A friend to the end

Their time together may be brief, but the bond grows strong between a hospice nurse and her patients.



By April Johnston

Fayetteville Observer



She can’t save her. The cancer decided that months ago.


So when Vivian Butterfield points at the oxygen machine humming beside her bed and says, “I want you to turn that thing off and let me have a cigarette,” Marie Buoniconti agrees.


She flicks the lighter into a flame and holds an ashtray over the bedsheets.


It’s been weeks since Vivian left the bed in her daughter’s living room or bothered to eat. She drinks only enough to wash pills down her throat.


Some days she’s sassy, pointing her dangerously long fingernails at people and telling them to shut up. Some days she stares at emptiness as if it’s putting on a show for her and smokes cigarettes that aren’t there, bringing empty fingers to her lips and inhaling again and again.


For seven months, Marie has been her hospice nurse, dressing Vivian’s gangrenous toe, ordering her pain medication, comforting her only child, Wanda Jackson, and waiting for death to steal Vivian away.


Marie used to save her patients, back when she was a med/surg nurse at Womack Army Medical Center.


There, when you lost a patient it was a shock, a mistake.


Here, when you lose one, you’ve done your job. It’s a job that demands a price, paid in increments of pain as patients become memories.


And sometimes, when a patient has been with you as long as Vivian has been with Marie, the pain is sharper.


“I’m leaving,” Marie announces when Vivian’s cigarette is gone and her IV has started to drip. “You ready?”


“Yeah, I’m ready,” Vivian tells her.



It’s their daily exchange, their inside joke, that one day when Marie leaves, Vivian will go with her.


“Can I put your oxygen back on?” Marie asks, holding up the clear tube.


Vivian sighs. It’s been rubbing the thin skin behind her ears raw, and she’s been complaining to her daughter about it all morning.


“Go ahead,” she says finally.


“Can I have a kiss first?” Marie asks.


Vivian turns her head and her lips meet Marie’s.


“Love ya.”


“Love ya, too.”




To the families who have to use it, hospice isn’t just a service; it’s a salvation.


When a hospice nurse knocks at the door, the mood behind it changes. Questions are answered, fears allayed, spirits lifted.


The tradeoff of such salvation is the nurses’ sacrifice.


Schedules are merely suggestions. Forty-hour workweeks are an aberration.


Beeping pagers call nurses out of conversations and away from meals. With the distance between patients’ houses, it’s not unusual to drive 1,700 miles in a month.


But there are rewards, too.


Marie chose hospice nursing three years ago, drawn in by the way patients rely on their nurses and the way nurses talk to their patients.


It’s honest, to acknowledge the inevitable.


Sometimes the inevitable comes too quickly for patients, before Marie is able to know them.


Sometimes it comes too young.


“The young ones get to me,” she says.



They have too much life in them to talk about death.


Lately, Marie’s youngest patient is Ronald Culbreth, a former sailor and firefighter whose blood vessels are clogged with a rare form of cancer.


He’s 37, the same age as Marie’s youngest daughter.


And she thinks about that sometimes when she knocks at his door with his weekly fix — a case of Ensure — in her arms.


“I’m his pusher,” Marie says when Ronald’s wife, Heather, opens the door of their lakeshore home.


“Push some more drugs while you’re at it,” Ronald calls from the couch.


Marie drops into a squat next to the couch.


“What you need?”


“What you got?”


What he needs are more pain medications. The swollen arm that sent him to the hospital weeks ago still hasn’t deflated. The pain won’t let him sleep. His fingers are starting to tingle.


“Something’s got to be done,” Ronald says.


“I’ve got a chain saw out in my car,” Marie tells him with a wink as she stands and reaches for the cell phone in her pocket.


She quietly steps outside and dials his doctor in Chapel Hill. She wants the results of his latest CAT scan. Something about Ronald’s pain isn’t right. If it were a blood clot causing his pain, the blood thinners he got at the hospital would have cured it by now.


But it isn’t a blood clot.


No one can hear the doctor say it, but no one needs to. Marie’s suddenly serious face says enough.


She steps back inside and kneels next to Ronald, laying her hand on his arm.


“It’s metastasized,” she tells him in a whisper.


Ronald nods.


“So that’s why it hurts,” he says. “That’s why it ain’t going away.”



“That’s why.”


Doctors have suggested a round of radiation to shrink the tumor and ease the pain.


“And amputation?” Ronald quips.




Whatever Ronald is feeling, he keeps it inside. Humor is his defense. It’s what keeps him afloat in this aching sea of cancer.


Marie allows herself one moment to feel it before she sees her next patient; one silent moment alone in the car to breathe.


It’s the worst part of the job, taking days away from a life that is already too short.




Marie is the mother of eight. She is the nurse of nearly 20.


In some ways, patients are a lot like children. They depend on her. They confide in her.


And every one is different.


So Marie gives each of them, and their families, what she thinks they need.


To Ben Bowans and his wife, Nell, she gives honesty. They were both nurse’s aides at the VA, and they know when things just aren’t right.


To Bill Bullock and his wife, Faye, she gives a little love to Simmi. The last nurse Bullock had was afraid of their dog.


To Vivian and Wanda, she gives relief.


Wanda promised her mother that she would never send her to a nursing home. So when the chemotherapy that was supposed to kill esophageal cancer ravaged her body and a feeding tube left a stubborn wound in her stomach, Wanda quit her job to care for her.


When Vivian calls out at night, it is Wanda who crawls out of bed to see what’s the matter. When Vivian insists she can walk, it is Wanda who stands near the bed, ready to catch her mother when she falls, because she will.


“If that was me lying there and she was healthy, she’d do the same for me,” Wanda says.



Still, the task exhausts her.


Marie revives her.


“You eat anything?” Marie asks Vivian one morning in March, taking up Wanda’s never-ending fight.




“Why not?”


“Because it makes me sick.”


“Why don’t you try some chicken broth?” Marie suggests, fitting her stethoscope into her ears.


Vivian snorts.


“Are you trying to gag me to death?”


“Yes,” Marie says. “I want you to gag to death.”


Vivian grins. What she’d really like to eat is fish. She made Wanda promise she’d buy fresh fillets for the weekend.


“You should eat some clear food before you eat that fish,” Marie says as she lifts Vivian’s arm to start an IV. But between Vivian’s sleeve and the sheets, she spots something that makes her forget her lecture.


“Look what I found,” Marie says, holding up a bent, never-lit cigarette and giving her patient a teasing, I-caught-you glare.


“I didn’t do it,” Vivian says immediately, pointing an accusing finger at Wanda.


Wanda just shakes her head. For seven weeks, she’s been warning her mother against refusing food and requesting cigarettes. Vivian won’t hear it.


“She told me the other day what’s done is done and I need to shut up about it,” Wanda says.


Vivian shrugs.


“I’m from the old school. I tell it like it is.”


In the car, Marie ponders the truth embedded in her patient’s words. What’s done is done.


Vivian’s right. She won’t live much longer without food. Maybe weeks. Maybe days.



Marie sighs.


“It’s going to kill me when she goes.”




For Marie, the only way to escape the tug of her job is to leave the city. So at the end of March she does, taking a New Orleans and Atlantic City vacation.


But this is her welcome home: Three patients died while she was gone. Ronald started having panic attacks.


And Vivian hadn’t spoken in days.


So even though she has laundry to do and car troubles to take care of, something tells Marie that Vivian needs her more.


She knocks on Wanda’s door at 4:10 p.m.


“Hey, lady, how you doing?” Marie asks her patient, cupping her hand around Vivian’s thin, sallow face. Her gray hair spikes wildly against her pillow.


Vivian doesn’t respond. She gazes at Marie for a moment and closes her eyes.


Marie listens to her labored breath. She knows.


“Wanda, come over here and hold her hand,” Marie says.


“Why, Marie? What’s going on?”


Wanda inches toward Vivian’s bed.


“Mama, open your eyes,” Wanda scolds her. “Mama! Open your eyes!”


But Vivian is gone.


For eight months, mother and daughter have been like Siamese twins, sewn together and sharing pieces of each other for survival. Now, Wanda feels as if someone has surgically removed that half of her.


No length of time, no amount of her mother’s suffering could have prepared her for this moment.


She throws herself on her bed and sobs.


Marie picks up the phone and, through her own tears, does what Wanda can’t: she calls Vivian’s relatives to tell them she’s gone.




People know when to die. They know when the last relative has arrived at the bedside to say goodbye. They wait for it.


In the days after her mother’s death, after the haze of pain burns off just enough for Wanda to collect memories, she remembers this:


The last words her mother said to Marie before she left for New Orleans were, “I’ll see you when you get back.”


And maybe because she wanted to say goodbye to Marie or maybe because she didn’t want her daughter, her only child, to be alone when she died, Vivian kept that promise.


She waited for Marie.