Fernando is a Hospice nurse. He is a mountain of a man; an ex-football player with a tapestry of tattoos and a black, full beard. He was recently diagnosed with Parkinson’s, so he moves slowly and deliberately, and he cannot completely hide his tremors. In one of his previous lives, as Security Chief at a Native American casino, he learned how to use his big smile to diffuse tensions and soften his imposing appearance, and I often see him use this smile to connect with Hospice patients and their families.
Fernando is very, very good at being a Hospice nurse. He is capable and conscientious, and, like a gentle giant, always comforting. I have marveled at his ability to bring calm and perspective to so many of the emotional hurricanes that can surround the end-of-life. Recently, after weathering one of these storms with a patient, he asked me “Which brings more to Hospice care: life experience or clinical experience?” Before we could think seriously about it we were busy with other storms, but for me, the question lingered, and begged an answer. Hospice care is immensely challenging, and not all providers can excel at it, or even cope. Burn-out is high, and “Compassion Fatigue” is real. What best prepares us to do what we do? Perhaps there is no definitive answer, but if we examine the story of Fernando’s incredible life and his journey to where he is now, we can at least appreciate the wisdom behind the question.
Fernando was born in Los Angeles to a mother and father so poor that they were homeless most of the time. His father was a meth addict who was rarely around. His mother worked hard to try to support Fernando, but their lives were always on the razor’s edge of poverty and violence. Fernando started getting into more and more trouble until, at age 12, his mother was diagnosed with cancer. For the next few years he supported her as best he could, accompanying her to all of her surgery, radiation, and chemotherapy treatments. He vividly remembers the return trips after therapy, when she would stop the car every 10 minutes to vomit, and he would help her clean up and carry on. It felt good to help people, and care about them, and he started to think about how he could be of service to others. His first big step was to become a Firefighter and, after a few years, when the Yavapai-Apache Nation needed a Fire Chief, Fernando was their choice. It was hard work, full of challenges and tragedies, and as time passed he found himself getting involved more and more with the broken people, and less with the burned properties. He trained as an EMT, and then became a Paramedic, attending more than his fair share of catastrophes and death. After so many emergencies it struck him that perhaps he could use his skills in ways that might be more supportive and preventative, so he applied to Nursing School. One day, nearing graduation, he noticed a tremor that wouldn’t go away. It was Parkinson’s, a diagnosis that not only challenged his well-being but also threatened to deny him his RN degree. Fortunately, the respect he had earned during his training carried the day and he was able to complete the program.
As a new RN considering his options he was certain that he wanted direct, intimate patient care. With his tremors better controlled, but still present, he ruled out Intensive Care/Surgical nursing, and he had little interest in administrative positions or shift work. He thought about the fact that, although he had spent his entire life trying to save people, he was quite familiar with death and dying, too, and so he found his way to Hospice care.
I remember preparing for Fernando’s interview. As Hospice Medical Director I had signed off on hiring many people over the years who hadn’t worked out. Stress issues, reliability issues, and personality issues had made me wary of considering applicants with no track record or pertinent experience. Recently out of Nursing School, with no Hospice experience, Fernando had me worried. I reviewed his records, and we started to talk, and slowly I started to realize what the word “experience” really means.
Experience, in Fernando’s case, has meant absorbing, and coping with, a lot of hits. Hemingway famously said, “The world breaks everyone, and afterward many are stronger at the broken places.” Fernando’s strength lies in his desire to help others, and that singular, magnificent compassion for others has allowed him to learn from every tragedy, grow stronger, and create out of suffering an unshakeable empathy. When patients and families get to know Fernando they quickly recognize someone who “has been through it”. They see his tremor, like a scar, and that vulnerability strengthens their bond that much more. Throughout, they trust Fernando. They instinctively know he cares and understands what they are going through. Our time caring for patients together has, for me, provided an answer to his original question: All my clinical knowledge and Hospice experience pales in comparison with the power of what Fernando brings to Hospice care.
We can train each other to be good Hospice clinicians and follow the protocols. We can even train each other to show compassion and understanding. Hospice organizations can provide that experience, and build on it. What we can’t teach is authenticity and the perspective on life and death that comes from each person’s personal experiences. We can’t teach the gift of connecting with patients and families out of a true understanding of having “been there”. Those connections, perhaps more than anything else we do, make the difference between an adequate Hospice experience and a special one. From now on, when I interview new candidates for Hospice positions, I will be looking for that life experience. I will be looking beyond an education transcript and looking beyond appearance. I will be looking for Fernando.