Hospice Girl Friday | ‘Survivor’s Guilt’


Devra Lee Fishman’s dear friend and college roommate, Leslie, died from breast cancer one month shy of her 46th birthday after a four-year battle with the disease. Being with Leslie and her family at the end of her life inspired Devra to help care for others who are terminally ill. Each week, she documents her experiences volunteering at her local hospice in her blog, Hospice Girl Friday.

Before my friend Leslie died, I thought hospice was for old people with cancer. According to the Hospice Foundation of America, approximately two-thirds of hospice patients are over the age of 65, which means that one-third are younger than 65. And while many are diagnosed with cancer, I’ve seen just as many patients at my hospice with pulmonary or heart disease, neurological disorders, Alzheimer’s, AIDS, or complications from any number of health issues.

When I check the census at the beginning of each shift I get a quick overview of the current patients: their names, diagnoses, ages, and dates of admission. Also listed for each patient is the name and relationship of the main point of contact. All of this information is helpful as I prepare to make my rounds. I always look at the ages of the patients first, hoping to find that they are older than I am–preferably much older. That way I won’t have to think about my survivor’s guilt–how it could just as easily be me instead of them. But every week there is at least one patient my age or younger (I am 53), and every once in a while, all of the patients are. Those days are the toughest.

One recent Friday there were five patients: a 52-year-old woman with lung cancer; a 33-year-old woman in a diabetes-related coma; a 46-year-old man with HIV/AIDS; a 49-year-old man with end stage kidney disease; and a 51-year-old woman with breast cancer. I felt my stomach start to roil when I read the census. I would have preferred to stay at the volunteer desk and not see any patients for my entire shift, but I swallowed my survivor fear and made my rounds.

My first stop was room five, the woman in a coma. Her mother was there and said they were both fine for the moment so I moved on to the 46-year-old man in room six. He seemed to be sleeping so I tip-toed out and walked into the room of the 52-year-old woman with advanced lung cancer.

Her name was Laura, and she was sitting up in bed when I walked in. She was rocking back and forth with her palms on her lower back and watching The View on her small flat-screen TV. I read in the volunteer notes that she used to be a dancer; she looked tall, lean, and muscular, but she was also bald and jaundiced from her cancer and chemo treatments. If I didn’t already know her age, I would have guessed she was in her 70s. Cancer–or the treatment–does that sometimes. I noted a pile of peanut M&M packets on the nightstand next to her untouched breakfast tray.

“Peanut M&Ms are my favorite candy,” I said to break the ice after I introduced myself. Focusing fully on the patient was difficult because I kept thinking: She’s younger than I am. I could be in that bed.

Laura glanced over at the stash. “My boyfriend keeps bringing those because he knows I love them. I just don’t have much of an appetite anymore.”

I wanted to have more of a conversation with her, and asking about her boyfriend would have been my next move, but when a patient mentions some sort of physical symptom like a loss of appetite, it’s important to try to find out if he or she is experiencing any other discomfort. The nurses visit as often as they can, but a patient’s comfort level can change minute-to-minute so I always try to help by passing along any time-sensitive observations.

“How are you feeling otherwise? Are you comfortable?”

“Pretty much,” Laura said. “My back still really hurts.”

That explained the rocking. Back pain is a common complaint with lung cancer patients, but should be fairly easy to fix so I said, “I’m sorry to hear that. I’ll tell your nurse.”

“Why are you sorry?” she asked. “It’s not your fault. I’m the one who smoked.” She said this without the slightest note of self-pity or anger.

“Fair enough,” I said, trying to sound as neutral as she did. My ‘sorry’ was meant to be empathetic instead of sympathetic, but I knew to follow her lead and then drop it. There was a pause between us, and before I could stop it, a feeling of relief rushed in along with the thought: Maybe I wouldn’t be in that bed after all because I don’t smoke.

On the days when the patients are younger than I am, I marvel at the randomness with which we move through life, as though we’re all playing one big round of musical chairs, dancing around one moment and eliminated from the game the next.

On those same days I also feel a deeper empathy for the patients and their loved ones, and I’ve often sensed the same from the hospice nurses and doctors. I know that cancer, diabetes, HIV, and other diseases do not discriminate by age, yet sometimes I wish they did. I see too many hospice patients who just seem too young to die–possibly because I feel like I am too young to die–and it feels unfair that they could not find a chair when the music stopped. Then again, I have no idea what age is “old enough” to die, so I continue to work through my survivor fear and do my best to help all of the patients in my hospice find some comfort at the end of their too-short lives.

Previous post: The Power of Listening Next post: Coming soon

Bonus: For more on end of life care from a physician’s perspective, see How Doctors Die from our March/April 2013 issue.

The First of October

Woman on Bench
She’d been sitting alone that day too, the first day of October, when Ben Thompson entered her life.
(Shutterstock)

The place looked the same, Penny thought. Two wooden benches, back to back on a hill above the campus, with towering oaks and shrubs and sidewalks that converged there like spokes on a wheel.

She sat on one of the shaded benches and looked down at the access road. It was here she had last seen him, trudging away down the hill to catch his bus. But even that memory wasn’t as deeply etched as another: This was where they’d first met.

Penny Wilson closed her eyes, remembering. In her mind she was back in college again, 40 years ago. She’d been sitting alone that day too, the first day of October, when Ben Thompson entered her life.

“Penny for your thoughts,” he had said.

She had looked up from her textbook to see him sitting behind her, on the other bench. Definitely Joe College, with his blue jeans and sunglasses and football jacket.

“I’m Ben.”

“Penny,” she said, over her shoulder. She had already gone back to her book. But she watched him from the corner of her eye.

“Penny,” he repeated to himself, then brightened. “I must be psychotic.”

“You mean psychic. At least I hope you do.”

“Right. I must be psychic.”

“I doubt it,” she said.

He just grinned. “What’re you reading?” He took off his sunglasses and leaned over the back of his bench to look.

“Organic chemistry.”

“Whoa. What are you, pre-med? Biology?”

She smiled and held up the book. “Just kidding. It’s English lit.”

Ben nodded, and laughed. It was a good laugh, she thought. A happy laugh. They sat there a while in the sunlight, feeling awkward but reckless in a way that only young people can feel.

Suddenly he said, “How about a movie, sometime?”

She studied him a moment. His smile was still in place, dimples an inch deep. He reminded her of a very young Burt Reynolds. Hadn’t he been a football player too?

“When?” she asked.

“Well…I don’t know. Tonight, maybe?”

“I’m studying tonight.”

Penny pretended to go back to her reading. Above their heads, yellow and orange oak leaves rattled in the wind. The sun disappeared behind a cloud and came out again, seemingly brighter than before.

“Did you happen to see the ball game Saturday?” he said. “No, let me guess—you were studying.”

She made a face. “I know you scored a touchdown, if that’s what you’re asking.”

His eyebrows went up. “How’d you know that?”

“My roommate.”

“I like her already. What else did she tell you?”

Penny looked up from her book. “She said it won the game.”

He seemed delighted at that, and Penny found herself smiling too.

After a pause she added, “I’m not planning to study at lunch.”

He looked puzzled.

“It’s 11:30,” she said, pointing to her watch. “That was my way of asking if you’d like to eat with me.”

Another grin. “You bet.” He started to rise to his feet, then winced.

“What is it?”

“I hope you’re not in a big hurry,” he said, blushing.

She gathered her books, came around the back of the bench, and saw the bandaged ankle. And the wooden crutch. With her help, Ben tucked the crutch under his arm and maneuvered himself out of his seat.

“I’m moving a little slow, lately,” he said. She looped his other arm over her shoulder, and they limped down the hill toward the university coffee shop.

“Did they tell you,” she asked, “what that touchdown was going to cost you?”

He hugged her closer. “Maybe it was worth it.”

Penny could still remember his smile as he said that, and the little thrill she had felt. She also remembered the following six months—the best of her life—and then, finally, that spring day when he was called to active duty, and their parting kiss, on this very hill. There had been parting promises, too—she to write to him in Vietnam, he to come back to her afterward. But life got in the way of their plans. Within a year Penny was engaged to someone else. After the wedding she and Terrell Wilson moved upstate, where she finished college and entered law school.

The marriage was a disaster. Six years later she was single again, and starting her own practice. A year after that, a mutual friend said she’d heard Ben Thompson had married too, after coming home a war hero, and was living somewhere out west. He never returned to Bridgeton.

Carrot Soup with Orange and Ginger

For an autumnal garnish, sprinkle soup with roasted pumpkin seeds or add crunch with a few whole-grain croutons. This soup can be served as an appetizer or entrée or paired with a sandwich for a light meal, and it can be enjoyed later as a coveted leftover.

Carrot Soup with Orange and Ginger

Makes 4 servings

Carrot Soup with Orange and Ginger

Ingredients

Directions

  1. In large pot, heat oil over medium-high heat and add carrots and onions. Sauté about 7-8 minutes. Add garlic and sauté additional 2 minutes.
  2. Add broth and orange zest strips. Cover and bring to a boil. Reduce heat, uncover and simmer until carrots are tender, about 10-12 minutes. Let mixture cool for several minutes. Discard orange zest strips.
  3. Working in batches, in food processor or blender purée mixture until velvety smooth. Return soup to pot. Stir in ginger and orange and lemon juices. Season with salt and pepper to taste. Over low heat, let soup simmer for 5 minutes for flavors to mingle. Garnish with chives and serve.

Nutrition Facts

Per Serving


Calories: 150
Total fat: 5 g
Saturated fat: 1 g
Carbohydrate: 23 g
Fiber: 4 g
Protein: 6 g
Sodium: 140 mg

Pear-Caramel Pie

This is a wonderfully comforting fall and winter pie. Pears spiced lightly with cinnamon and ginger are made all the richer by brown sugar and homemade caramel. Make the caramel first so that it has time to cool. Any leftover caramel can be used to garnish each slice of pie or save for future use. The caramel will keep for one week at room temperature in an airtight container or in the refrigerator for a few weeks.

Pear-Caramel Pie

(Makes one 9-inch double-crust deep-dish pie)

Caramel-Pear Pie from Baking By Hand: Make the Best Artisanal Breads and Pastries Better Without a Mixer by Andy and Jackie King.
Caramel-Pear Pie from Baking By Hand: Make the Best Artisanal Breads and Pastries Better Without a Mixer by Andy and Jackie King.

Ingredients

Crust

Caramel

Filling

Egg wash

Directions

  1. For crust, roll dough into 2 circles about 12 inches in diameter. Bottom piece should be a little bit bigger, to cover pie dish. Fit bottom into dish and chill until ready to put filling in and top it. Chill top piece as well until ready to assemble pie.
  2. For caramel, combine sugar and water in large very clean saucepan over high heat. Make sure all utensils used are very clean as impurities can cause caramel to crystallize. Stir with spatula to dissolve sugar. Have pastry brush and cup of water ready to wash down sides of pot. Bring mixture to a boil. Once boiling, wash down sides of pot periodically to prevent crystallization. It should become a deep amber/caramel, which is about 325˚F on a candy thermometer.
  3. When caramel is right color, slowly whisk cream into sugar syrup, being very careful to avoid steam that will burst up toward your hand. Continue to cook caramel for 2 minutes. Remove pot from heat and stir in butter.
  4. For filling, peel and cut fruit. Combine with all dry ingredients, tossing until evenly coated. Allow fruit to sit for 30 minutes.

Assembling Pie

  1. Preheat oven to 450°F
  2. Pull pie dish and top circle of pie from fridge. Trim overhanging edge of bottom crust with knife.
  3. Toss fruit again, and then pour it all into pie dish. Pour 1 cup caramel evenly over top of fruit.
  4. Egg wash rim of bottom crust lightly, and then put on top piece. Crimp edge of pie to seal it. Create a decorative edge by putting thumb and index finger of nondominant hand together and pressing dough together. Press dough into that wedge with other index finger in order to create a point. Do this around entire rim of pie.
  5. Cut 6 evenly spaced slits on top piece of pie, and egg wash top and edge. Place directly on baking stone, and bake for 1 hour. Top needs to be a deep golden brown and filling should be bubbling. If taking too long, raise pie up on rack so that it gets more direct heat. It may take another 10 minutes to bubble and color. Remove pie from oven and cool for 6 hours or more before serving to allow filling to set.
  6. Serve warm or at room temperature. Drizzle extra caramel on top when plating each piece. Boom!



Recipe and photo from Baking By Hand: Make the Best Artisanal Breads and Pastries Better Without a Mixer by Andy and Jackie King.

Top-Rated Holiday Gifts

tech gifts hanging as ornaments

No one needs another scarf, tie, or festive cheese ball. Tech gear? Well, that’s a whole ’nother story. Here’s an eclectic mix of holiday gifts—any of which are sure to win the love and admiration of the technophile on your shopping list. 
One proviso: We’ve left off some 
obvious (and very good) choices, like the Apple iPhone and Kindle Fire, since we covered them in recent 
issues.

Distil Union Snooze Alarm with iPhone

1. Distil Union iPhone Snooze Alarm
This $35 nightstand dock turns an iPhone into a bedside alarm clock, complete with a “slap-happy” snooze bar. Distil Union’s free Snooze App shows the time on the iPhone screen. To silence the morning alarm—or ignore an incoming call—simply slap the rubber snooze bar button. The wooden dock is built to hold an iPhone (4 model or later) alone or in a small iPhone case. Another plus: The built-in cord catch prevents the iPhone’s charging cable from falling behind the nightstand.

SanDisk Sansa Clip Zip

2. SanDisk Sansa Clip Zip
Not only does SanDisk’s $50 digital music player have twice the storage of the 2 GB Apple iPod shuffle, it has a 1.1-inch color display for viewing album track titles and art work. (The shuffle doesn’t have a screen.) The Sansa Clip Zip is compatible with most digital audio formats, including AAC (iTunes), and has a built-in FM radio. A clip on the Sansa’s backside makes the player easy to attach to a belt, clothing, or backpack strap. And here’s the kicker: The 4 GB Sansa Clip Zip costs the same as—OK, 99 cents more than—the Apple iPod shuffle.

Google Chromecast

3. Google Chromecast
Chromecast is a small device that plugs into an HDTV’s HDMI port.
Wait, stifle that yawn! Chromecast ($35) is one of the easiest and cheapest ways to stream Internet video and audio—including Netflix and YouTube—to a big-screen TV. Using Google’s Chrome browser or app, you control Chromecast via a tablet, smartphone, or personal computer (PC). Even better, Chromecast will add features as software developers write more video apps to work with it.


Fitbit Flex.
4. Fitbit Flex
This water-resistant wristband is handy for that special someone who’s trying to shed pounds, exercise more, and get healthy. Fitbit Flex tracks calories, distance, and steps during the day, as well as sleep activity at night. It also compiles the wearer’s stats and syncs them wirelessly with a smartphone, tablet, or PC. Graphs and charts show your physical activity and reveal health trends, such as whether you’re burning more calories by walking to lunch every day. Priced at $100, Flex even lets you challenge friends and family to fitness competitions.

Bluetooth HP Runaway headphones
5. Bluetooth Headphones
If there’s a music lover on your list, wireless headphones are a great way of saying, “I love you, but please keep your music to yourself.” You could spend hundreds of dollars on high-end Bluetooth headphones, but there are plenty of quality options south of $100. The $45 Kinivo BTH220 headphones are comfortable to wear, fold up easily, and deliver good sound quality for the price. And the MEElectronics Air-Fi Runaway ($99.99 list, but street-priced closer to $60) phones have soft padding, a hidden microphone, enhanced bass, and convenient music and phone controls.

Google Chromebook

6. Google Chromebook
A laptop for $200 to $350 … that’s actually usable? Reputable PC makers such as Acer, Hewlett-Packard, and Samsung offer Chromebooks, bargain laptops that run dozens of free Google Web-based applications. Built for cloud computing, a Chromebook comes with 100 GB of free space on the Google Drive online storage site for two years, after which you’ll have to buy more room for additional files. For folks who spend most of their computing time inside a Web browser, the Chromebook is an appealing alternative to pricier Mac and Windows laptops.

Microsoft Xbox One

7. Microsoft Xbox One
Know a serious gamer? Well, if you don’t mind dropping a cool $500, your timing is impeccable. Microsoft is about to launch the Xbox One, the latest version of its popular game console. In addition to stunningly immersive and realistic games, Xbox One comes with Microsoft’s Kinect technology for controlling the device with gestures, movements, and voice commands. The Blu-ray player is handy for watching HD movies on disc too. With an Xbox Live Gold Subscription ($60 per year) you can stream Internet video services like Netflix, and engage in Skype video chats with friends while watching TV. Bottom line: Xbox One is a powerful, if pricey, home entertainment system with something for everyone, even non-gamers.

Sony PlayStation 4

8. Sony PlayStation 4
If the Xbox One is too pricey, consider the PlayStation 4, which is slightly more affordable at $400. The PS4 also features rich graphics and immersive games. It plays Blu-ray discs, has optional motion-control features, and you won’t have to pay extra, aside from the service fee, to stream Internet video services (e.g., Netflix, Hulu Plus). As with the Xbox One, you can start playing games while they’re downloading.

Samsung Galaxy S4

9. Samsung Galaxy S4
Too many Android phones out there? Check out the Samsung Galaxy S4, a huge handset that somehow manages to be both slim and stylish. The 5-inch HD display shows sharp details and bold colors, and the 13-megapixel rear camera with LED flash captures images that rival those of a good point-and-shoot. The Galaxy S4 does some clever — and vaguely creepy — tricks as well. Smart Pause, for instance, pauses the video you’re watching when your eyes look away, and then resumes playing when they return. The S4 costs $200 with a 2-year AT&T, Sprint, or Verizon Wireless contract, or $600 and up without a contract.

Hospice Girl Friday | ‘The Power of Listening’


Devra Lee Fishman’s dear friend and college roommate, Leslie, died from breast cancer one month shy of her 46th birthday after a four-year battle with the disease. Being with Leslie and her family at the end of her life inspired Devra to help care for others who are terminally ill. Each week, she documents her experiences volunteering at her local hospice in her blog, Hospice Girl Friday.

There was a woman in the hospice’s communal living room when I came in to start my shift. She was wearing navy blue sweatpants, a pale gray t-shirt and slippers. She was slumped on the sofa, facing the television but staring at something much further away. After I put my bags down under the volunteer desk I checked the list of current patients and then asked one of the nurses about the woman on the sofa.

“Her sister is in room three,” the nurse replied. “Fifty-eight years old. Colon cancer. They’ve both been here since yesterday morning.”

Once I settled in, I walked over to the woman and introduced myself. She told me her name was Mary.
“I understand you’re Ann Simpson’s sister,” I said as I perched myself on an arm of the chair next to her, careful not to assume she wanted company.

“I am,” she said as she sat up and straightened out her t-shirt, which had bunched up against the sofa behind her. “She’s my baby sister, and I’ve been taking care of her the whole time she’s been sick, which feels like forever. I’ve gone to every doctor’s appointment, every treatment, and now we’re here.” She swept her eyes around open space and then slowly shook her head.

“How wonderful you’re able to be with her,” I said, acknowledging that caregivers need to know someone cares about them and the effort they make. Mary looked back up at me and nodded. “Yes,” she said. Her mouth hung open like she was going to say more, but she didn’t.

“The nurse said Ann is resting comfortably,” I said. “How are you holding up?”

“I’m fine,” Mary said. “Tired. It’s been a long six months since Ann was diagnosed. And tomorrow is my 60th birthday. I’d hate for her to die on my birthday, but if she needs to go, she needs to go. She’s been through enough.”

Since she answered more than my question, I slid down into the chair and waited for her to continue.

“Ann’s husband is coming over later this morning so I can go home and get some stuff done,” Mary said. “Then I’ll be back to spend the night again.”

I wondered if she wanted to talk some more, so I searched around for a question that would open up more of Ann’s story. “What kind of work did Ann do?” I asked.

“She was a school teacher,” Mary said. “Fifth grade. She loved her kids and her kids loved her. Never had children of her own, so they were her family.” I nodded slowly as she spoke. She continued, staring at a space somewhere between the two of us. The words spilled out as though they had been backed up for a while.

“I work for the power company. My manager has been very understanding and has given me a lot of flexibility so I can take care of Ann.”

We sat and chatted like that for about fifteen minutes. I would have happily stayed there for my entire shift, but Mary said she wanted to check on Ann. I stood with her and told her I would stop by in a little while to see if she needed anything. Maybe I could get her to tell me more about her sister, I thought.

I have always enjoyed learning people’s backstories, but once I became a hospice volunteer I made it a point to learn as much about the patients from their loved ones as I could. Talking about people who are dying helps us to lock in memories of who they were–and who we were–when everyone was healthy and living their everyday lives. I learned this from the experience I had with my friend Leslie, who died in 2006.

I will always cherish the time I spent with Leslie during the four years she fought breast cancer, and it was my honor to be with her at the very end of her life. But when I talk about her now I have to work hard to replace the picture of her as she lay on her death bed with one of the gazillion (she loved to exaggerate so Leslie, this one’s for you) mental images I have of who she was during the nearly 30 years that we were friends. Maybe we’re programmed to more easily recall extraordinary moments, such as the birth or death of a loved one, but I think it’s just as important to remember the string of ordinary images and moments that tell the whole story of how we lived. I want that for myself, and I want that for the people I meet in the hospice.

I made my rounds later in my shift, and when I walked into room three Mary was sitting in an armchair next to Ann’s bed and holding her hand. Ann seemed to be sleeping comfortably, but the blanket covering her moved only slightly as she took shallow, infrequent breaths, indicating that she was nearing the end. Mary watched me as I studied her sister. I wondered if it would help Mary to talk more about Ann, so I asked, “Were the two of you close growing up?”

And with that question, Mary took me back to their childhood (Ann taught Mary how to ride a bike), their weddings (they were each other’s maid of honor) and their families (they’ve lived on the same street for 25 years). Mary also told me she always thought Ann was the prettier one, and she said that the two of them took care of their mother together, who died from Alzheimer’s just last year.

I stayed with Mary and Ann until my shift ended, grateful for the picture Mary drew of the ordinary moments they shared throughout their lives. I hope talking about Ann with me will help Mary bring those memories forward every time she thinks about her beloved sister.

Previous post: Coming Home to Say Goodbye Next post: Survivor’s Guilt

Bonus: For more on end of life care from a physician’s perspective, see How Doctors Die from our March/April 2013 issue.

Red Rice Stuffing with Dried Fruit

On Thanksgiving, I am a traditionalist and an adventurer. Maintaining a family tradition, I include the canned small French green peas with pearl onions that my mother always served. And I always start Thanksgiving dinner with soup, but a different one every year. Stuffing is another dish where I am adventurous. (I should say dressing, since it is always baked separately from the bird.)

This year, my dressing will be rice-based. Red rice, to be specific. There are several varieties of red rice. All are aromatic and whole grain. California-grown Wehani is the most dense and chewy. Bhutanese red has a lighter texture but still has that full, nutty flavor. You may also find red rice from South America or France’s Camargue region.

Bhutanese is my favorite rice to use in this recipe because it combines well with the dried fruits, almonds, and other ingredients. But any red rice is good. Simply cook it according to package directions. If you cannot get red rice, most other kinds work nicely, too.

Red Rice Dressing with Dried Fruit

Makes 6 servings
 Red Rice Dressing with Dried Fruit

Ingredients

Directions

  1. Preheat oven to 350°F.
  2. In small bowl, plump cranberries, raisins, and apricots in orange juice, 20 minutes. Drain and set fruit aside. Reserve juice for baking or for glazing sweet potatoes.
  3. In medium saucepan, combine rice with 1 cup broth. Add 1 cup water. Bring to boil over medium-high heat. Cover, reduce heat, and cook for 3 minutes less time than on package directions, until rice is slightly less than tender. Fluff with fork, cover, and set hot rice aside.
  4. In small Dutch oven, heat oil over medium-high heat. Add onions and celery and cook, stirring often, until vegetables are soft, 8 minutes. Add cooked rice, soaked fruit, almonds, stuffing seasoning, remaining 1/2 cup broth and mix to combine. Season dressing to taste with salt and pepper. When broth boils, cover and bake for 30 minutes, until dressing is hot. Fluff with a fork and let dressing sit for 15 minutes before serving.

Nutrition Facts

Per Serving


Calories: 240
Total fat: 9 g
Saturated fat: 1 g
Carbohydrate: 38 g
Fiber: 4 g
Protein: 4 g
Sodium: 125 mg

3-2-1 Pie Dough

This recipe is perfect because it’s incredibly easy to remember, amazingly easy to produce, and infinitely applicable to treats both sweet and savory. It has saved our butts a few times when we had excess fruit at the end of a summer day. Here’s where the “3-2-1” part fits in: By weight, this dough is three parts flour, two parts butter, and one part ice water. Plus, throw in a teaspoon of fine sea salt for every double-crust pie you’re baking. That’s it. Now you can make any quantity you need.

3-2-1 Pie Dough

(Makes enough pastry for 1 standard two-crust pie)

Ingredients

3-2-1 Pie Dough
3-2-1 Pie Dough from Baking By Hand: Make the Best Artisanal Breads and Pastries Better Without a Mixer by Andy and Jackie King.

Directions

  1. Combine cold flour, salt, and cold butter in large bowl. Using fingers, begin to pinch and combine butter and flour, making sure not to hold the butter in your hands too long. Keep working flour and butter between fingers until largest pieces of butter are no smaller than peas. The key is to keep mixture as cold as possible, and if you feel that it is warming up too much, you can refrigerate it.
  2. Add ice water to flour-butter mixture, and toss together with fingers, eventually pressing it together with hands. You want dough to form with no dry patches or crumbly parts, but you do not want to overwork it so much that you break down butter completely. Otherwise, you will lose flakiness and your dough will become tougher. You want to see streaks of butter running through dough.
  3. Divide dough into two equal pieces and wrap them in plastic wrap. Chill for at least 1 hour before proceeding or overnight. You could also freeze at this point for future use.


Recipe and photo from Baking By Hand: Make the Best Artisanal Breads and Pastries Better Without a Mixer by Andy and Jackie King.

Diabetes ‘Breathalyzers’

“Fruity breath” is a common trait among people with high glucose levels. Now, researchers at the University of Pittsburgh are exploring the possibility of measuring breath acetone—which often presents as a fruit-like odor—as a way to detect and monitor type 2 diabetes. The researchers created a sensor device that can measure acetone vapors emitted in the breath. The team is currently working on a prototype of the sensors, which it will soon test on different human breath samples.

Diabetics typically use blood meters to measure glucose levels. Recent years have seen the development of implanted devices that track glucose levels without drawing blood.

The University of Pittsburgh researchers believe their technique has the potential to significantly simplify the surveillance process.

“Once patients are diagnosed with diabetes, they have to monitor their condition for the rest of their lives,” says Alexander Star, principal investigator of the project and Pittsburgh associate professor of chemistry. “Current monitoring devices are mostly based on blood glucose analysis, so the development of alternative devices that are noninvasive, inexpensive, and provide easy-to-use breath analysis could completely change the paradigm of self-monitoring diabetes.”

For four simple steps to reducing your risk of developing diabetes, don’t miss Dodging Diabetes from the November/December 2013 issue.

Why Kennedy Still Matters

Don’t Miss Out: Limited-edition commemorative reprint of the John F. Kennedy In-Memoriam issue in its original as-published format. Available for purchase at shopthepost.com.

Why do Americans have such a high opinion of John F. Kennedy? The 35th president completed only three years of his term and left behind a pile of unfinished projects and unraveling plans when he died. So why, in opinion polls over the decades, have Americans consistently ranked Kennedy among our greatest presidents?

At the time of his death, his grand design for a united Europe had recently collapsed. In Southeast Asia, the South Vietnamese president he had been supporting with money and troops had just been overthrown and assassinated. And Americans in 1963 could not have forgotten the failed invasion of Cuba by anti-Castro refugees, which had been launched with Kennedy’s approval.

And then, there were Kennedy’s problems at home. “On the day of his death,” wrote Stewart Alsop (“Was John F. Kennedy A Great Man?” Dec. 3, 1966), “all four of his major legislative objectives–aid to education, the civil-rights bill, Medicare, the tax cut—were hopelessly stalled in Congress.”

But consigning Kennedy’s bills to the ‘defeat’ pile, Alsop argued, would be short-sighted: “The four legislative objectives which were so hopelessly stalled in Congress when he died…are all the law of the land now.” They were passed through the efforts of President Johnson and backed by a wave of public support for the late president’s programs. Without Kennedy’s initiative, these laws might never have been introduced or passed.

President Kennedy meets with Russian president Nikita Khrushchev in Vienna in 1961.
President Kennedy meets with Nikita Khrushchev in Vienna in 1961. Photograph from the U. S. Department of State in the John F. Kennedy Presidential Library and Museum, Boston.

Americans of 1963 would have regarded Kennedy’s handling of the Cuban Missile Crisis as one of his successes. He had demanded that Russia remove the missile bases it had built in Cuba, and threatened the use of force if they refused. At the time, Kennedy was criticized for risking a nuclear war. But he proved himself to be a tough and tactful negotiator, and by establishing some limited rapport with Soviet premier Khrushchev, Kennedy was able to restart talks to halt the nuclear arms race.

In 1962, the two leaders signed the first test-ban treaty, which bound both nations to stop testing nuclear weapons in the atmosphere. The treaty reduced radioactive fallout in the earth’s atmosphere and slowed the development of bigger bombs. Kennedy was particularly proud of the treaty, which he considered a first step toward nuclear disarmament.

Americans today are more likely to give Kennedy credit for advancing the nation’s space program. After the Russians launched the first satellite (1957) and the first man into space (1961), Kennedy asked Congress to fund a multi-billion-dollar space program. Its goal would be “landing a man on the moon and returning him safely to the earth” before the end of the decade. It seemed like an utterly fantastic idea in 1961, but Kennedy’s goal was reached in 1969, with six months to spare.

Kennedy is also given high marks for the Peace Corps, which he launched shortly after entering office. Within a few months, thousands of Americans had volunteer to share their time and technical expertise. In the half century since then, the program has sponsored over 200,000 Americans who have helped improve the quality of life in over 130 countries.

But are the Peace Corps, the space program, and a distant crisis enough to earn Kennedy continued high regard? Perhaps what makes Kennedy admirable today is not what he accomplished but how he inspired. When Joseph Alsop wrote of how Kennedy would be remembered, (“The Legacy of John F. Kennedy,” Nov. 21, 1964), he emphasized how the president, by the example of is character, had introduced a time of “renovation and renewal” for the country.

Of course, Stewart and Joseph Alsop were writing about Kennedy in the days before his many adulterous affairs and his precarious health became public knowledge. These later revelations did much to tarnish Kennedy’s character and caused Americans to reconsider the late president’s judgment and achievements. But with the 50th anniversary of his death, many writers are taking a broader view of Kennedy’s performance as chief executive and distinguishing between his public service and his private life.

Official White House Photo Portrait of President John F. Kennedy, 1961.
Official White House Photo Portrait of President John F. Kennedy.

In the 1960s, Joseph Alsop had been impressed by Kennedy’s style and outlook, which had so little in common with the “average, day-to-day America in the mid-’60s. No one could have differed more sharply from the good, average American, who watches television in his off-hours, is content if his is a two-car family, and does not mind bulging a bit in middle age.”

America had lost its edge during the complacent 1950s, Alsop believed. “Our wealth and our machines have made us, as a nation, just a bit soft and fat, and most of us do not mind this in the least. But Kennedy minded…[He]…was decidedly repelled by softness and flabbiness.”

Throughout Alsop’s article, you can hear the dissatisfaction and search for a better life that was the spirit the 1960s. It’s the same spirit that Post reporter Beverly Smith described in “The Prospects of Candidate Kennedy” (Jan 23, 1960)—the “troubled feeling that we have failed to live up to the greatness of our heritage.”

Americans, Alsop believed, identified with Kennedy’s focus, energy, and passion for achievement. “The routine, the ordinary, the merely average displeased and bored him,” wrote Alsop. “He wanted to live…meaningfully, to the utmost limit of his powers.”

Kennedy told Americans that a better life, and a better world, was possible, but it would take conviction, hard work, and a courage that, Alsop wrote, was “exceedingly uncommon” in modern America. “For Kennedy, courage, whether physical or moral, was the first and most essential of the virtues.”

Americans elected Kennedy because he showed the intensity, idealism, and courage they wanted in their lives. They were hungry for a sense of achievement after years of caution, stagnation, and continual fear of devastating attacks on the U.S. In this regard, they were not so different from us, which is why the example and the memory of Kennedy still matter.

Black Friday

Although Beatrice and her children left the house right after the Cowboys game, there were already three people in line at the Wal-Mart when they arrived. Three people, and the Lions had just started playing.

Black-Friday-Featured

Who gets in line before the end of the Cowboys game? Beatrice thought, setting up her lawn chair. She tugged her beanie down her forehead and sunk her gloved hands into the pockets of her poofy jacket, which made her look heavier than she already was. Her eldest set up his chair next to hers, and then set up chairs for his brother and sister. Her youngest cried that he was cold, and her daughter played with the drawstrings of her jacket’s hood. Some people, Beatrice thought, looking at trio ahead of them. Some people and their priorities.

For lunch, she gave her eldest a few crumpled dollars and had him run over to the Carl Jr.’s, telling him chicken tenders, large fry, large Coke, and extra honey mustard, as well as a reminder to be careful because all the nuts jobs out this time of year. He nodded and took his siblings’s orders and headed over, his breath fogging around him as he shrunk smaller and smaller, passing her Honda on the other side of the empty lot and disappearing into the restaurant.

By the time he came back, there were twelve more people in line. As the new arrivals thumbed through their phones and gave updates on the Lions, Beatrice’s eldest took his seat and handed his mother her food. Her youngest reached for the warm, greased-stained bags in his brother’s lap, while her daughter sat quietly, her hands underneath her bottom. With a fry dangling from his mouth, her eldest handed his sister her food and intentionally kept his little brother’s bag away from him. Her youngest whined as Beatrice dipped a fry into one of the extra honey mustards.

“Just as good as turkey and stuffing,” she said, eating the fry and adding, “Give your brother his hamburger.” Her eldest did as he was told and made fun of his brother for getting a burger on Thanksgiving. “Who gets a burger on Thanksgiving?” he said, and opened his box of tenders.

Beatrice’s family ate quietly, her youngest moistly smacking while he chewed, as if his showmanship added warmth to eating out in the cold. To the frontier life he imagined they were living. In line behind them, more new arrivals played with their phones or talked about the turkey lunches they had to cut short just to stand in line. Two heavyset men threw a foam football back and forth.

As the sun crept along the sky behind the clouds, more cars pulled in and parked, closing the gap between Beatrice and her three-year-old Honda, the car one of the few things her husband had left, along with the payments. The car which she had parked at the end of the lot, near the exit and the bad neighborhood across the street. Parked far away so by the time Beatrice and her family were ready to leave, they wouldn’t have to maneuver past other shoppers pulling in and searching for a place to park at that hour.

She had gotten the idea to park over there when her family had come to the Wal-Mart the night before, an hour until the store was set to close. They had scouted the potential locations where blue-shirted employees might set up the four, 55-inch televisions the store would sell for $1,000 marked down, most likely on an end cap facing Boy’s Clothing. The X-box Kinect, one of the eight systems the store would have, probably under the glass case of video games. When the time came, her eldest would be responsible for sprinting through the store and securing a TV, while her daughter was to head straight to Electronics. Her youngest wasn’t old enough to go off by himself, so she had to hope a few Iron Man figurines would still be available by they time they made it to Toys.

Hospice Girl Friday | Coming Home to Say Goodbye


Devra Lee Fishman’s dear friend and college roommate, Leslie, died from breast cancer one month shy of her 46th birthday after a four-year battle with the disease. Being with Leslie and her family at the end of her life inspired Devra to help care for others who are terminally ill. Each week, she documents her experiences volunteering at her local hospice in her blog, Hospice Girl Friday.

Our volunteer supervisor sent out an urgent request on a Tuesday: ‘We have a rather unusual situation in the IPU tomorrow, and I’m looking for someone who can cover the 12-3 shift…we will receive a patient via air transport from Atlanta. He is from this area and his parents would like to have mechanical ventilation stopped closer to home.’

I could not recall a patient on a ventilator in the six years that I have been a volunteer so I did not know what to expect. I only knew that help was needed. I responded immediately:‘Yes, I am available.’

My supervisor sent more information: The patient was a 27-year-old man being treated for cancer. Chemotherapy paralyzed him and he was put on life-support. The family could not find a local hospital willing to admit him and eventually they were referred to our hospice.

On Friday mornings the inpatient unit is quiet with only a few staff taking care of patients and paperwork. When I arrived for my special Wednesday shift, there were additional nurses and higher-level administrators preparing for the arrival of the patient and his family. I saw small teams of people discussing and rehearsing the plan for the day, carefully reviewing checklists like pilots before a flight. The atmosphere was tense.

My supervisor was standing with the regularly scheduled volunteer at the front desk. I walked over, said hello and asked for an update.

“The plane is delayed,” she said. “We’re expecting the patient around 2 p.m. His father is traveling with him. His mother and siblings should be here any minute.”

“What is our role?” I asked, nodding my head toward the other volunteer.

“One of you will need to man the desk and help out with the rest of the patients,” she said. “The other might be called on to assist the family when they arrive. We’re not exactly sure what to expect.”

I was about to say ‘I’ll help with the family’ when I heard the other volunteer say it first. I was disappointed, as though I were now less important. I wanted to be a part of the experience, not a spectator, and then I remembered that the other patients needed support too.

Just as we finished our conversation, the front door opened and a woman and two teenage girls walked in. The woman was tall, slim, and looked like she was in her mid-40s. She walked up to the desk, smiled and said she was the patient’s mother. She then introduced her daughters and explained that two older sons were on their way from the college they attended together. She was calm and composed, as if she were checking in for a doctor’s appointment. I said hello as the other volunteer walked around the desk to greet them and offer a tour of the facility, which the mother accepted. Her daughters shuffled behind her.

A little after 2 p.m., the patient arrived. As he was wheeled in on a stretcher I was surprised to see that he was conscious and alert. I had to catch my breath as I registered that the decision to remove the ventilator might have been his.

I know the patients I see are terminal and have opted out of curative medicine and heroic measures. For them the dying process takes a natural course as the body shuts down, and hospice care keeps them comfortable during that time. While this young man was just as eligible for hospice care as anyone else, I was moved by his choice to remove his life support, and wondered how his parents—or any parents, for that matter—would cope with that decision.

Once I regained my composure I looked up and saw the patient’s father talking to the mother. He was older, heavier, and used a cane to walk. His sons must have slipped in quietly, because the patient’s four siblings were now sitting on the matching sofas, each pinned to a corner like they were trying to disappear into the cushions. The father broke away and went into the patient’s room. The mother sat down in a chair between the two sofas with her back to me.

“Okay so we’re here to say goodbye to Michael,” she said, scanning the sofas for a connection. No one looked up, but the younger girl started to cry. She hugged herself.

“I need you to be strong and remember we are a family. We will get through this together,” the mother continued as she looked from child to child. Still no eye contact. The crying turned into sobbing. The mother kept talking.

“No one wants Michael to suffer, right? This is his decision and we have to respect it. He is never going to get better, remember, he has cancer.” The sobbing continued as the girl covered her face with her hands. I walked over and placed a box of tissues next to her. The other three children sat as rigid as the furniture.

I hurried back to my desk to try to separate myself from their pain, but the girl’s sobbing was inescapable. I turned toward the nurses and other hospice staff and saw that we were all fighting back tears. None of us spoke while we listened to Michael’s mother try to console her children.

About 20 minutes later another volunteer came in to relieve me. I did not know when Michael’s procedure would begin, but I was grateful to be leaving before it did. (I learned that the ventilator was removed that evening; Michael passed away about 18 hours later.) I was surprised and disappointed that the situation and the family’s grief were too much for me to bear. I thought I was stronger and more able to step outside of my own emotions to help others deal with theirs.

I called my mother on my way home from the hospice. She’s always said that losing a child is every parent’s nightmare, and I wanted to tell her that even though I am not a parent, I finally understand what she means. She told me how precious life is and how lucky we are—my parents, brothers, and I are all alive and well (knock on wood). That day, just hearing my mom’s voice soothed me, as it always has. I hope Michael’s parents, brothers, and sisters find a way to comfort each other, too.

Previous post: Just Being There Next post: The Power of Listening

Bonus: For more on end of life care from a physician’s perspective, see How Doctors Die from our March/April 2013 issue.

Spanish Pasta

Most people associate pasta with Italian cuisine, but this main dish has a decidedly Spanish flair. Saffron, a popular spice in many Spanish dishes, infuses an earthy, hay-like flavor and beautiful yellow-orange color. Saffron is the dried tiny threadlike strands of the fall flowering crocus, also known as the saffron crocus—a member of the iris family. Although it’s the world’s most expensive spice by weight, very little is needed to flavor and color food.

Spanish cuisine is also ripe with olives. Note that if seasoning with salt, go a little lighter because olives contribute to the saltiness of the sauce as do the capers. The capers, which are the unripened, pickled flower buds of a prickly perennial plant native to the Mediterranean and some parts of Asia, round out the Latin flavor with their tangy, lemony essence.

Add your favorite green salad and you have a complete, nutritious meal featuring an old favorite—spaghetti—in a new Spanish style.

Spanish Spaghetti

Spanish pasta
Makes 6 servings.

Ingredients

*Tip: Saffron is also available in powdered form. Be careful if buying the powdered variety because it is sometimes combined with turmeric or other less expensive substances. The powdered spice also loses its flavor more quickly than the threads. You can recognize good quality threads because they are bright red but have a dark shade with tips that have a slightly lighter shade, indicating that they are natural and have not been dyed to look darker. Some threads include a small amount of yellow, which usually means that they are not as strong.

Saffron is very sensitive to heat and light, so it should be stored in a cool, dark, and dry location. High humidity can cause it to smell musty and make it age faster. If stored properly, it can last for several years. Before cooking, place saffron in small bowl and add 1 to 2 tablespoons hot water. Let it sit until dissolved, about 20 minutes, before using.

Directions

Nutrition Facts

Per serving


Calories: 330
Total fat: 7 g
Saturated fat: 1.5 g
Carbohydrate: 54 g
Fiber: 10 g
Protein: 16 g
Sodium: 490 mg

How One Community Saved a Homeless Shelter

Abbey Duke and Nina Zorfas in bakery
“It’s like a bake sale that happens 365 days a year,” says Abbey Duke, as baker Nina Zorfas preps the dough. Last year, they sold more than 38,000 cookies for charity. (Photo by Glenn Moody)

Moving around the big yellow kitchen lined with stainless steel ovens, prep tables, stacks of King Arthur flour, blocks of Cabot’s butter, and bowls piled with chunks of rich, dark, Callebaut chocolate, 43-year-old Vermont chef, farmer, and foodie entrepreneur Abbey Duke inhaled the rich buttery smell of holiday cookies cooling on the racks beside her and broke into a smile.

“It’s like a bake sale that happens 365 days a year,” says Abbey, waving a spatula toward the cookies that, 
as Christmas and Hanukkah approach, will eventually number in the thousands.

The huge mixer will be fired up; sugar crystals will be creamed into butter; and flour will fill the air. Then the delicate scent of orange blossoms will blend with the intensity of rich chocolate to entice every human within sniffing distance—and three local shelters for the homeless will have the heat on, the water running, and the lights shining into the winter darkness.

Homelessness is a life-or-death issue with little margin for error—particularly in Abbey’s home town of Burlington, Vermont, where temperatures measure 20 below zero in the darkest months of the year. Bordered by snowy mountains to the east and an ice-bound lake that runs 120 miles to the Canadian border on the west, there are few places to go when the library’s closed and you can’t afford a room.

The city’s residents became sharply aware of that fact in 1982 when a bunch of young men from Winooski—a town on Burlington’s northern border—returned from military service in Vietnam and began sleeping on park benches and huddling in doorways on Church Street. They were suffering both from physical disabilities and the psychological effects of war. They had nowhere to go.

Fortunately, one of the side effects of living in a small state with arctic temperatures, treacherous mountain roads, and not a lot of people is that most folks have a well-developed inclination to reach out and help when someone’s in trouble. Whether it’s the neighbor next door whose car won’t start or the guy down the road whose dog disappeared over the mountain, Vermonters tend to step forward and lend a hand.

Which is precisely what happened in Burlington. By the time temperatures began to plummet in December 1982, a dedicated group of religious leaders, business people, and ordinary citizens had organized the Committee on Temporary Shelter (COTS). They borrowed cots from the National Guard, rounded up volunteers, and convinced a local community center to let them use its space at night. On Christmas Eve, they threw open the doors.

The COTS folks expected to close the program when the weather warmed in the spring. But that spring, when the problem didn’t go away, COTS instead approached a local bank and applied for a loan to buy a building. “There was no reason to give us one,” says COTS straightforward Executive Director Rita Markley. “We looked like a bad risk. But Dudley Davis, the president of Merchants Bank, told the loan department to do it.” She shakes her head. “We got the loan, renovated the building, and opened a shelter.”

The Genius in Lincoln’s Gettysburg Address

Portrait photo of President Abraham Lincoln
This portrait of President Lincoln is thought to have been taken only four days before he delivered the Gettysburg Address on November 19, 1863.

After 150 years, the Gettysburg Address remains one of the most powerful speeches ever delivered. It is also one of the most surprising. In just 270 words, a self-educated, frontier lawyer managed to convey a sense of national loss and give purpose to America’s civil war. He also produced as fine a work of prose as any American has ever created.

In 1959, historian Jacques Barzun invited Post readers to take a closer look at “Lincoln The Literary Genius.” If you only knew Lincoln from his Gettysburg speech, he wrote, you might get the impression of a man who sat down one day and wrote a masterpiece. But Lincoln had been working on his unique style for a lifetime before he spoke at the Gettysburg cemetery.

His talent with words seemed to come from nowhere. Certainly it wasn’t anything he learned; Lincoln’s formal education amounted to less than a year of instruction spread thinly across his youth. Learning all he could from borrowed books and stolen hours of reading, he left home and drifted between jobs, finally studying law and entering politics. It would have seemed like one more of Abe Lincoln’s poor career choices because, on the surface, he had little appeal. He was awkward, homely, ill-dressed, unkempt, and spoke with a high, nasal voice.

But his years of riding the court circuit in Illinois had taught him how to capture and hold the attention of strangers. He learned how to translate questions of law into simple, clear choices. He spoke in a comfortable, familiar style, which narrowed the emotional distance between himself and his audience. And when necessary, he could drop into joking talk, mimicking the drawl and twang spoken by Illinois farmers.

Lincoln learned to write standing up; that is, he developed his clear, powerful style while he honed his oral arguments for court. As a result, his writing and his speeches have a similar clarity and cadence. But Lincoln had a special genius for order and brevity, Barzun claimed; he presented his thoughts in the most convincing sequence using the least words. Barzun also stressed Lincoln’s gift for rhythm, illustrating it with a fragment from a lecture by Lincoln.

“There is a vague popular belief that lawyers are necessarily dishonest. I say vague, because, when we consider to what extent confidence and honors are reposed in and conferred upon lawyers by the people, it appears improbably that their impression of dishonesty is very distinct and vivid. Yet the impression is common, almost universal. Let no young man choosing the law for a calling for a moment yield to the popular belief—resolve to be honest at all events; and if in your own judgment you cannot be an honest lawyer, resolve to honest without being a lawyer.”

“The paragraph moves without a false step,” Barzun observed, “neither hurried nor drowsy; and by its movement, like one who leads another in the dance, it catches up our thought and swings it into willing compliance. The ear notes at the same time that none of the sounds grate or clash: The piece is sayable like a speech in a great play.”

This advertisement for the printed copy of Edward Everett and President Lincoln's Gettysburg speeches appeared in the Post in 1864. Everett's speech was deemed "eloquent" while Lincoln's was "excellent and appropriate," an example of the preference for the more verbose, lofty style of speech-making at the time.
This advertisement for the printed copy of Edward Everett and President Lincoln’s Gettysburg speeches appeared in the Post in 1864. Everett’s speech was deemed “eloquent” while Lincoln’s was “excellent and appropriate,” an example of the preference for the more verbose, lofty style of speech-making at the time.

Lincoln never mastered the florid, wordy style that kept 19th Century audiences enraptured for hours. The admirers of fine oratory found Lincoln’s speaking style “flat, dull, lacking in taste,” Barzun wrote. When they came to the dedication ceremony at the Gettysburg cemetery, November 19, 1863, they were more interested in hearing the keynote speaker, Edward Everett.

The difference between Lincoln’s and Everett’s speeches that day illustrates the changes taking place in American thought and style. Lincoln spoke for two minutes. Everett spoke for two hours. Lincoln’s opening sentence, “Four score and seven years…,” was a concise statement of American principles. Everett began his speech with this windy fanfare:

“Standing beneath this serene sky, overlooking these broad fields now reposing from the labors of the waning year, the mighty Alleghenies dimly towering before us, the graves of our brethren beneath our feet, it is with hesitation that I raise my poor voice to break the eloquent silence of God and Nature. But the duty to which you have called me must be performed;–grant me, I pray you, your indulgence and your sympathy.”

In Everett’s defense, he knew what made a good speech. He wrote Lincoln on the following day, telling him, “I should be glad, if I could flatter myself that I came as near to the central idea of the occasion, in two hours, as you did in two minutes.”

The lean but powerful beauty of Lincoln’s prose impressed itself on Americans’ minds as generations of schoolchildren committed it to memory. It helped influence American writers to favor clarity over ornamentation. And its lean style, free of sentimentality and romanticism, brought a new honesty to the way Americans though about the Civil War.

Hospice Girl Friday | ‘Just Being There’


Devra Lee Fishman’s dear friend and college roommate, Leslie, died from breast cancer one month shy of her 46th birthday after a four-year battle with the disease. Being with Leslie and her family at the end of her life inspired Devra to help care for others who are terminally ill. Each week, she documents her experiences volunteering at her local hospice in her blog, Hospice Girl Friday.

I’ve been playing clarinet in a community band for 20 years. We rehearse Wednesday evenings for two hours in a local high school and perform in retirement homes and parks every other month. There are no auditions required and no age limits, so we have members who are just out of college and people who recently retired and started playing their instruments after a 50-year career hiatus.

When I first joined the band I was working full-time and I rushed to get to rehearsal every week. Other than the rest of the clarinet section and a flute-playing friend I had recruited, I didn’t know anyone else’s name. There wasn’t time to socialize during rehearsal, and I didn’t stick around afterward because I needed to get up early for work the following day.

That all changed when I stopped working and could linger after rehearsal to chat with some of the other musicians. I learned that a clarinet player who sat next to me for more than 10 years was a former nuclear physicist, and one of the trombonists—Frank—once commanded a submarine and was married for more than 40 years to Betty, a French horn player also in the band.

When I got married I encouraged my husband Jim to dust off his trumpet and join the band, which he did in the fall of 2011. Jim introduced himself at his first rehearsal (a band ritual) and announced that he was married to me. This seemed to delight Frank so much that he made his way over to Jim that evening to share stories about being happily married to another musician. Often Frank, Betty, Jim, and I would walk out to our cars together after rehearsal chatting about superficial stuff like the weather, a recent concert we played, or our new conductor’s sense of humor.

Last summer Frank was diagnosed with inoperable brain cancer. He underwent chemotherapy and for several months and it seemed to keep the cancer at bay, but earlier this year we watched Frank get weaker and thinner. He still came to band, but talking was difficult for him, and then impossible as the cancer affected his ability to speak. At rehearsal about a month ago, I looked over and saw Frank slumped in his chair with his trombone across his lap while the rest of his section stood and played the final ‘big brass’ strain of Sousa’s “Stars and Stripes Forever.” When Jim and I were leaving that evening we noticed Frank shuffling behind a walker with one band member carrying Frank’s trombone and Betty guiding him to their car.

I know from my hospice volunteering and from spending time with my friend Leslie at the end of her life that being a caregiver can be physically and emotionally draining, so when I got home that night I sent an email to Betty saying just that. I offered to come over and stay with Frank while she ran errands or took a walk. I told her I knew we weren’t close friends, but we were part of the same band family and I hoped she would take me up on my offer. To make it easier for her to accept, I suggested a few specific dates and was delighted when she replied to my email to lock in a time. In her note she told me she was grateful for the chance to go to the mall in order to have Frank’s cell phone transferred over to her, a seemingly mundane task that she hadn’t been able to do because Frank was no longer able to walk on his own.

Jim wanted to come with me. I told him that, according to Betty, Frank would likely be sleeping when we got there since we would arrive just after a visit from his hospice nurse. When we arrived, Frank was sitting on their sofa with the day’s newspaper draped in his lap. He gave us a weak smile when we greeted him, and then a gauze curtain dropped behind his eyes as he tried and failed to stay focused on us. As soon as Betty left, he nodded off and slept until she returned two hours later. I gave her a hug when we said goodbye, and she fought back tears as she thanked us for coming over.

That evening I told Jim I was glad he came with me. I liked having him there and I believe Frank did too. Jim said, “I know you’re around people like Frank every week at the hospice, but I was kind of scared. I’m not used to being with people who are sick like that, and I don’t know what to do or say.”

“I’ll tell you a secret,” I said. “I’m scared too. Every time I go into a patient’s room I get nervous. And today, for a split second as we walked into Frank and Betty’s house, I felt that old familiar flutter of fear that I am not qualified to be around someone who is terminally ill. But I’ve learned that simply showing up and saying ‘I am here with you’ is all that a patient or their loved one needs to know they are not going through this horrible thing alone. You did that today for Frank and Betty.”

“Wow,” he said, “I never thought about it that way.”

Frank passed away two weeks after our visit, and Betty came to band rehearsal the following Wednesday. During our break I went over and sat quietly next to her as people stopped to chat and pass along their condolences. I wanted Betty to know that she was not alone in that moment, even though she was surrounded by our bandmates. As I left to go back to my seat, I offered my help again and this time she said, “Maybe in a couple of weeks we could just get together and talk.”
I’ll be here for her whenever she’s ready.

Note: Names have been changed to protect privacy.

Previous post: Learning How to Listen Next post: Coming Home to Say Goodbye

Bonus: For more on end of life care from a physician’s perspective, see How Doctors Die from our March/April 2013 issue.