Abstract
Issue Editor’s Note
Holistic nurses understand what it means to be with a patient and family to hear their story, as they are often our greatest teachers. As nurses, we must open our hearts and be present for all levels of suffering so that suffering may be transformed for others, as well as for the self. This story reveals connections to the sacred that involves feelings, thoughts, experiences, rituals, meaning, value, direction, and purpose. In this article, the author shares the journey with her husband from his brief diagnosis with metastatic pancreatic cancer to his final breath and transition. As you read this profound journey, drop into the present moment with deep listening and compassion as you bear witness while maintaining a spacious mindfulness in the midst of life’s changing conditions.
She stood there watching over us. Her head turned very slowly from left to right and back again, but she never took her eyes off us. She stayed with us throughout the night. Florence Nightingale was there with us in the hours before Bruce’s death.
The experience of my husband’s death has given me a knowledge and a strength that will live in me forever and I would like to share that experience with you. Bruce died on August 13, 2009, at the age of 61, after being sick only a matter of days. We had just celebrated our 25th wedding anniversary.
I realize now that this beautiful experience actually began months before Bruce showed any signs or symptoms of illness. Looking back, God had sent us many gifts, or messages, to help prepare us for his death and to give me comfort in my time of grief. As difficult as it may be to believe, one of those gifts was the apparition of Florence Nightingale. She appeared to us on the afternoon of Tuesday, August 11, and she stayed with us throughout the night and into the next morning.
To tell the story, I need to go back a couple of years. Bruce and I moved from Sharon, Massachusetts, to Lakewood Ranch, Florida, after we became empty nesters. Even before we moved, I began to see heart shapes in everything: in water droplets, spills, leaves—in all kinds of random things. I felt it was a message of some sort but had no idea what it could possibly mean. This past June, I experienced a series of incredible coincidences around the time of my Aunt Helen’s death. I recorded them because I felt there was some meaning there that I didn’t understand.
Bruce and I had a close, loving, fun, happy marriage. We did everything together except our work and his golf. He really, really loved golf! We very much enjoyed being together and celebrated our good fortune: three fabulous kids, our family and friends, and our good health. We appreciated our present and dreamed about our future. Our financial situation suffered tremendously with the real estate bust and the economic downturn, but we really tried to stay upbeat. Often we would say, “It’s OK, we still have each other,” and Bruce would often add, “and nobody’s got cancer.” Well, as it turned out, Bruce’s Aunt Madelyn was diagnosed with cancer and died last fall and my best friend Lauren was diagnosed with breast cancer. During our daily walks, Bruce often spoke about how disenfranchised he felt about our health care system. He sold health insurance to individuals and was disheartened that he had to tell so many of his customers that they were uninsurable. He understood how messed up our health care system is and how it really hurts the folks that are struggling to make ends meet. He took it very much to heart and felt deeply sorry for those people. Despite our disappointments, we remained thankful for what was good. We were very optimistic that our financial situation would soon improve dramatically. Bruce had just received an excellent job offer, and we were planning to move back to Massachusetts in mid August.
Last winter, my very good friend Cynthia gave me the book The Secret. Believing that those who have gone before us are part of our universe in unknown ways, I decided I would use the “the secret” to try to reach out. I didn’t think much about it, assuming only positive experiences could result. Well, I got myself into “the zone” lying in bed one weekend morning, and I was startled to feel a presence in the bedroom. It seemed to hover low, about level with the top of the mattress. My eyes were closed, but the vision of a small dark puff or cloud hovering near the bed best describes what came to mind. I sensed that it floated around the outside of the bed from Bruce’s side, to the foot of the bed and then over to my side. It scared me. It seemed to have a deep “voice.” I don’t know what it said, but the large presence of it frightened me. I hopped out of bed to join Bruce in the kitchen and tried to forget about the experience. I feared getting myself into that state again, and I vowed never to try that again!
In May, we moved out of our primary residence (which was in preforeclosure) and into our rental property in the same community. (We hoped to sell the rental property before we moved back to Massachusetts.) Soon after moving in, a strange whooshing, poofing sound would occasionally come out of the wall in the kitchen in the area between the refrigerator and the stove (coincidentally near the cabinet where we kept our medicines and vitamins). It was a sound neither of us had ever heard before. Bruce and I joked that we needed a party line ready just in case it happened during a showing! There was just no way to explain it. We also had a “pet” butterfly in the backyard. It was a beautiful Monarch butterfly that just floated back and forth within the confines of our small back yard all the months we lived in that house. Both occurrences, we knew, were odd, but we had no idea the significance of them, at the time, anyway.
One weekend afternoon in mid July, Bruce and I went to Siesta Beach. The parking lot was full, so Bruce dropped me off and said he’d meet me to the left of the green lifeguard stand (our regular spot) once he got a parking space. The sand there is pure white and so soft and cool, even on the hottest days. As always, I took off my sandals and carried them so I could feel the sand on my bare feet. That day, the scenery seemed particularly beautiful, so I put down my stuff (my beach chair, beach bag, and the sandals I was carrying) and fished out my new cell phone and tried to take a photo, although I wasn’t too optimistic it would come out because I didn’t really know how to use the camera option. Anyway, I tried to capture the view, and then I picked up my stuff and headed to the left of the green lifeguard stand. Bruce met up with me, and we sat for a while, went for a swim, and then took our regular long beach walk. When we got back to our chairs, the tide had come in, so we picked up our stuff and moved back several feet. When it was time to leave the beach, completely out of character for him, Bruce started walking ahead of me toward the car. I started to follow him, but then I realized I didn’t have my sandals. So I called to Bruce to tell him I was going back to look for them. I yelled for him, but he didn’t hear me. I yelled louder, and he still didn’t turn around. I became frustrated that he wasn’t paying any attention. He was definitely within earshot, but he just kept walking. It was very strange. Finally, I ran up to him and said, “Bruce, I have to go back and find my sandals.” He said, “No, they’re over there,” pointing to his left about 200 yards or so. I said “Why do you say that?” He said he heard the cop in the dune buggy ask whose sandals they were, and he said they looked like mine. I said he wasn’t making any sense. I told him it was impossible for him to hear the cop in the dune buggy from that distance, and why would the cop care whose sandals they were anyway? He said, “Go look.” So I humored him and went over there. Yes, they were my sandals. It blew my mind. He didn’t seem to think anything odd of it. I knew something extraordinary just happened. The next weekend we went to that same beach. I took a photo of my sandals in the sand, and he asked, “Why are you taking a picture of your shoes?” and I said “because something very strange happened with those sandals last week, and I want to remember it with a photo.” He just shook his head and kind of rolled his eyes, as if to say, “You’re such a weirdo!” I think now that it was God saying “Carolyn, you’re going to have to stand on your own two feet soon.” Coincidentally, a few days before we moved to Florida, Lauren gave me a silver and gold bracelet with a Cape Cod Sandal clasp. All things seem related now.
On Friday, July 24, Bruce picked up our new car, and we had a fabulous weekend together. We went to an outdoor concert on the Sarasota bayfront that evening. Bruce played golf the next morning, then we went to Siesta Beach, came home, took showers, went to dinner and then to a play. (We saw two plays in July with tickets we purchased back in February. The first one was Margaret Edson’s Wit, which was about a poetry professor’s final hours as she’s dying from cancer. The other one was called Hay Day, a story about a woman with Alzheimer’s, a disease Bruce very much feared because he had a very strong family history of it. Looking back, both those plays were relevant to our story.) Then Sunday morning, we got ready early and drove up to Anna Maria Island and enjoyed the beach and the shops and took some nice photos. On the way home, I said, “It’s still early, what do you want to do now?” He said he was kind of tired and wanted to go home and relax. I’m not sure if I said it out loud, but I thought there must be a golf tournament on TV this afternoon, and he wanted to watch it! As we know now, he wasn’t just tired, he was deathly ill.
Bruce continued to feel tired, but, somehow, we continued our walks over the next few days. On that Tuesday evening (July 28), a family came for a showing on the house, and while they were there, a very tall cat with a very long tail walked what seemed to be very determinedly at an angle from the golf course to the corner of our yard, cozied himself up between the row of bushes against our lanai and the lanai itself near where I was standing, and slowly walked the entire width of the lanai. Just as elegantly as he entered, he walked away. It was very strange. I thought it might have been a bobcat, but I knew it wasn’t. This cat was otherworldly, not a cat that exists in our world. I believe now it came to us (me, really, Bruce never saw the cat) as a message. We loved our kitties so much, and we were so sad when they died. I think this cat represented our Pedro and Sylvester telling us Bruce was going to be joining them soon.
As the days went on, Bruce wasn’t feeling any better. On that Friday (July 31), he pretty much stayed in bed or lay on the couch all day. He continued to get more and more fatigued as the days went on and then developed a fever with profuse sweating with general abdominal discomfort, and we thought he had a stomach virus. He never left the house that weekend. This was really unheard of for Bruce. He was always so strong, healthy, and active.
Then, on Monday, he went to the doctor, and she agreed that he probably had a stomach virus and told him to come back in a couple of days if he didn’t feel better. Rather than starting to improve, Bruce was feeling worse and worse. On Thursday, August 6, my 51st birthday, we decided I would go to work early and I’d call the doctor again as soon as her office opened at 8:30. On my way to work, I noticed there was one cloud in the otherwise clear blue sky. That cloud had a beautiful rainbow in it, and I thought this must be a good sign, that everything would be OK. Straight ahead, though, I noticed a large “W” marking in the sky, and I remember wondering how a plane could have made that design.
I called the doctor, and she advised me to take Bruce up to the community hospital’s emergency room. Once he was settled in the gurney in the ER waiting to be seen, Bruce told me he saw a man’s face in the pattern of the cloth privacy curtain. I tried, but I couldn’t see what he was seeing. He was adamant, so I tried really hard, but I still couldn’t see it. I sat down and picked up my book The Five People You Meet in Heaven. (I had grabbed that book thinking we’d be at there for a while waiting for them to diagnose Bruce with the flu or diverticulitis or something, and that book fit nicely into my purse.) The doctor came in and examined Bruce. They put him on IV fluids, took lots of blood, and brought him down for a chest X-ray and a CT scan of the abdomen. We were stunned when the doctor said they found “a lump on his pancreas.” When the doctor left the room, Bruce said to me, “I thought I’d live to 80, but everyone dies, and I couldn’t have had a better life.” There was no mention of cancer, no talk about treatment, no discussion of prognosis. But Bruce knew then he was going to die. He accepted the news with ease, dignity, grace, and gratitude for having been given a wonderful life.
Bruce was admitted to a room upstairs in the care of a hospitalist, who was trying to identify and treat a suspected infection. (His white blood count was very high.) There was no oncology department at the hospital, so they sent in a visiting oncologist. This doctor came into our room, looked down at Bruce with a long sad face, held that look for what seemed like an eternity, and said very matter of factly that Bruce had pancreatic cancer with multiple lesions on his liver. The visit lasted no more than 2 minutes. She told us she was heading off for vacation now and said, “If you need anything, call my service.” Bruce was quite angry with her. He felt her attempt at showing empathy was quite insincere. We felt alone and helpless. We went through a day or so of mourning and grieving together, but this turned to optimism after speaking with friends and family who gave us much hope with stories of their loved ones who were diagnosed with pancreatic cancer and were still among the living. We decided together we could fight this thing. We’d get the Whipple operation and we’d survive this. But the hospital there seemed to focus only on his elevated white blood count and not on the cancer itself. During this time, there was a lot of friction between us and the nursing supervisor, and it was causing us both a great deal of stress and anxiety. It was particularly hard on Bruce. She seemed to have no understanding of what it might be like to be so recently diagnosed with a terminal illness. She also had made a series of medical mistakes, and there were several “miscommunications” attributable to her during our three nights there.
The hospitalist mentioned that pancreatic cancer can thrive on sugar, so we decided to cut sugar entirely out of his diet. I went to the grocery store and purchased all kinds of sugar-free foods and energy drinks. We talked about the power of positive thinking and imagery. We were both very anxious to get this cancer treated somehow. I massaged his twitching leg muscles and tried to push the negative energy out of his body and into my cupped hand and away from us. He became more relaxed. I taught him the relaxation technique I learned in childbirth classes 23 years ago. He found it helpful but suddenly got impatient with it, saying he’d had enough of that. The only thing that calmed him was the thought of being home and sleeping in our own bed. He thought he’d feel better and stronger if he could just get some sleep.
Days went by, and we continued to feel unsupported in that hospital. We felt we were losing precious time. We felt the cancer was growing as we waited for them to deal with the infection. We wanted to get ourselves to Boston, specifically to the Massachusetts General Hospital, where we knew they had great success with the Whipple procedure. A friend of ours was a nurse at Mass General for many years. She came to support us at the Florida hospital, made some phone calls, and gave us contact information for the doctor we needed to see at Mass General. I wanted to go directly from the Florida hospital to Mass General. But Bruce still wanted nothing more than to eat and sleep at home one last time.
On Sunday, August 9, the Florida hospital told us they were discharging him because they had identified the infection and could treat it with oral antibiotics. I was literally fighting with the hospital staff, telling them that they could not discharge him because if we were not under the care of a physician, our chances of seeing this world-renowned surgeon would be slim to none. I lost the fight, though. They told us there was nothing more they could do for him and went ahead and discharged him. I took him home, so sick and weak, and we spent the night together at home with our son, Barrett. I booked a 10:25 a.m. flight to Boston. In the morning, Barrett drove us to the airport in Tampa, and we got Bruce into a wheelchair, and I got a Skycap to help me get him boarded. It was a tense 3-hour flight, to say the least. I had to give Bruce Tylenol to try to keep him from breaking out in a soaking sweat so we wouldn’t call attention to our situation. We weren’t sure if the Tylenol was going to hurt his liver or kidneys, but we knew we had to make the flight. We got to Mass General and in triage at the ER, I said to Bruce, “What I do say when they ask what we’re here for?” He said, “LIFE.” I told the triage nurse we wanted to see Dr. Andy Warshaw because we wanted the Whipple operation. He did not laugh at us. He took us very seriously. Everyone there took us very seriously. Bruce received excellent care in the ER, better care in the first few minutes there than he received the entire time at the Florida hospital. It was clear they tried their best to determine if he was a candidate for the Whipple.
After many hours and many tests, they sadly ruled out the possibility of the Whipple because they knew now that the cancer had spread beyond the gastric organs. They told us that with outpatient palliative chemotherapy, Bruce could live somewhat comfortably for weeks or even months. It was now the middle of the night. They were still trying desperately to identify why his white blood count was so high (35,000 now; normal 4,300-10,800). They moved us up from the ER to a room on the 16th floor. In the daylight, we could see we had an amazing view of Boston, overlooking the Charles River with the Duck Tours floating by and kids playing soccer and baseball in the fields below. We could even see Fenway Park off in the distance!
My family was right there with us from arrival at Mass General. On Tuesday, Bruce said to me and my sisters Roseanne and Mary, “Why are there images in the light?” We said, “What?” He said there were images in the light above his bed. Roseanne bent down next to Bruce and looked up into the light. She saw it too. I lay down next to Bruce. I could see it too. It was a woman standing, holding a light, wearing 1800s-era clothing as seen in Figures 1 and 2. Bruce said, “This isn’t like something you see in the clouds. This is real. The image changes.” Later that evening, I climbed in the bed with Bruce for the night, and together we watched the image. Her head moved ever so slowly from side to side . . . left to right and back again, very, very slowly, but it seemed she didn’t take her eyes off us. The background also changed, ever so slowly. Our suitcases were in the hospital room with us, and I searched out my camera and took several photos of the light and the image. She stayed with us throughout the night.
We had to tell our story of Bruce’s illness over and over, to every team of doctors and nurses. We were told that there were at least 60 doctors involved in our case. We (more than subconsciously) remained hopeful that one of these doctors would realize their mistake and tell us they were wrong about the whole thing. As the day went by on Tuesday, Bruce became weaker, and he spoke less and less often. Quite unexpectedly, he sat up at the edge of the bed, looked at me and slowly and intentfully said to me: “When my eyes are closed, I envision dark thunderclouds. But when I open my eyes, all I see is beauty” (and opening his arms wide) “framed just like this.” The look in his eyes reflected a beauty I’d never seen before. As he spoke, his blue eyes sparkled like diamonds. I will never forget it. Then he said “Unexpected.” The weather changed within minutes after that. Dark thunderclouds came out of nowhere. It had been clear moments before. A deep dark fog hovered for a long time. Bruce’s nurse said she’d never seen anything like it before and said it felt kind of eerie.
Bruce was being treated aggressively for infections of all sorts. (His white blood count was now 65,000.) He was given what they referred to as the atomic bomb of antibiotics. We realized that the antibiotics were causing further damage to his organs, but we remained hopeful that the docs could treat this infection and we would be able to share more time together, even if only days or weeks. In the early morning hours on Thursday, August 13, we were moved to ICU, where we’d have the option to have dialysis to keep his body functioning while they fought to identify this infection. By now, I was feeling undernourished and sleep deprived. All alone, on my way back up to the 16th floor to get my suitcase, I experienced what I thought to be a hallucination. I reported the incident to a social worker who stopped in to check on us, but disappointingly, she didn’t follow up in any way.
That morning, the ICU doc told me (out in the hallway) they now believed that the cancer had spread to the bone marrow, and that was what was causing the rising white blood count. He said Bruce probably had only a short time to live, could be as little as only a couple of hours to 2 weeks at best. I went back into Bruce’s room where Barrett and our youngest son Travis were sitting with him and told them I had spoken with the doctor and we were going to be moved back upstairs where we’d be more comfortable. Bruce understood immediately what that meant. He slowly removed his oxygen tube and his blood pressure cuff, and then he started to peel off the IV tapes. I began to help him shed all that medical excess, neither of us saying anything, but all of us knowing the significance of our actions. The ICU nurse saw what we were doing and shut off the monitors and covered the screen with a towel. In the hours we waited for our room back upstairs to become available, we spent beautiful time together. The Red Sox game was on. We all tried to stay positive. There was laughter, but there were tears. Our oldest son Jason and his wife Lisa and friends and family visited and waited in a family room nearby.
Once we were moved out of the ICU, I invited friends and family to come to visit and say goodbye. After our visitors left, we settled in for the night. Bruce’s sister Sue sat right by his side. I climbed in bed with Bruce and we held each other’s hands under the covers. Our boys fell asleep on a cot at the foot of our bed. I fell asleep holding Bruce’s hand. He died peacefully that night holding mine. It was beautiful. We were blessed.
There is no doubt in my mind that the photos I took of the images in the light above Bruce’s hospital bed captured the apparition of Florence Nightingale. The image reflected her physical form, shrunken to fit within the casing of the light fixture, standing, head to foot, perfectly proportional, holding her lamp. I do not think it was a coincidence that Bruce died on August 13. Florence Nightingale died on August 13.
I find multiple meanings in her presence. I think she was there to nurse us through this experience. And I think she was there to honor Bruce’s nurses and all the other nurses and their patients that came before us in that bed and in that hospital. I think she was there to honor Bruce, knowing how distraught he was over the current condition of our health care system. I also think she was there to help guide me into the next chapter of my life. I’ve been drawn to nursing and the health care field since I was a little girl but fell into accounting because of life’s circumstances. Although I had always wanted to be a nurse, I realized then that I really only needed to be a nurse for a week and that I had spent my life preparing for that week, from August 6 to August 13, 2009. Actually, I could so clearly see God’s plan during those miraculous days. All I was, all my experiences, led me to that day. You often hear that your life flashes before you just before you die. I’m not sure if Bruce experienced that, but I know, somehow, my life flashed before me. I could see the puzzle pieces of my life fitting together. Everything suddenly made sense, and it all felt right somehow.
Knowing we were the recipients of many blessings during the weeks, days, and hours leading up to Bruce’s death was very comforting, despite all the challenges in dealing with the health care system. It seemed to me that all my previous life experiences just came together at that time and everything made sense. I felt and still do feel strongly that God had a plan for us, and everything was going exactly according to that plan. It was wonderful to have that feeling of understanding, of knowing. It was and is a wonderful blessing, a miracle really, to be given the gift of acceptance when things could seem just so wrong. Bruce died peacefully, feeling he could not have had a better life, and I was given the gift to clearly see that this was the plan all along.
Although I know we were extremely blessed, it became apparent to me that there is a great need in our society to put more value on and resources into the death experience, to treat it as a beautiful, natural life experience and not as though it’s a medical failure. Bruce and I and the kids did value every moment of his dying hours despite all the obstacles. I’d like now to help others recognize God’s gifts in their own death experience. I feel Florence Nightingale’s presence there was a call to me to be there for others.
I am no longer interested in my career in accounting. I am now committed to working in the health care field to help others take in, enjoy, and appreciate the gifts given to us at our time of death. I want to help people get their basic needs met: making sure their water pitchers are filled, that cups, facecloths, clean linen, sponges for the lips, are easily available to them. I want to make sure the care-giver gets meals, clean clothes, a shower, whatever it is they need during those crucial days or hours. It seemed so difficult for me to get those things because a big part of me didn’t want to continually bother the nursing staff but I didn’t want to leave Bruce’s side, either. I felt precious time was taken from us when I had to go and get those essential items myself, items that may seem insignificant to busy doctors and nurses who are trained to focus their energy on healing, not dying. I believe there needs to be a transition now from physical healing to spiritual healing.
I think hospice is a wonderful concept, but we fell outside of that because the end came so quickly, and it is those of us who fall outside of hospice that I wish to help. I’m sure there are many others who could benefit from a nonmedical helping hand during that precious time in their lives. There were a couple of occasions when we noticed that Bruce was very uncomfortable but too weak to tell us. (Once his leg was caught in the mechanism of the reclining chair, another time his elbow was caught in the bed-rails, and we were so thankful we were there to notice and to help him.) Everyone needs to have someone there to help.
I believe now that those who are dying, along with their loved ones, each experience their own miracle in death. I’d like to make it my mission to help “clear the way” so they can experience it more fully and enjoy the blessings we all deserve at our dying hour. I believe this will allow for a greater acceptance of life after death and would help us see God a lot more clearly. I know now that death is very much like birth, and loving assistance can make both life transitions much more beautiful, satisfying, and meaningful.
In our case, it turned out that Bruce did not need any of those antibiotics. Had we known, he could have lived his final days without all the IVs. He could have moved his arms without machines beeping and alarms going off. He could have been much more comfortable, because he didn’t have an infection at all. The autopsy showed the pancreatic cancer had spread to his liver, lungs, spleen, stomach, and heart, and there was extensive necrosis. That is what caused his fever and sweating. There was no evidence of infection. They couldn’t have known. The doctors and nurses did what they could to try to save him, and I’ll be forever grateful for that. It is unfortunate that in doing so, his final days were made unnecessarily uncomfortable. How I wish Bruce had not suffered at all. I am tremendously grateful, though, that he did not linger and suffer as so many do.
We had a beautiful homemade funeral service for Bruce (that’s another story!). At the cemetery, a tiny butterfly came out of nowhere and gently touched down on the rose I had just placed on the wooden box that held his ashes. It felt like Bruce had blown me a sweet, gentle kiss.
I know Bruce is present with me now. He’s with me all the time. He sends me signs every day, some big and some small, and I’m so grateful for those gifts. The gifts come faster than I can keep track. Actually, I’ve stopped keeping track. I believe they will keep coming as long as I appreciate receiving them! I continue to see hearts everywhere: in the clouds, as a shadow on my bedroom wall, even in my teardrops now. The hearts make me smile now and give me strength.
On Tuesday, August 11, Bruce was lying there quietly and from out of the blue, he looked at me and said, “Irish doctor. Murphy, I think. Does that sound right?” And then he closed his eyes. That was it. That was all he said. I looked everywhere for that Dr. Murphy. At first, I thought he was referring to my cousin, Mark Murphy, who is an estate planning attorney. I know Bruce would have wanted that all settled as quickly as possible. I later told Mark what Bruce said, and Mark said he was premed before he went to law school. Bruce and I did not know that. I thought that was quite amazing. But now, I realize he may have been referring to Dr. N. Michael Murphy (someone Bruce never would have known about). His name has come up in many of my recent Internet searches related to death and dying. I think Bruce was telling me my future is related to Dr. Murphy’s work.
We were so blessed to have been under Florence Nightingale’s watchful eye, but I can’t help but think that we weren’t singled out. We are just ordinary people. Not super religious or spiritual people, not even churchgoers! I believe now that Florence is looking out for all the ill and dying, that she is in a place now where she has that ability, and if our minds are open to receive her, to receive God, no matter what our religion, then we can all find comfort in that knowing.
I’d like now to combine my years of nonprofit management experience with my long-standing calling into the health care field by starting an organization that will send in nonmedical help to the dying, like a SWAT team of hired angels.
I thank Florence Nightingale for being there for us, and I thank God for sending her. She has changed my life forever.