Passing On
Cathy and Linda were the same age, grew up in the same place, and could have been girlhood chums. Instead, they met when Linda was terminally ill and Cathy, a hospice nurse, was assigned to ease her final days.
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“Linda, there’s nothing more I can do except just hold you,” Cathy told her patient, trembling herself. She encircled Linda with her arms and in a quiet voice told her to breathe slowly, ever so slowly. Linda complied, and as her respiration rate slowed she nodded faintly and hummed or snored. In a few minutes she fell into an uneasy sleep. Cathy carefully slipped out of the house, late for her team conference meeting at the hospice.
As the other nurses, social workers, volunteers, and household aides compared notes and discussed treatments for patients, Cathy kept silent, offering no advice and asking none. When her turn came to report, conference leader Charles Kemp asked about Linda’s condition. Cathy blurted out something about intractable pain, then broke into sobs.
Kemp, who sat on Cathy’s left, put his arms around her, as did the nurse on her right. Rather than admonishing her to stop crying, both encouraged her to express herself. Phrase by phrase, Cathy explained her difficulties with Linda’s pain control program. She also talked about how Linda’s impending death frightened her. After all, Linda Mihlan was in many ways her double: they were the same age, they had both been born and raised in the Dallas area and spoke with the same accent, and, as her hospice co-workers had noted, they were both women of a somewhat serious disposition, friendly but sometimes somber. Before the discussion of Linda’s status was over, half a dozen people were crying with Cathy. It was the sort of mutual support meeting that hospice workers claim they must have in order to face their jobs. They must give strength to families facing death, and in the course of their work they themselves often need emotional bolstering.
The Texas hospice movement’s leading visionary was nurse Charles Kemp, 36, a tall, thin, bass-voiced, black-bearded man. Kemp was a Marine machine gunner during the Viet Nam War, and he returned home disillusioned and frightened. He became a counter-culturist, and even today he neither blinks nor grins when he cites Dr. Timothy Leary as an authority on matters of metaphysics. Like Kübler-Ross and other hospice pioneers, Kemp has unorthodox ideas about the afterlife, and though these views do not enter into his hospice or nursing work, they were in part responsible for his interest in the crises of dying patients. Kemp graduated from nursing school in 1975, with some help from the GI Bill, and three years later completed a master’s degree at the University of Texas at Austin. He went home to Dallas, where he and a handful of associates began providing ad hoc hospice care to terminal patients, sometimes on a voluntary basis.
His efforts won approval in the nursing community, and in the fall of 1978, at the request of the VNA, he put together a hospice program. Though the project grew—it now has a paid staff of fifty and a $1.5 million annual budget—late last year Charles Kemp resigned as director and was replaced by a licensed nursing home administrator whose background was entirely orthodox and bureaucratic. Kemp had become a victim of career burnout. His new occupation, however temporary, is as a yardman and gardener. “I just got sick and tired of death,” he says. But Charles Kemp was there when Cathy wept at the hospice meeting, and he, more than anyone, gave her the resolve to go on. Though he ultimately gave up himself, Kemp brought dozens of new hospice workers into the program and steeled them.
Linda’s condition improved in early November, and once again she was able to venture out in her wheelchair. One of the few wishes she expressed was to visit a simple seafood restaurant on Buckner Boulevard; methadone allowed her its fulfillment. Though she was weak and by then weighed not more than ninety pounds, she and Chuck also went one Friday night to dinner at a Bonanza steakhouse in Mesquite, at the invitation of a co-worker of her husband’s. That dinner was her last meal.
Over the weekend Linda weakened rapidly. She refused food and on Monday laid her cigarettes aside. She could no longer rise from bed and slip into her wheelchair; Chuck now carried her from room to room. Her complexion grew pale, her body turned cold, and her breathing became labored. On Monday, when Cathy Little visited the home, Linda’s blood pressure was abnormally low. On Tuesday both Cathy and Chuck knew that she would not live long.
Chuck called Cathy outside the front door of his house. “I don’t know, Cathy,” he said, “but Linda is getting weak pretty fast. I don’t see how she can make it another week.”
“I think you’re right,” Cathy told him, reaching for his hand.
Chuck braced himself, as he had for months, in the belief that harsh news hurts less on a stiff backbone.
Some premonition told Cathy to give Chuck her home telephone number. She wrote it out on a slip of paper and, as she left, told Chuck to call her if he had any problems that night.
Linda lay on the old couch in the living room that evening, sometimes whimpering, sometimes wailing with pain that not even methadone could hold down. She hurt, as she had for days, in her right thigh, and she hurt in her bowels as well, for that evening diarrhea had come upon her. About ten o’clock her multiple pains were severe enough that she began imploring Chuck to call an ambulance. She wanted to go to a hospital.
“Linda, we’ve discussed it before, and you know there’s nothing they can do for you in a hospital,” Chuck told his wife.
But Linda would not be content. She told Chuck that she loved him and repeated her plea for an ambulance.
By ten-thirty Chuck was perplexed and afraid. He sat down in the overstuffed chair next to the couch where Linda lay and picked up the telephone. He dialed Cathy’s number. “I don’t know what to do. Linda’s in awful pain and she wants an ambulance,” Chuck told Cathy.
Cathy made several inquiries about Linda’s condition, then counseled Chuck to fend off the requests until the pain subsided, as it always had before.
“Just a minute,” Chuck interrupted, turning his head toward his wife. Linda had moved one foot onto the floor and attempted to pull her torso erect, as if to rise up from the couch. Now she sat in that position, stiff, with eyes and mouth wide open.
Chuck laid the receiver on the floor, then checked his wife’s respiration and pulse and looked into her eyes for dilation, as Cathy had taught him to do. In seconds, he knew that Linda was dead.
He picked up the receiver again. “Cathy, she’s gone. It’s all over now.”
Cathy counseled him to accept what he had known was inevitable.
“I’ll tell you what,” Chuck said. “You go to your icebox and get a beer, and I’m going to get some margarita mix we’ve got here, so I can get drunk.”
After Chuck had mixed his drink, he continued his conversation with Cathy. They planned out the steps that were required that night: telephone calls to a funeral home, to Chuck’s best friend, to Linda’s family. They hung up, and after he had made the phone calls, Chuck turned to look at the woman who only minutes before had been his wife.
“It’s hard to say how I felt, but I felt so, so alone,” he recalls. “I didn’t know what to do, so I tried to close her eyelids. I couldn’t get them closed, though, and I just sat there, not knowing what to do. Finally, about the time her family came in, I went into the bedroom and sat down and played the stereo with my headphones. It was a hard thing to handle.”
With Dave, the hospice social worker, Chuck visited the funeral home the following day. He selected a modest casket and looked at Linda.
“I wanted to make sure that she didn’t look worse than when she died, or else I wouldn’t have let her have an open-casket funeral,” Chuck says. “It was a good job they did. They stuffed her cheeks with something, so that she didn’t look so thin. She looked better than she had in months.”
After approving the morticians’ work Chuck went to the Buckner Baptist Childrens’ Home. The three boys were called into the chaplain’s office, where Chuck told them their mother was dead. All three wept, and one of them, who at times had beaten his mother about the waist, later blurted out, “It’s my fault, it’s my fault.”
Two days later the children were out in their Sunday best to attend Linda’s funeral, held on the fifth anniversary of her marriage to Chuck. The funeral was Baptist, simple, and well attended, like most services for the young. But it fell short, in some ways, of what Linda had wanted. She had requested that a popular country-and-western song, “I’ll Go to My Grave Loving You,” be sung at her service. Chuck could not arrange for it. Nor could he afford to give Linda’s grave a headstone.
Wearing a sport coat of his own and a pair of pants borrowed from his father-in-law, Chuck showed up at the funeral to perform the tasks the widower’s role required of him. But he was not comforted there. As soon as Linda was in the ground, he slunk off with Cathy, Dave, and a hospice volunteer—the people who he believed understood him best—for drinks in a Dallas restaurant where he and Linda had often dined. The four sat together for about two hours, reviewing the events that had brought them, a group of strangers, into familylike intimacy in the past weeks. By the time they left, all four were as clouded, and as comforted, as well-wishers at any whiskey wake.
Cathy Little, who had spent weeks preparing for Linda’s death, found that the memory of her patient was, in many ways, a personal one. “Linda had always wanted to go to Colorado, and Chuck always said that if there had been any way he could have afforded it, even after Linda got sick, he would have taken her,” Cathy says. “Well, after she died, I began to have the strangest new desire. I wanted to go to Colorado myself, as if for her, in her place. I haven’t gone yet, but I will.”
Chuck Mihlan has found solace hard to come by. For a few weeks after Linda’s death he turned to drinking—hard. At Christmas he carried a small tree with an ornament on top to her grave. There he broke down and cried for the first time since hearing Linda’s diagnosis. Social worker Dave Overton’s objective advice to Chuck was to seek out the company of new women, but Chuck spurned that counsel. Instead, he turned for consolation to the Pentecostal faith of his adolescence. In a world where youth, family, medical science—and even the specialized services of a hospice—are not as extensive or protective as we would like, Chuck Mihlan is finding a way to cope with Linda’s death: “You put your faith in God, you stay close to the one you love, and when she is gone, you pray that she is not alone.”
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