HOSPICE: A CALLING

When Vallerie Martin tells people what she does for a living, the most common response is, “Oh, that must be so depressing.” Martin has been a hospice nurse for seventeen years, and despite working in a field where the burnout rate is about two years, she says she cannot imagine doing anything else. Her reaction to the notion that her work is “sad and depressing” is this: “It is a great privilege to do this work.”

I first met Martin in April of 2007 when she was my brother’s hospice nurse. She was in charge of making sure my brother had the best quality of life possible in his little time remaining–notwithstanding the ravages of the cancer that was killing him. My family was new to the hospice experience, and in the midst of our crushing grief, we found ourselves constantly relieved by how much we could rely on Martin. Having her in charge allowed my brother to die at home with his wife, son and sisters tending to him. We didn’t have to run around to pharmacies, make endless phone calls to doctors or force him into agonizing trips to hospitals and doctors’ offices. Martin saw to it that all medications were delivered to the house, and ordered new or different medications from the doctor when needed. She spoke to my brother’s wife about grief counseling, arranged for a chaplain to speak to her if she desired, and advised her on how to speak to her teenage son about the imminent death of his father. Martin helped my brother with his most uncomfortable symptoms, often behind closed doors. She bathed him and counseled us on how to administer to his symptoms and what to do in the case of a brain seizure. And when he died in his own bed, it was Martin who came to the house to pronounce my brother’s death and to call the funeral home. Martin says, “We make clinical assessments, order medications that take care of symptoms, give emotional and spiritual support. We switch hats ten times in one visit.”

Martin’s mother died when she was seventeen years old, and it fell to the young Vallerie to care for her. No one, she says, told her that her mother was dying: “It was just me and this woman who was dying right before my very eyes.” Years later, Martin started her nursing career in pediatric oncology. It’s hard to imagine a more emotionally challenging environment—except, perhaps, hospice work, where death is a given and patients can be all ages. She says she knew early on that pediatric oncology was not a perfect fit, and so she wrote to the National Hospice Organization. “I didn’t really know what hospice was,” Martin says. When she eventually began working as a hospice nurse, “within two weeks I knew this was it. I knew this was what the Lord has for me.” In her early days as a hospice worker, Martin worked very hard on educating herself about pain and symptom management. She continues her education to this day, keeping abreast of advances in the treatment and management of pain.

After working as a hospice nurse for more than ten years, Martin became a clinical manager, a job that required overseeing other nurses rather than going out into the field and working with patients. But, in an unlikely move, Martin chose to go back into the field. As a manager she was not able to do the teaching and mentoring that is so important to her. “I can mentor our nurses that are new to hospice more effectively going from home to home,” she says. Asked how her three teenage daughters reacted when she told them she was going back into the field to do hospice work, she says they were not particularly surprised. “I’ve told them stories throughout the years, stories they didn’t want to hear,” she says. Her children are all grown now (Martin has one grandchild and another on the way), but something of those stories must have struck a chord; one of her daughters is currently studying nursing.

Listening to Martin talk about her work, as I recently did by phone, you get the impression that being a hospice worker is the most desirable job in the world. Her passion for the work is disarming, and is perhaps made more so by the soft Southern lilt of her Oklahoma childhood.

It is all too easy to forget just how grueling and difficult hospice work really is; most people cannot imagine doing it for one day, much less for seventeen years. Her work involves daily interaction with death and grief, not to mention the more unpleasant effects of patients’ bodily functions shutting down. It falls on the hospice nurse to administer to these needs. In one recent three-week period, Martin pronounced six people dead, and she knew that two more were on their way. “Emotionally, I get tired at times,” she says. “I have to go in and be up for each one of them. I discuss the signs of approaching death with three families in one day maybe, with another yet to go. I have to meet people right where they are.”