Annie Bramlett was the first person I ever saw as a Hospice Volunteer.
Needless to say, I was a nervous wreck. Would I know what to do? Would I be
enough? Would I run away in horror?
Let's face it- I was not your normal candidate for hospice work. I had
stumbled into hospice looking for a more meaningful existence after a
lifetime of working in that most disposable of businesses, rock and
It was a good stumble. I had unintentionally fallen into a group of
people with whom I was immediately comfortable. I recall feeling after that
first volunteer meeting that I had "finally I've found my people." It didn't
hurt that one of the women looked so stylistically like my deceased Mom that
it was actually comforting.
This positive start led to my volunteer training and study and now here I
was, ready for my first assignment, Annie Bramlett.
Meeting someone who was dying was intimidating enough. (Did they have an
odor, a look or maybe a presence of death about them?) But then there was
the matter of Annie's personal biography. She was a self made woman who
moved from Oklahoma to San Francisco in the 20s, when women just didn't make
those moves. Especially a divorced, single Mother with a small daughter. She
went on to become the office manager for the local bureau of a national
paper, retiring there 40 years later. In the course of her life she became a
world traveler, sophisticated and smart. She was my kind of role model, and
I hoped to impress her.
I drove to to the high rise retirement community, parked and went inside
the lobby. I called up to her room. She told me to come on up as she had
been expecting me. Each step toward her door was portentous with
anticipation for me.
I had to walk into the room myself, since Annie was resting her easy
chair. She was suffering from terminal lung cancer. More obvious though was
her "macular degeneration". Macular degeneration is a certain blindness that
afflicts mostly older people. It is a particularly cruel blindness that robs
you of all but your most peripheral vision. As Annie lamented on more than
one occasion, she could not see her darling grandchildren's faces. When she
looked out of her eyes, all she saw was a large black spot. Lightness and
darkness were discernible around the edges, but no clear images.
But, this small bird of a woman, 81,still had her Oklahoma grit. Instead
of having the cool demeanor I associated with sophistication, she was down
to earth and self deprecating. She had an earthy, sly humor and didn't stand
on ceremony. And although she welcomed me warmly, I sensed a distinct air of
She lived in a studio apartment with a sink, small refrigerator and hot
plate. A DNR was posted to the fridge door. There was a full bath. One small
closet held her belongings. The kitchen had built in cabinets above and
below, which also held her things. There was a single bed, her wheelchair, a
recliner, one casual chair with cushion and a low table and lamp. A TV was
on a stand near the bed, next to an oxygen tank. There was a transistor
radio on her table on low. She liked to listen to ball games. There was also
a tape player and recorder. She now listened to books on tape, since she
couldn't read. There were windows on the north wall overlooking a park.
On the wall were pictures of her family- her daughter and son and her
grandchildren. There was also a wall rack of specially designed, enameled
spoons that she had collected on her many travels...the Alps, China, Grand
Canyon, Florida, Paris, Roma.
I was a bit more stunned by the meager surroundings than her condition.
81 years reduced to THIS? I had always heard people speak of others in "
diminished circumstances" but I had never understood what it meant.
I wrote about this later, in my journal, wrestling with this same
question and trying to understand the diminishing nature of life. Ultimately
I decided only the outside appearances and circumstances were diminished,
not the person. Annie was very much alive and vibrant, if somewhat
handicapped. It was a valuable lesson for me to learn.
Annie taught me well about how a person can be reduced to paltry
surroundings but retain a strong sense of self. She had absolutely no self
pity. Her life was just what it appeared to be, pragmatic and sensible.
Except for the pictures of her grandchildren and her spoons, she had few
attachments. She got meals brought up three times a day from downstairs, had
a home health aide come in every day to check on her, change the sheets,
help her shower and do the laundry. It was clean and familiar. She had her
hair done every week. She had lived there for seven years. She accepted her
Although she couldn't see her grandchildren's pictures, they meant a lot
to her. She adored her grandchildren and regretted them moving to Denver
with her son. "So far away"... she would fret. Her daughter who lived
locally and was responsible for her care, visited every week. But the
daughter had no children and her relationship with her Mother was somewhat
The daughter resented her Mother for all the years she worked and left
her alone. Annie would argue that she had no choice but to work. She said it
had never been her decision and she would have given anything to have been
able to stay home. She actually remarried in San Francisco in order to give
her daughter a father and so she could stay home to raise her. But she found
out too late that her husband was a lazy bum. By then she was pregnant with
their son. So after his birth, she was forced to return to work. After that
, she divorced for the second time. For the remainder of her life she said
she had little to do with men, finding them useless.
As she continued working, her situation became more settled. As her kids
became grown, she took to traveling around the world with another woman
friend. Cruises and travel. Australia, Europe, the Caribbean. Her friend
loved comfortable surroundings and to dress up and socialize. Annie had a
stronger sense of curiosity and was less demanding of her accommodations. In
respect for each other, they would divide the trips accordingly. For every
trip to the Outback, there would be a trip to the George V in Paris. She
regaled me with wonderful stories of their adventures. Each spoon held a
Although Annie didn't look necessarily look sick, she did indeed need a
wheelchair. The lung cancer had left her too weak to walk anywhere, except
around her small room, holding onto furniture. Her blindness, aggravated
things and reduced the scope of her life even more. But she didn't let any
of this stop her. She enjoyed being social and always had a quick retort.
She liked to get outside and do things. I quickly became accustomed to
loading her up in the wheelchair and wheeling her downstairs and out the
building for adventures.
The first time I tried to put her in the wheelchair was no problem...
except I couldn't get the footrests onto the chair. That's very bad for the
patient. Without the footrests, they have to hold their feet up to keep them
from dragging. A tiring exercise in the best of circumstances. I finally put
the heavy metal foot rests in her lap, maneuvered the tank-like wheelchair
through the two fire doors to the elevators, and got her down to the lobby.
There I enlisted the help of the maintenance director. Boy did I feel like a
fool when I found out how easy it was to put on the foot rests. It was just
a matter of knowing. (I guess I was asleep during that class in training).
You can bet I'll never forget again.
Once I got the hang of pushing the wheelchair, we went out, almost every
time I came to visit, which was weekly. Our downtown was just a short
distance from her door. It was a lovely little community of shops and
restaurants. We'd go to lunch in fancy and plain restaurants. Everyone was
always quite accommodating. She was never really hungry, but simply enjoyed
hearing conversations, traffic, and the bustle of everyday life. Sometimes
we'd just have coffee and a cookie, or "window shop".
My favorite times were when we wheeled through Central Park, which
actually abutted her building and had beautiful winding paths. The
children's playground was a particular favorite of hers. She couldn't see
the children but she could hear their squeals of delight. It made her very
happy. She could also smell the flowers, particularly in the Japanese Tea
Garden and the Rose Garden. Those were favorite moments, sitting quietly
together, in the park's embrace.
Since life moves inexorably on, Annie inevitably deteriorated. Her
interest lessened in current events, outside activities or food. When I took
here down to get her hair done in the old-timey building beauty parlor,
clumps of hair would fall out during washing.
More importantly though, she had gotten so weak that she began to worry
about falling. This fear was especially acute during the night, when was
alone and had to go to the bathroom. She started awakening with severe panic
attacks and sometimes stayed awake all night, afraid and fretful.
She began discussing alternatives with hospice for more comprehensive
care. Her two alternatives were either getting a full time attendant and
remaining in her apartment, or moving into a skilled nursing facility. For
reasons unknown to me (but most likely the cost), she chose, with her
daughter's input, to go into a skilled nursing facility, aka a nursing
I had been informed by my hospice that she would soon be leaving for the
nursing home. At that time that meant leaving our care, although now those
rules have changed. I went to see her, for what I clearly thought would be
the last time in her studio apartment.
We talked about her going into a nursing home only elliptically. She
would deny making a choice and say she didn't know what would happen. She
imagined her daughter would just show up and take her away with no advance
notice. While it was obvious to me it had been discussed thoroughly, it was
unclear to me who made the final decision. However with her night terrors
and the real fear of her falling and injuring herself, she certainly
couldn't continue living alone.
She said, "I wonder what will happen to my spoons?" I wondered too, but
was too naive and lacked the confidence to know how to speak to that subject
We gathered up our things and went to Central Park. It was a picture
postcard summer day. We sat in the sun and absorbed it's healing warmth.
I'll never forget the sweet simplicity of sitting with her silently. For a
moment, there was no future and no past, just a perfect present. We sat
suspended in time, savoring and absorbing the moment with all our might. I
was sure this would be the last time she would be in the park. I wanted to
infuse her with all the memory, warmth, smells, and sounds that it held. The
children's distant voices were a soft constant in the background. The sun
baked our faces. Flowers scented the air. The birds sang.
I was afraid for her going to the nursing home. I was afraid of her
losing her independence. I was afraid of losing her! Neither of us wanted to
leave that spot. We both seemed to understand, in unspoken fashion, things
would never be the same. It was with great mutual reluctance, that we
finally headed back.
On the way back into the retirement community, we met a friend of hers.
The friend was crying and rushed up to Annie in great distress when she saw
her. Medicare was trying to collect $900 from the woman because she had
fallen and called 911. It was not covered under her policy so they wanted
her to pay the cost of the emergency 911 call. She lived on a fixed income,
as did most every one in the retirement community. She was in tears." How do
they expect me to pay this?" she sobbed. "I Have no money. I went to their
offices and no one would listen to me." The two old friends held hands, both
weeping, tears running down their faces. Neither women knew Annie would
probably be gone from the residence community within 24 hours.
I tried to give them some privacy. But I couldn't help overhearing the
woman tell Annie, "They say life is just a bowl of cherries. But when you
get old it's just the pits. The real pits. No one knows, do they Annie?"
Annie and I were both shaken from this encounter and it dampened our
spirits. She felt very sorry for her friend but helpless. We completed the
trip home, through the lobby, up the elevators and to her apartment,
silently. She was still quiet when I gathered my things to leave. I told her
I would be in touch, no matter where she went. I left her sitting in her
recliner, lost in private thought.
Though our agency discouraged personal visits to patients who had left
our service, I decided to quietly continue visiting her in her new location.
The nursing home she had chosen had a very good reputation. Good reputation
or not, I was not prepared for what I encountered when I went to see her.
Many, many old people tied in wheelchairs and just sitting in the hall,
staring vacantly. The more able bodied residents ignored the less able
bodied residents. It was disconcerting and uncomfortable. .
I found Annie's room. She had a huge bruise on her forehead. She had
tried to get out of bed during the night to use the bathroom. They had put
the rails up on the her bed. She was not used to rails and tried to climb
over them and fell. She was now confined to bed and in diapers. She had
never worn diapers before. She was humiliated.
She was happy to see me, though a strong element of desperateness
accompanied it. She grabbed my hand and immediately whispered "I don't like
it here. I want to go home." My heart sank. That was exactly what my Mom had
begged me, when she wanted to leave the hospital. I had no power to save her
or Annie. She was so pleading. She repeated the request. I got that familiar
feeling of helplessness.
Resignedly, I just sat with her awhile, absorbing the sights, sounds,
smells of the nursing home and trying to put positive spins on the
situation. I joked and held her hand. I told her things would get better. I
told her things would be okay. I felt like a liar saying it, but what could
Eventually things did even out a bit. Everyone liked her because she
never took herself seriously and cracked jokes. The workers seemed good, but
you lived on their schedule, not yours. Patients were basically regulated by
pills to wake up, eat, and go to sleep. I once found Annie out in the hall,
tied to a wheelchair, all but unrecognizable. She had been given her morning
shower and parked out in the hall, while they continued on with the other
patients. Her hair, still damp, hung lankly along her down turned face. She
looked utterly defeated to me in that moment.
I got into the habit of stopping by to see her after I would go to my
horseback riding lesson. It was on the way home. I would stop and get her a
milkshake, one of the few things she would still eat.
I would stroll in, wearing my riding apparel and tall jumping boots, a
bit sweaty, with my hair in total disarray. I knew it didn't matter to her,
since she couldn't see me but God knows what the other people thought when I
clomped into her room. Once I arrived to find her daughter already there. We
had both brought milkshakes. There was a subtle feeling of competition
The woman in the bed next to her was in terrible shape, possibly a major
stroke. Although she couldn't walk or talk, her family and husband were very
loving and were there often. Annie paid them no attention and tried to
distance herself as much as possible. She may be dying of lung cancer but
she wasn't that bad.
Finally one day, I stopped in and found her very tired and distracted.
She was wrapped up tight in her sheets, mummy-like. She didn't want
anything. She really didn't want to visit. I stroked her brow and told her I
loved her and was thinking of her. She was surprisingly forceful when she
said to me, "Don't worry about a thing, Dear. Don't worry. Just don't
worry." I had the strangest feeling that she was blessing me.
Several days later, I stopped in again...the bed was empty and made up. I
saw the daughter of the women in the next bed.
"Didn't they tell you? She died two days ago. She had a terrible time at
the end, but went quickly. I told them to call her family, but nobody
When you think about people dying and their lives being extinguished,
many assume that you don't want to be there to see it or witness it. But
personally I would have liked to have been there with her. I was sorry she
died alone. She meant a lot to me. It was my first hospice loss.
There was no funeral or service and I never saw the spoons again. I had
very little closure except the fact that we had shared life. And in the end,
that has proved to be enough for me.
I've discovered now, that no matter how brief, it's these glimpses into
someone's life that honors the living. This is the living testament. When we
are called to bear witness, I think this is the witness the Bible is talking
about. Witnessing a life.
It's been more reassuring more than depressing. Choice is freedom. We can
all make a choice to be kinder. Annie Bramlett is someone I'll never forget.
She was my first real kindness. She was very kind to me.