FEATURE: Angels at the bedside

EVA BRADLEY
It's 8.20 on a Monday morning and the scene inside the staff room of Cranford Hospice is completely unremarkable. Coffee cups rattle, the Zip whistles and colleagues share stories about their weekend, trading friendly office banter. But that's about where the similarities between the Hastings-based hospice and other workplaces end abruptly.
Employed to care for the terminally ill, the team who gather for their morning meeting are in many ways the handmaidens of death - or, as one patient prosaically puts it - if there was a heaven on earth, the Cranford nurses would be the angels.
Such is their bashful sense of duty to the sick and dying that if you mentioned this metaphor to them, the all-women team would "tsk tsk" with embarrassed efficiency, mumbling something self-consciously about "sentimental nonsense".
Truth be told, it takes only a few hours in the company of the Care in the Community team to realise that each and every one of them is not only sentimental, but completely dedicated to the task of helping people in pain - physical, emotional and spiritual.
Karen, a bubbly nurse with a round face and rosy cheeks, who is almost certainly someone's mum, is the first to go through her list of yesterday's house calls, updating the team of nurses, doctors and the Cranford pharmacist on the improvement or otherwise of her patients.
Forty-something George is first up, and while his medical situation is addressed, it is his inability to find a way to explain to his two young children that he is dying which dominates the conversation. Eventually they decide a session between the children and the resident art therapist would be the best way forward.
After Karen's list comes Diane's. The on-call nurse overnight, she seems to have spent much of it at the bedside of a patient in her mid-80s, but despite this she is fresh-faced and recaps the background of the woman's ongoing care. Almost as an after-thought, she chips in at the end: "Oh, and she passed away, very peacefully, just before 6am."
The reaction of the staff speaks volumes: no sad faces, no expressions of despair. In fact they receive this news with delight. For them, death is usually a certainty for their patients, and it is the way they die that concerns them most.
To know a well-liked elderly woman has died painlessly at home surrounded by her family is good news, not bad. Nurse Janet's experience wasn't quite so textbook perfect. She speaks at length about the passing away of an elderly man in considerable distress - both for him and his family. "If only they had called me," she says softly.
Her colleagues listen patiently and the doctor, a young English woman called Susan, says what the others feel: "you did what you could".
As Janet loads up her "office" - a tidy white Ford Mondeo - she explains that the chance to sit down with a patient in their own home and discuss the grandchildren or the weather can often tell her as much about a patient's condition as a medical chart and examination.
Her first visit is a case in point. An ageing Flaxmere woman, who seemed "a bit tearful" but otherwise fit as a fiddle during a telephone conversation, reveals in person that she is in fact feeling "horrible and lousy".
It takes 15 minutes of gentle questioning, mixed with idle chit-chat, but eventually Janet finds out what that means: her patient feels dizzy and has mixed up her medication.
En route to her next stop, she radios to the pharmacist at Cranford and the medication is quickly sorted out, while a family member has been advised to schedule a visit to the GP.
Next up is another older woman who is absolutely thriving in one of the hospice's two respite beds in the Rollinson Wing at Atawhai Elder Care in Taradale.
There are no pressing medical conditions to monitor, but Janet wants to make sure her patient is happy about arrangements to move into a more permanent rest home facility.
Her next stop is just around the corner - a patient who has stayed at Atawhai in order to give his full-time caregiver and wife, Helen, a rest.
"I felt a completely different person since I had that complete break," she admits.
Hooked up to a permanent oxygen supply and unable to do anything unassisted, the elderly man knows he is dying but his jokes and cheeky comments pepper the conversation.
"You haven't lost your sense of humour, have you?" observes Janet.
"Well, you've got to keep something," he replies with a grin.
Moments later it is back to the car and out on the road again. Janet has seen her next patient at home before, but pulls over to check the map.
"I'm not sure if she'll be there. I love it when I miss my patients because it means they're out enjoying life," she says as she turns into a tidy cul-de-sac.
Linda is only in her early 40s but has just been told she has 12 to 18 months left to live.
"I was surprised, I thought I was doing so well," she says to Janet, but smiles as she does so.
Like many terminal patients, she has come to terms with her lot and has no plans to waste her precious months being down in the dumps. In fact, she's "thrilled" to have achieved a personal goal and come off her pain-reducing morphine. She talks a mile a minute about holiday plans, a family reunion and her appreciation of the job Cranford is doing helping her at home.
"For my husband, it's invaluable because he sometimes thinks he's so inadequate and being able to pick up the phone and check something out with you is invaluable." As we drive back to base in Hastings, I wonder aloud about the toll such a job must take on those at the coalface. Aside from dealing with death on a daily basis, the community nurses are on-call for a week every month and can often get seven or eight phone calls during the night and still be expected in at the hospice first thing the next day.
Despite this, Janet says she is never bitter about being woken in the night.
"I think a lot of it depends on the person you are but also it's just the nature of the job. I chose to do it and so I want to be there with my patients when they need me. Sure, I get grumpy but it's usually with my husband, never my patients!"
Last week she worked extra shifts due to heavy demands but it's not always that bad, and "if something comes up you just do it".
In return, the nine-year veteran of Cranford says she gets an incredible sense of satisfaction knowing that she makes a difference to people's lives - and deaths.
"Helping people may sound twee but it is as simple as that." As for being surrounded by death?
"I'd hate to think I was immune to it. There are times when we do cry, especially if we've built up a strong relationship with a person, or if they are young."
Seeing people in their homes is especially satisfying for Janet. Instead of knowing the patient, she also knows the person - the photos on the wall show children growing up and healthy-looking people before they were hollowed out by illness.
It's also a time to meet family members - the secret ingredient in ensuring a patient dies happy.
"You have to work hard at family relationships because half will be very anti-Cranford, seeing it as a place to die, but others clearly aren't coping on their own at home. "Often we see partners who are completely exhausted but wracked with guilt at the thought of ignoring a last wish to die at home."
And while that isn't always possible, Cranford is dedicated to making it happen for hundreds of patients every year.
It's sad, admits Janet, that there are seldom miracle recoveries by the time people are referred to them, but making it possible for the inevitable last moments to be spent comfortably at home with family instead of on starched sheets inside a hospital is what gets Janet and her colleagues out of bed in the morning - and in the middle of the night.
* Patient names have been changed to protect their privacy.