sure he eats his breakfast.’ Sitting in a comfortable chair beside Bob’s bed with her knitting and the crossword, she kept a watchful eye on Bob’s every movement. At 1 p.m., after she had settled Bob for his afternoon nap, Doris packed her belongings, ready for the 1.30 p.m. tram for home. What then? ‘I do Bob’s washing, go down the street for my messages, then make a hot thermos of soup and my sandwiches for tea, lock myself in for the night and hop into bed at five o’clock. I eat my tea while I listen to the wireless (it’s good company). I’m usually asleep by seven or eight, and the alarm goes off again at 4 a.m.’
Some staff found Doris’s constant presence a source of irritation. ‘She sets herself up here just like it’s her own place!’ Others felt insecure or offended by Doris checking on all Bob’s care. Some, like the cleaner, felt Bob needed more of his own space. ‘I see Bob close his eyes as soon as the wife comes in. I know he’s not asleep, he’s just faking it. He’s probably been under the thumb all these years and even now he can’t get away from her!’ Words of wisdom or the cleaner’s imagination?
And what of Bob? It was Doris’s perception that Bob had always directed her life;
their closely shared history would not easily be interrupted. She described him as ‘a wonderful protector’ who accompanied her even to the corner shop, never let her dry a dish and was always concerned for her comfort. ’ “You sit down and let me sweep the floor,” he’d say.’
We never knew Bob’s thoughts about Doris’s reflections or his nursing home admission because he never spoke a word. The speech pathologist could give no reason for this but perhaps it was that Bob had said all he had to say and was now resigned to the last chapter of his life.
From the day of Bob’s admission to the nursing home, Doris was convinced that each day would be his last. ‘I don’t think he’s got much longer,’ she would confide.
When his deterioration became unmistakably rapid, Doris demanded hospital admission. ‘I promised him I would never put him in an old men’s home to die.’
Staff at the acute hospital were sympathetic, agreeing to her wishes for intravenous fluids, treatment for his pneumonia and every possible intervention to reduce his fever. When it was evident that these measures were not life saving, negotiations commenced about his transfer back to the nursing home. Hospital doctors and staff explained the palliative measures available in the nursing home, gently convincing Doris that resuscitation measures were not advisable and not appropriate. After two days of bargaining, Doris made up her mind. However, her version of events was different from the hospital’s: ‘They kept waiting for me to make up my mind. They wanted to keep him at the hospital but I told them that the nurses at “the home” all
loved him and wanted him back there, so they finally agreed to let him come back. I want him to be where all his things are.’ All Bob’s ‘things’ included several jars of faded plastic flowers, wedding photos, pictures cut out of magazines and some football trophies from his teen years. All these articles Doris had dusted tenderly each day, unwilling to trust them to the cleaning staff.
The nursing home had a carefully formulated palliative care policy, including the use of subcutaneous fluids in exceptional circumstances. It seemed a good palliative measure to offer for Bob because Doris could not bring herself to have the hospital’s intravenous fluids ‘switched off ’. She was comforted by the knowledge that a continuous infusion of normal saline would meet Bob’s hydration needs. At the staff team meeting, all agreed that this may bring Bob some physical comfort, while providing reassurance for Doris.
Doris showed the ambiguous feelings common to those who watch over the final days and hours of their loved ones. She hoped Bob would recover and yet she claimed to be prepared for his death. Afraid that she was not able to accept that Bob was dying, concerned staff arranged a meeting with Doris and her son to offer an opportunity for them to discuss their feelings and expectations and to describe the nursing home routine following death. The charge nurse was about to begin the discussion when Doris spoke up, ‘I know it could be any hour now and while I don’t want it to happen I’m prepared for it.’ It was gently explained that when Bob stopped breathing, indicating his heart had stopped pumping, there would be nothing more we could do in the sense of reviving him. ‘I know all that,’ she said. ‘They told me at the hospital they would have to pounce on his chest and I was horrified. He’s already got cracked ribs. I told them Bob wouldn’t want that, and neither would I.’ With that cleared up, the discussion became easier. There would be many other elements of nursing care to offer him and yes, she could give him sips of lemonade.
The discussion turned to what might happen after Bob’s death. There would be no hurry to remove his body, Doris was assured. She could stay and say her goodbyes until she felt ready to go, unlike what would happen in the busy hospital setting.
‘Oh, yes, I know what that’s like. They’d be wanting someone else in the bed even while it was still warm!’ She also welcomed the reassurance that she had done everything possible to care for Bob and that his death would not be of the ‘old men’s home’ variety she had feared.
True to her word, when Doris was notified of Bob’s imminent death in the early hours of the morning, she arrived within the hour. Her visit extended to several hours following his death, her actions carefully measured, consistent with her lifestyle and with her self-expectations and what she believed Bob would have
wanted. ‘We’ve often talked about all this you know, we knew this time had to come.’ Night staff offered non-intrusive care and support, leaving this last exchange between Doris and Bob to the privacy it deserved. If the cleaner had been present, he may have altered his previous judgement.
After several hours the nurses, in their desire to be helpful, were anxious to pack all Doris and Bob’s belongings. ‘You go home and rest, we’ll see to packing all this.’
However, this was an affront to Doris’s housekeeping routines and to the final act of her care for Bob. Never having been apart for 67 years, never ceasing to look after his clothes and possessions, this final act was not to be hurried, nor was it to be placed in the hands of others.
The funeral service was to take place from the nursing home chapel. Doris confessed Bob was never a religious man but nevertheless he would like a decent burial and she would be glad of the chaplain’s services. Having no specific religious sentiments to express, Doris was keen that the chaplain should emphasise the wonderful care she and Bob had experienced over the six months. ‘Don’t you forget to thank them,’
she reminded the chaplain.
Thoughtful as always, Doris wanted the flowers from the funeral to be taken to
‘Bob’s bed’ ready for the ‘new man’. No longer concerned about indecent haste in filling the bed, Doris was resigned to the fact there would soon be someone else to take Bob’s place.