Because the first anniversary of Isabella’s death is this week (Jan. 15), I wanted to talk about my unplanned reunion with Ferdinand. It happed on August 15; seven months to the day that Isabella died.

I passed a local restaurant and saw Ferdinand sitting outside…alone. I was on my way home from work and my hands were full of groceries and dry cleaning and I walked past quickly, a little terrified. When I arrived at home I dropped my things and told John that Ferdinand was eating on the corner and I had to go see him. John agreed and held off cooking our dinner until I returned.

I walked to the restaurant and knocked on the table. Ferdinand recognized me and agreed when I asked if I could sit down. There is no other way to describe our meeting than awkward. We spent intense time together in January waiting for his wife to leave this world and that was our only mutual frame of reference. Since she had died on Jan. 15 I suggested that maybe it was karma that brought us together on August 15 to check in.

Ferdinand told me about the funeral and their two sons, and support groups, and a new roommate. We had a comical moment when he said, “You’re much thinner than I remember.” I hypothesized that I was wearing turtleneck sweaters and a down coat in January.

We made small talk about the restaurant’s Monday night trout and goulash specials and then he asked the question I had been expecting. “Why didn’t you return my call?” I was honest. One of the benefits of hospice is that the primary caregiver receives 13 months of bereavement care if desired. It’s not usually the same volunteer who provides both the care giving and the bereavement services. I have been doing this work long enough to know that I am the gal you want around in a crisis, at the time of death, or in the immediate aftermath, but a different type of emotional connection is needed to help the bereaved, and I don’t do a good enough job with the people in my own family who are bereaved. I can’t practice on strangers.

Ferdinand indicated that he understood what I was saying, or perhaps he wanted to return to his New York magazine and his trout. I said that I needed to get home for dinner. We stood and hugged. As I began to walk away, Ferdinand thanked me for coming up to talk to him. “I know it took courage,” he said.

He had no idea how right he was.

I have a pet peeve regarding eulogies. It makes me absolutely livid when the person officiating defines the person by her illness, rather than by her accomplishments, or, even worse, when a person is remembered in negative terms.

This brand of eulogy was given for an aunt of mine who had breast cancer in 1976, but died in 2009 after living a long life, owning her own business, having many good friends, and contributing quite a bit of karma into the world. The eulogy was given not by a family member. It was not given by a member of the clergy. It was delivered by a good friend of the family who was a hospital administrator. Later, at the meal of consolation, he solicited gifts for his hospital, but that’s a totally different pet peeve and a different blog.

I attended a funeral late last year where the son’s entire eulogy apologized for the way his mother treated people. I couldn’t tell if this behavior was a result of the illness or a character flaw since birth. It didn’t really matter to me; I was uncomfortable either way.

I understand that eulogies are not written months in advance, although in some cases I bet they are. Often they are pasted together from a group’s shared memories, transmitted through a prism of grief. And if you have been through a long illness with the deceased, those experiences are the freshest. Try keeping a notebook and writing down interactions with your loved one that just made you smile. Here’s a wild thought. Start this now, with people you adore who aren’t sick.

And keep this important point in mind: eulogy comes from the Greek meaning good words.

When my friend Eva gave her mother’s eulogy last March, she wrote it in the form of a letter to her mother. Commenting on the values she learned from her, her mom’s love of Law & Order (made even more poignant when Eva herself became an Assistant District Attorney), and offering an overview of the people with whom her mother would reunite as well as some new friends she would make in heaven (my mom and my husband’s dad, among others)… it was the sweetest eulogy I ever heard.

It is probably too simplistic to suggest that when called upon to deliver a eulogy just assume that the deceased is listening. But I would offer this bit of advice. Ask yourself what you would want said about you at your funeral, and do the same for the person who has gone before you.

One of the best reasons to love New York City is the opportunity to invent relationships with strangers. Take your local coffee cart guy. You see each other five days a week, and he knows you as “small decaf regular and a plain croissant.” When you don’t show up for a few days he asks if you’re feeling better. Some days it feels as if his is the only attention you get. This economic relationship is strong and infinite.

Then there are the people you meet on the subway, who are also interested in creating an economic relationship with you, only this one is more short-term. When I first moved to New York, like all newbies, I fell for every subway drama or display and after a few months I became more selective with my donations or gave out granola bars.

Recently, on my way home from work (Brooklyn-bound R train from Whitehall) I had an encounter that had a profound effect on me. A youngish African-American man stood in the middle of the car. His body language was despondent. His voice, plaintive. He announced that he had just gotten out of prison and that his mother had recently passed away. He said that she told him to keep himself together, “don’t end up back in prison.”

And so he was asking for help. He was grieving in front of strangers because he had nowhere else to turn. Three world-weary New Yorkers gave him money. A woman in her 50s, a woman in her 40s, and a young man with a beard, mustache, and headphones. When he approached me, I looked him in the eye and told him, “May your mother’s memory be a blessing,” and I handed him all the money in my pocket. He thanked me.

I have ridden the subway long enough to know when I’m being played. But I have also been around enough grief to recognize when it is so palpable that strangers can feel it. In this season of giving thanks, think of the people in your life who will rescue you when you are lost in a sea of sadness, and make sure to tell them thank you.

VNSNY Hospice provides bereavement services for families of patients enrolled in hospice. If you are not part of the hospice family, you can contact 1-800-Lifenet, which provides 24-hour-telephone crisis support, and can make referrals to more than 4,000 community resources.

^{Photo by WalknBoston through Creative Commons.}

I don’t know when exactly my tears started to flow. I don’t know if it was because I adore my siblings and the thought of losing them fills me with abject terror, or because Ms. Simpson, keeping vigil with her brother and sister-in-law, understood the preciousness of each passing moment, and the beauty of her brother’s spirit. Or because my first vigil patient, Brian, died two years ago today and I’m feeling a little weepy.

Given her skill as a writer, it is no wonder that Ms. Simpson crafts each sentence with loving care. In true journalistic fashion, she shows us…she doesn’t just tell us. She is funny and warm and honest.

Please read the eulogy for yourself, and appreciate learning about a man who kept this very special part of himself for those he loved the most.

The power to change is not easy at any age but I can recall an adolescent patient many years ago who with the new label of diabetes. He told me in no uncertain terms that we were wrong and that the diagnosis was a mistake. He yelled,“I will be fine. I don’t need you!”

Labels are hard to deal with no matter what, but we are only given one body and with that great responsibility. Taking care of that one body can be overwhelming especially if challenges are thrown into the mix. Many years later I happened upon a member of this patient’s family. He remembered me, and I remembered him. In asking how the family was doing he quickly informed me that his brother was no longer with us and how hard it was to watch him deny, decline, and die surrounded by all those who loved him. I recollect, that this patient that got away will be the one his family will always remember, for his strong will and determination. What a smart teenager but what a true loss.

At the end of the day, I will sometimes get a call from one of these parents. The worst is happening, and although we knew it was coming, it doesn’t make it any easier. The parents need support as their child spends his or her last hours on earth in a living room now outfitted with a hospital bed, suction machine, oxygen, monitors, and medications. Siblings may be nearby waiting, crying, and feeling powerless to help, or perhaps not completely understanding the moment at hand, and yet sensing that something major is about to happen.

Providing care, support, and ensuring the patient is as pain free as possible is our goal in Palliative Care. This patient (like many other adults and children with terminal conditions) is spending their last days at home — with the ones he or she loves. Planning and counseling are key to transitioning from one stage of life to another. VNSNY Maternal Newborn and Pediatric Program currently offers Pediatric Palliative Care services in Brooklyn and will be expanding to other regions in 2012. Families and children need community support and access to comfortable care. And for some families, being able to say good-bye at home means they provided their child with love, care, and compassion, free of extreme measures and painful procedures.

The sadness of loosing a child is very difficult for all involved — the family, medical staff, nurses, and others who are involved in their care. As professionals, we try with all our skill to provide these children comfort and final days which are pain free, but for some it is not the pain that harms them as leaving those they love. Children worry for their siblings and parents, and even their close friends. OFten, older children leave written instructions for family and friends to remember them and let them know that “it is OK to move on.” Reading this from a patient that had passed made me quickly realize that While the patient, a child, may be ready to move on, they feared that  their parents were not.

No one can truly prepare for the death of a child.  Planning for the “after”‘ takes time and then more time. A mother once told me that “the year of firsts without her daughter” was the most difficult time for her and her family. It was as if they were incomplete — wondering if only, or if they had done things differently, would their child still be here.

We all grieve differently, we all heal differently, and there are no clear-cut answers to what is right or wrong. But there is help for families struggling in grief. Seek out help, it may be difficult for you and your children to do that but is something your family member would want you to do.

What I have not discussed is the connection between September 11 and my volunteer work. I watched all of the events of that morning from my office on the 25^th floor of a building six blocks south of where the Twin Towers stood; my office faced north. As I walked home over the Brooklyn Bridge with my husband, I was traumatized and non-verbal. I could not get undressed nor take a shower because I felt I would be washing the remains of human beings down my drain.

It took me a few weeks to realize how fortunate I was and knowing that made me crave opportunities to volunteer. I spent my birthday that year volunteering for Safe Horizons calculating receipts for displaced residents needing reimbursements. I stood at Point Thank You on a freezing cold night yelling and clapping at every truck that drove down the West Side Highway. I purchased socks, Power Bars, and Red Bull for rescue workers because I was told that’s what was needed. And like almost every other Brooklynite, I baked dozens and dozens and dozens of chocolate chip cookies to deliver to local fire houses.

These one-off activities weren’t doing it for me. I needed to commit to an activity with my heart and soul, and one that could quiet the guilt I felt for making it home that day. It took a few years to figure out that VNSNY Hospice was the place to do that very thing.

As it is for so many others at this time of year, this season is very difficult for me. Historically I am irritable, short-tempered, depressed, anxious, all while consuming copious amounts of chocolate and counting down the days until September 11 is over.

Yet this year feels different. Maybe I have been so busy thinking about “Hazel’s” passing on August 20, the earthquake, and the hurricane which required the staff to evacuate the Museum, that I haven’t had time to dwell on it. And that is okay. Because my own legacy from September 11 is the work I have done for Hospice. The people who were murdered on September 11 were not surrounded by loved ones, or cared for by strangers who became family. In my own small way, escorting the souls of strangers on the path to the next journey is my way of honoring the souls of the men, women, and children who died alone that day.

Be well.

September Eleventh Two Thousand and One.

My life is clearly delineated into two parts separated by that clear, crisp beautiful Tuesday morning in September. I drove into the Brooklyn VNSNY office from my home in Queens listening to Howard Stern (yes, I like Howard Stern) on the radio as per my usual routine. He announced that a plane had just hit the World Trade Center. I was parking my car and said to myself “how could that happen, what a horrible accident.” As I walked into the office, it became increasingly clear that it was not an accident. I don’t need to recount the details of the day as you all know them. Volunteers were sought to go triage victims of the attack and so I went along with many of my colleagues. I wore my VNSNY issued navy blue sweater so I could be easily identified among the throngs of people, police and firefighters milling about in what seemed to be a fugue. I wound up at Stuyvesant High School across the street from the World Trade Center where we prepared and waited for victims. Mostly what I did that day was wash the eyes out of the firefighters in order to send them back out for what would become months of searching and removing debris from Ground Zero.

What I saw in those brave men when I looked into their eyes was the most profound, childlike sadness and fear I had ever seen and have not seen since. They were desperate and determined along with the police officers and many, many other heroic rescue workers to find and help their fellow citizens and fallen comrades. Late that night I left the triage site and walked alone up the West Side Highway to a friend’s house on 24^th Street. I left a piece of my soul, many, many prayers, and my VNSNY navy blue sweater there.

Here I sit reflective almost ten years later. I have since lost over 140lbs, finished my baccalaureate degree, met my future husband Robbie, started pursuing my masters degree in public health, got married, left VNSNY, had my precious daughter Madeline Grace, bought a house, and proudly returned to VNSNY and now once again I am working in the great city of Brooklyn.

I ask my self how has the experience of that day as a VNSNY employee changed me?

I remember and pray for those lost and their families’ everyday.

I have infinite gratitude that is beyond the use of words that I have life and the ability to profoundly appreciate it.

I strive to feel more of the love in the world and give more love everyday.

I know this can come off as hokey and trying to wrap up a tragic event into a “feel good” message, but the absolute truth is that I am forever changed…

and I have never replaced that navy blue sweater…

Peace,                                                                                                                                         Lisa HS 8.1.11

Dedicated to Louis Modafferi Battalion Chief, his family and all of his brothers at Rescue 5.

My hospice patient, Hazel (not her real name).

In addition to my vigil work, I have a regular patient whom I have seen every Friday for the past three and a half years. Patients typically are enrolled in hospice for 180 days (incidentally that’s also the title of an excellent and powerful one-woman show by Taren Sterry, about her own hospice work), because that is the expectation of how long the patient has to live. Of course there are times when patients are recertified for another 180 days. Sometimes patients are discharged because they are stable, there is no decline, and their prognosis improves. Patients can go back on hospice if their situation changes. Hazel has experienced all of these scenarios and more, and I’ve been with her for all of it.

For most of our 3.5 years, I have been opening her mail, paying bills, filing, writing letters and thank you notes, and serving as her social secretary. One day two years ago, we were going through old papers and we ran across a letter from the Dean of the College of New Rochelle congratulating Hazel on making the Dean’s List. She got her bachelor’s degree at the same time I was getting mine, except that she was 77. She is a pretty stubborn dame with a lot of opinions, but if you get on her good side, she is sweet as can be. When my father-in-law died last summer, she wanted to know how my mother-in-law was doing, and asks after her often, and when I told her about my recent promotion, she wanted to hear all about the view of from my new office.

In February, Hazel fell, and she began to decline. When I was leaving to go on a vacation in April we had a difficult and heartfelt goodbye because I really didn’t think I would see her again. But, per Hazel’s modus operandi, she rallied, and seemed much better when I returned from France. She didn’t want to talk about herself; she just wanted to hear about my trip. Her advice to me was to take more trips.

A wonderful woman who is loving, generous, wise, and special cares for Hazel. I wish I could clone her. I want her to go to nursing school and then go on to teach nurses, although I am not sure her level of caring can be taught. It is really an art. She had a 101^st birthday party for Hazel on Thursday. I attended as well as Hazel’s other volunteer, Ann. We sang to Hazel, had cake, and the three of us talked in the living room about what will happen when Hazel dies; Hazel slept the whole time.

Hazel is transitioning from living to dying, and my work with her is no longer administrative and jovial. I hold her hand to comfort her while she sleeps and give her sips of water and watch her breathe. I look at my work piling up on her desk knowing I can’t get to it because she does not want me to break the connection between my energy and hers. I cover her with blankets because she is cold, even though it is 100 degrees.

And I begin to understand that I have made my own transition. I am no longer a hospice volunteer sitting with her patient. I am a woman watching her friend die.