s gone, I feel his body pull in air again. And out, and in, and out and wait, and wait…

I look out the window and the deers’ eyes are glowing more brightly now, reflecting a light I cannot see. Under my hand there is a thrumming as though he is holding a stretch, as though his body is full of electricity. And then the sensation is gone and he is, too. I know it the way I know what the smell means.

I know it the way I know who the woman at the foot of the bed is.

She makes a noise that sounds like awe. She murmurs something I can’t hear. And suddenly the room feels darker, although the lamplight still puddles warmly on the nightstand.

The deer lower their heads and step, delicately and silently, back into the shadows.

“One more thing,” she says. She is closer to me now, just behind my left shoulder. I can feel her lean in, careful not to touch me. It’s not time yet for her to touch me.

“Every human life. Every one. No matter how much time you had. No matter what you did with that time. Every one of you a glorious, blazing universe whose coming, and going, remakes the world. I meet you all and I am awed by the magnificence of every single one of you, and the Life you gave life to.”

She is gone, and the smell is gone too. But somehow I still hear her.

“Know that,” she says.

And now I do.