A Hospice Social Worker’s Take on Inside Curveballs
By J. Scott Janssen
When something is coming at you that may cause pain or self-doubt, it’s natural to want to duck.
Nothing cuts the early morning silence like a pager going off. When you're a hospice social worker, the sound is an electronic SOS. Someone's in trouble! I'm instantly awake. A telephone number flashes on the pager display, giving the room a pale green luminescence. I dial the number, adrenaline racing, wondering what I'm about to walk into at this hour.
"Scott? Is that you?" I recognize our on-call nurse's voice. Usually, she's as calm as a field of untracked snow, but tonight she sounds nervous.
I draw in a deep breath, hoping she'll do the same. "What's going on, Rita?"
"It's horrible. . . . She's bleeding to death."
She gives me the patient's name and a quick rundown: a 35-year-old woman with throat cancer, receiving home hospice care, who has a husband and two kids, ages 8 and 10. A week or two earlier, the tumor broke through the skin on her neck. An hour ago, it tore her carotid artery. Now blood is trickling out, and there's no way to stop it. Rita says she thinks the woman may live another 30 minutes, 45 tops-just enough time for me to get there.
The night air is cold as I walk to my car. I can see my breath rise into the autumn darkness. The stars are beautiful-pinpricks of light through a black canvas. As I start the engine, I think of a story I once read about a Native American people who believed that each star was a footprint left by a soul on its journey into the heavens.
It's tempting to try to distract yourself when driving into situations like this. With the heat cranked up, I roll down the window just enough to hear the whirr of wind streaming into the car. Somehow, it's soothing. It can be scary showing up on someone's doorstep at 3:00 a.m. as they struggle with emotional pain, knowing that all you can offer are words, shared silence, a listening ear. Maybe the most important thing I can offer is the willingness to sit beside them without flinching as thoughts and feelings, however intense, tumble out. I can bear witness. I can trust that, however desperate things seem on the surface, underneath, each second is full of meaning and possibility.
My mind drifts to a conversation I had years ago with a clinical supervisor who said, "Ninety percent of this work is having the guts to show up and look at what's happening without changing the subject." She'd assured me that the other 10 percent would fall into place over time, and she was right. Knowing what kinds of questions to ask and when and how to ask them, knowing something about crisis de-escalation and trauma, knowing how to reframe or recontextualize an internal narrative-these are all good skills to have, but in some ways, they're just window dressing.
Showing up in the midst of a crisis with kindness in your heart, listening without judgment, gently asking questions, or knowing when to sit still without asking-it all sounds simple, but it isn't. Few things are more difficult and, on some level, few things are more frightening.
The roads are empty tonight. Street lights and my car's headlights slice through the darkness. I fumble for directions. Right on Cortland, go about 10 miles, and then turn right on Seminole Drive. Inexplicably, a baseball field is lit up by floodlights as I drive by. The neighbors must love that at this hour! I smell the damp earth from the freshly tilled infield and the scent brings a flood of memories: the weathered rawhide of a well-worn glove, fresh grass stains ground into the knees of a blue-and-white uniform, the clatter of wooden bats in an old army surplus duffle bag, the excitement of sprinting to first base and seeing the base coach wave me on to second.
I grew up playing baseball. Its rhythms and metaphors are familiar to me. Part of me would rather be trying to get a hit right now than having to make a crisis visit with a family I've never met. Compared to working with people who are dying, the pressures and dramas that used to seem so monumental on the field seem benign and inconsequential. It's just a game. That's all it ever was, but any events-even the ones on a baseball diamond-can seem gripping and intense when you're in the middle of them.