It Takes an Apple

While working a very busy job as the speech pathologist between several hospitals, the therapist who normally handled home-health patients took a vacation. Why? At the time I concluded principally to inconvenience me. She may in fact have had other motivations. So of course, on a particularly busy day, I got a call that a home health patient had been referred. To make matters even better, the patient was nearly an hour away. I complained. A lot.

She was a hospice patient. It was a little unusual to have hospice referrals, but they did happen. Swallowing problems are in the purview of my discipline, and a terminal patient sometimes needs help there. Such was the case on this day.

After driving for over an hour and getting lost twice, I found the little cottage where the patient lived. I climbed the stairs and made my way to her. She was bundled up in her bed, covered in blankets, thin and bright-eyed. She told me her problem: she was having difficulty swallowing, and wanted  – more than anything – to eat a steak. It was all she was hungry for.

I had reviewed her chart before walking into the house. And although her history and her diagnosis were there for me, one key piece was missing: her prognosis. While hospice means terminal, it could be anything up to a year. I looked at the thin face with the attentive eyes I asked, as kindly as I could, “How long?”

“Two, maybe three months,” she answered.

The numbers failed to match the strength of the voice that responded to me, and while trying to resolve the incongruity in my head, my mouth opened and I said, “I’m sorry. How do you feel about that?”

To this day I do not know why I asked the question. If I had thought clearly, I would have labeled it stupid, invasive, clueless or all three at once. I regretted the words as soon as they escaped.

So imagine my shock when she answered simply, “Emancipated.”

I blinked. “Emancipated?” I asked. “Why?”

And she told me. She told me how before she knew about the quick terminal illness, she’d been diagnosed with a slow, progressive one. How the thought of the slow, progressive one – which would day by day drain her body, her mind, and her bank account – terrified her with its inevitable debility and dependence. How she was afraid she would exhaust her friends and family in her demands for care. How she was afraid of what her world would look like when she ran out of funds. How she was terrified of her quick mind slipping away without even the ability to recognize the loss.

But now she would go quickly. With her loved ones around her, her finances intact, with even a little left for the people who mattered most to her. She would have medical care that would keep her as free of pain as it could until the end. An end coming in quick months with her mind able to appreciate each day she had left, instead of slow years where one day would bleed memoryless into the other.

And in that paradox was her emancipation. Her freedom.

“I see,” I said once she had explained. And I did. With so much depth and clarity that I could feel its resonance in the moment it happened, clear through my body and down to my feet resting on the braided rug beside her bed. Understanding struck in that moment: a gift wrapped in the orange glow of the vanishing afternoon sun. I did not need to ponder to find appreciation, there was no slow realization. I was blessed to see and feel it all in that single glorious instant.

I wracked my brain for her, pulling up every trick I’d learned in my years in the field to make a piece of steak edible for her. She didn’t want hamburger – nothing chopped or ground. She wanted steak, and I wanted her to have it.

And as I left, walking down her stairs while the sunset painted the sky radiant reds and yellows, I savored the moment when “I have to go see this patient,” became “I got to go see this patient.” Because what I wanted to remember most was that moment of transition – when my sour outlook was swept away by a joyous one, when an inconvenience became a celebration. I needed to remember – because the next time my psyche sank into a state of cynicism and my perspective could see no further than the next annoyance, I might not be so lucky to have an apple fall from the sky onto my head.

Apples simply don’t fall like that every day.

Details about this patient have been purposefully changed or obscured to protect their privacy. Although I think if I had thought to ask at the time they would have been happy for me to share them in full.

32 comments

  1. That is an amazing story. I would never have thought of it that way but understood it instantly as well. And will probably never think about a prognosis the same way again. What a marvelous gift from a patient.

  2. You see what you’ve done here? You’ve dropped apples on all of us. Just like that.

    So she was not only emancipated, but she has taught lessons beyond her imagination.

    Through you.

    Brilliant.

  3. We should all be so lucky to have an apple fall on us.
    It sounds like this woman was so lovely…so wise…so peaceful.
    What a blessing to have met her.

  4. Tiny, tiny pieces of steak? Also, one could chew steak without swallowing it, thereby getting the main pleasant sensations of eating a steak.
    I saw my grandmother die from one of those slow, creeping, debilitating kind of conditions. I’m sure she would have welcomed a quicker demise at that point, and having seen her suffer, I can totally understand why.
    Jodi

  5. Wow. What a truly touching story. Its in moments like those that the true beauty of this world comes alive. Gorgeously told, Lori. You are an amaizng writer and an amazing person.

  6. Oh, thank god, I thought you were going to write a post about a computer.

    I love it when you tell stories like this. You have a gift for it. But tell me, did she get to eat her steak? I really hope so.

    1. She did. I did not get to see her again. The regular therapist came back from vacation and took the case over. But I checked in. She did. :)

  7. When my grandma was sick and could no longer eat, we felt terrible noshing on tasty food in the kitchen while she was sick in the bedroom above us. And we knew she could smell what we were cooking. The hospice nurse said, if she really wanted to, she could chew her favorite foods for the flavor and then spit them out. It broke our hearts.

    1. Swallowing problems are huge. And a huge part of what I do, consequently. I’m sad to hear about your grandma. I hope things in general were as peaceful for her as they could be.

  8. Lori, this is wonderful. What a gift you gave her (and yourself) in spending time there and even just asking her that question.

    You have such a way of telling stories, and I can tell you have a wonderful way with your patients.

  9. This IS lovely, Lori.

    Just what I needed this morning. I am glad that I chose your blog as my one “sneak a read” during my first hour today.

    Thank you, lovely you, for throwing this apple at me.

  10. Amazing story, my love. Beautifully told.

    I often say that my favourite thing in the world is being proven wrong.

    Delightful, isn’t it?

    Much love, my sensitive Miss Lori.

    – B x

  11. Just. Lovely. Death is such a painful topic for so many people; I could only hope it could be approached in such a way by more.

    And you – this is just so indicative of how powerfully able you are to look deep into and feel even more deeply about a situation. At the risk of sounding like a biased grandmother, you’re SO special, lady.

    I want to know, too, though: Did she get her steak?

    1. She did. I didn’t see her again, the regular therapist came back and took over. But, she did. Tiny little bites of the best quality money could buy, timed very carefully with her medication.

  12. I read this post originally on my phone where it is a pain in the ass to comment, but had to check back to make sure she got to have her steak even though I just knew she did. Loved this.

  13. I am woefully behind in my blog reading.

    This? Is a wonderful story. :) I hope that when my time comes? I have such clarity. What an amazing outlook. :) And I’m so happy she did, in fact, get her steak. Steak is pretty damn awesome, IMHO.

    Thank you for sharing this. :)

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