A Second Exodus

A Second Exodus

1956, Alexandria, Egypt

 

The wave was bigger than he had anticipated, knocking him off his feet and pushing him down under for a few seconds before carrying him quickly to the shore and spitting him out onto the sand. 

At nine years old, Sami wasn’t the tallest kid in his class at the Lycée Francais, but he was strong and stocky. His naturally olive-toned skin was particularly tan after many afternoons at the beach that summer. He could have passed for an Egyptian, but even though the bustling cosmopolitan city of Alexandria, Egypt had been home to his family for generations, they were never considered Egyptian. 

Sami emerged from the cool Mediterranean Sea, wiping the foam and sand from his brow as he pulled himself up. He loved everything about the beach: the sand, the water, the people, the colors. He could spend all day there, watching people, surfing the waves, munching on his favorite Caca Chinois candy, running and playing on the sand and in the water, his family’s private cabine serving as a home-base filled with his extended family – cousins, tantes and oncles.  

“Sami, viens ici!” his mother called. He looked up to see her walking quickly toward him with a multi-colored towel held out, her shapely bare legs, tan and olive-toned just like Sami’s, emerging from beneath her blue bathing suit, and her rich brown hair pulled up into a colorful scarf. People said Jeanette was beautiful, elegant. But to Sami, she was just his mother. 

My father, Roland Sam Malka was an only child, and more than a bit spoiled – un enfant gaté – by anyone’s account. He would hide his toys so he didn’t have to share. One time he went so far as to dig a hole in the ground and bury a toy he didn’t want his cousin Yves to play with. He got a taste of his own medicine when he later went to dig it up and couldn’t find the exact location where he had buried it. But he was charming and sweet, a golden boy with a good heart, so his brattiness didn’t keep his cousins from loving him. 

No one ever called him Roland. Maybe it was too hard to pronounce in Arabic. Or maybe Sami just suited his playful personality better. Jeanette – my Nana – tended to coddle him a bit, not in a modern indulgent way, but in an old-world protective way. The only daughter of a wealthy Italian businessman, her family was part of the fabric of Alexandria. 

Victor Malka – my Papi – had courted her and they had married, and once he had his son, he had felt no need to further procreate. Jeannette would have liked more children, but she didn’t argue with her husband. That just wasn’t done. 

The Malka family lived an upscale life in a gorgeous apartment. Papi was a bank executive at Banque Belge and spoke six languages fluently. He also worked at the racetrack on weekends, helping with the spreads, the charts, the numbers. The only boy in a family with seven children, born right in the middle of his six sisters, he served as the patriarch of the family, making sure everyone was taken care of and that they all knew he had it all under control. He was also a charming ladies’ man, the life of any party, and there were many in the vibrant metropolitan city of Alexandria in the 1940s and 50s. It was an international hub of activity, life and culture. The Europeans who lived there enjoyed a peaceful co-existence with the Arabs. They spent their leisure time at the cinema, cafes, French patisseries. At the Alexandria Sporting Club, they played squash, tennis, cricket and golf, and enjoyed horseback riding and gambling. They spent weekends at the beach year-round, relishing in the mild climate.  

Jews and non-Jews alike, the Europeans were welcome guests in Egypt. They ran the banks, the shops, the cinema, the racetrack. But despite the fact that Egypt was their home, their passports were French, Italian, British, etc. Some of them were technically apatride – stateless. They were neither Egyptian nor European, nor Israeli. They were children of the world.

At home and school, Sami’s family spoke mostly French, but they were part of a multireligious, multicultural and multiethnic environment. Abdul – the family’s servant who felt more like a big brother or an uncle – had taught Sami some Arabic. 

The Malkas were among some 80,000 Jews who lived in Cairo and Alexandria, but they were not particularly religious. They followed the traditions of their faith quietly alongside their Muslim and Christian neighbors. Each of them worshipped with their families – Muslims at the mosque, Catholics at the cathedral, Jews at the synagogue – Eliahu Hanavi – Elijah the Prophet – a beautiful, intricately carved Italian-built structure at the heart of the city on Nebi Daniel Street. And each different group would wait outside for their friends from the other religions to complete their mass or service and then they would gather together at someone’s home to sing and dance until late at night.  

Kids rode their bikes in the streets. Everyone knew everyone, and they all respected one another. They were integrated, but not assimilated. Each group kept their unique identity, even though they were friends. Intermarriage among the different religions was rare. 

The Europeans didn’t feel like foreigners. Egypt was their country. You could hear a mixture of languages in the streets. At the cinema, movies were played in their original language – English or Arabic usually, with French subtitles, so everyone could speak at least a little of several languages. 

Back at the beach cabine, Abdul served Sami some macaroni au four, a baked macaroni and cheese dish he had prepared at home, the perfect comfort after his tumble in the sea. There was never a shortage of food in Sami’s family. They enjoyed frequent large family dinners together and even when they just popped by to visit, his aunts, who all lived close by, would bring out platters of nuts and dried fruit, coffee cake, phyllo stuffed with spinach and cheese, feta cheese, olives and other Mediterranean foods. And his mother did the same when guests showed up in their home. Not being hungry was not an acceptable answer. It was considered impolite to refuse to eat. Il faut manger quelque chose.

It was a beautiful life in Alexandria, a golden age for younger and older people alike, the perfect playground for a young adventurous boy. 

Sami was blissfully unaware that Alexandria had been changing for years now, that the peaceful coexistence the Jews and Europeans had enjoyed with the Arabs for so many years was coming to an end. 

Politically, the Jews of Egypt had always leaned toward the left – with Zionism, socialism and even communism attractive ideals after the oppression of World War II. 

Egypt was part of an Arab military coalition that attacked the newborn Jewish state of Israel in 1948, and an anti-Zionist movement began to form. Jews who were believed to be connected with Zionist groups were arrested, thrown in jail or thrown out of the country. The political climate was changing quickly and some families decided to flee, knowing they were on the blacklist. Papi never talked about politics, but I get the impression his views were more moderate. Eventually, though, that didn’t matter.

There was political corruption in the Egyptian monarchy and a new Republic of Egypt was established in 1953. A revolution against all foreigners – particularly British and French – began to sweep the nation. Fires burned through the city as Egyptians burned down Jewish owned stores, and the beautiful cinemas and cafes symbolic of the British occupation. 

The new President, Nasser wanted to nationalize Egypt, claiming ownership of all major assets – factories, fields, buildings, even privately owned companies. He was a charismatic leader who delivered long speeches on the radio. When he decided to nationalize the Suez Canal, which used to be a private company, owned primarily by the French and British, it started the 1956 War. 

France and England attacked Egypt, and Israel alongside them, so Egypt began to expel its French and English residents, as well as all Jews, regardless of nationality. First they placed restrictions on importing and exporting, travel, and work permits. They tapped telephone lines, screened personal correspondence. Soon people couldn’t even access their own bank accounts.

Businesses closed, and families left Egypt to head to Brittain, Italy, Spain, France or Israel. 

There were rumblings among Sami’s family of leaving. Il faut partir, they’d whisper. 

And one night, it was their turn to be evicted from the home they owned, torn from their country, from the only life they had ever known. But even when authorities showed up at their home, garnishing artwork, collectibles, antique furniture, china, cash and jewelry, Jeanette shielded her little boy from the harsh reality of what was happening. When they were told they could each take only one valise, Nana piled layers of clothing onto herself and her son, despite the warm night air, placing valuables in the pockets. Papi hollowed out a large dictionary to hide whatever jewels and money wasn’t confiscated, and entrusted it to Sami to hold onto. For Sami, it was all a fun game, an exciting journey. He wasn’t completely oblivious to the violence and fear, but he never truly worried for their safety, and he had no idea of the horrors and violation that even some of his close family members endured. 

They boarded a big ship called The Yugoslavia, and even though it was packed with too many people, Sami didn’t understand that the journey was anything but a glorious adventure. When they arrived in Sardinia, the people threw bread and olives up to the refugees packed onto the ship like sardines. 

“Why are they throwing us food?” Sami asked his grandfather. “We play at the beach and have a membership at the country club. We are not peasants.” 

They eventually landed in France, staying at a refugee camp in the south for a few months, then moving to Paris where Papi was able to secure a new position with his old company, Banque Belge. My family was among the lucky ones. Despite the traumatic expulsion from Egypt, not speaking the language, and not knowing anything about the local customs and culture, they landed on their feet pretty quickly and began to rebuild from scratch a semblance of the comfortable lifestyle they had enjoyed in Egypt, though they’d never be able to recreate quite the same level of cosmopolitan elegance. 

People committed suicide, before and after their departure. Some didn’t want to leave Egypt. They wanted to be buried in their homeland. Others made it to the new country, but living in a refugee camp, they were forced to take entry-level jobs when before they had been heads of companies. Their beautiful life had gone down the toilet like yesterday’s caca

After about a year in Paris, Papi moved his family to the US, first to New York City and then eventually to the suburbs of Long Island, purchasing a brand new tri-level on a quiet street in Bellmore. Three of his sisters stayed in France and raised their families there. The other three settled in New York, close enough to continue the tradition of large family gatherings. They enjoyed the vast and broad Jones Beach, though it was a far cry from the Alexandrian coast.

My dad had an array of cousins spread out over two continents. The family would always remain close, with a fierce love and a strong bond that I didn’t know was uncommon in families. 

By the time they got to Bellmore, my dad started introducing himself as Sam, and he would practice speaking English for hours in front of a mirror, trying desperately to erase all traces of his Egyptian French accent so he could be just like the other kids. 

“That’s an interesting accent,” people would say to his parents. “Where are you from?” 

They would respond vaguely that they were French, rarely mentioning Egypt, because it was too complicated to explain that they were from Egypt, but not Egyptian. 

“Malka, such an interesting name. Is that Italian?” others would ask.

They usually avoided explaining that actually, Malka is the Hebrew word for Queen. It wasn’t that they were embarrassed to be Jewish exactly. They were proud to be Jews, but it had always been a quiet and personal faith, even before it had become a crime just to be Jewish in their home country. 

Papi was all about picking yourself up and starting over, focusing on the good. Focusing on his family and their health and safety. He knew that you can’t go back. You must move forward. 

In a 2016 documentary called Starting Over Again, my dad’s cousin Yves said, “The Jews of Egypt are one of the best examples of resilience because they survived and adapted all over. We saw our parents fight back after they were humiliated. They stood up and gave us a message of tolerance toward others.”

They loved Egypt, but they were forced to leave it and start over again. They left Egypt, but Egypt never left them, someone else said. 

Another Egyptian Jew in the documentary, Alec Nacamuli said, “We have been equipped with tools of understanding and tolerance that at the end of the day could be a bridge to get to the other side.”

This resilience and strength tempered with tolerance and understanding was ingrained in me from childhood, but I never fully realized the drama and the trauma in my family’s expulsion from Egypt, and until I saw that documentary, I didn’t understand how common their story was, how many of us there were. When I watched it, I felt a nostalgia for a place I never even knew.

 Even though most Americans have never heard of this “Second Exodus” of the Jews from Egypt, I had heard the story so many times as a kid. I’d always ask questions, wanting to know more, but Nana and Papi gave me only a vague picture, glossing over the horror like it was a cute little parable. They really did just move on, start over and never look back. Papi never even wanted to visit Egypt. America was his homeland now.

My father succeeded in erasing his French accent and becoming a part of the American melting pot, a carefree American guy, popular with the ladies (he did sometimes use the French strategically). And he remained particular about his toys, or really anything that was his. In college he’d hide a quart of gourmet ice cream inside a huge tub that had once held some hideous flavor he knew his roommates would overlook in the freezer. On the surface, he hadn’t changed a bit from the adventurous enfant gaté he had been in Alexandria. 

But if you looked closely, you’d notice he had no emotional attachment to the things he seemed to prize more than people – whether electronics or cars, houses or boats, he always held them lightly, happy to sell if he got the right price, excited to move on to the next shiny object. He took meticulous care of his things, but said goodbye to them without a second thought. Because he was always eager to try something new and never one to set down roots, we moved every few years as a kid, which made it hard for me to form attachments and deep friendships, too. 

My dad has always avoided emotional life events, anything that might make him feel sad or scared. Though he was married to my mom for more than 20 years, and even still remains close to her after more than 20 years of divorce, he always seemed emotionally unavailable to me. I knew he loved me, but I rarely caught a glimpse of his deepest thoughts and beliefs about life and love. 

I wonder, after all these years, if any of his quirky personality is a result of the trauma of being ripped away from his home at nine years old. And as I think of that, I want to give him a big hug and let him know that it’s OK to cry. Sometimes life just really sucks. But it does get better. And I wonder if my own desire to delve right into the messy emotional side of life, my constant search for community and connection, my desire to build a bridge between any two opposing parties, and to always move quickly toward joy and silver linings, never resting too long in sadness, was at least partially formed from this thread of my ancestry running through my own life.

 

Arya Grace

Arya Grace

My baby is turning five tomorrow! Facebook memory from five years ago today..

Every morning for about the last month, I have woken up half surprised that my water didn’t break during the night and that instead I’m still pregnant! (I have a double uterus, so the baby really only has half the space that other babies have in their mom’s tummies.) With both my older girls, they scheduled a c-section, but my water broke a few weeks earlier than the scheduled date.
I’ve been having contractions for months, have been to the hospital twice convinced that I was in labor. But no, this one appears to be quite content to wait for her scheduled arrival time, despite our impatience!
Can’t wait to welcome Arya Grace Tantone into the world tomorrow. By the way, her name seems to be confusing for people, but it’s just like Aria (Ah-ree-ah or even Ahr-ya) – like an Italian opera solo or the Vegas hotel, spelled with a y instead of an i. Aria also means lioness in Hebrew and the word Arya itself is sanskrit for noble.
Grace also has a lot of meaning for us. On one hand Grace is simple elegance, refinement of movement, poise, finesse. And on the other hand, in Christian belief grace means the free and unmerited favor of God. It is something we don’t deserve and cannot earn, and one of the hardest things to give to other people, especially those who hurt us, an amazing blessing…
Can’t wait to hold my amazing blessing from God tomorrow!

 

Moving Along the Illness-Wellness Continuum over a Lifetime

Moving Along the Illness-Wellness Continuum over a Lifetime

This is not my typical blog post, but a paper I had to write for my GCU nursing class. Since much of my creative juices are currently being directed toward nursing school, I figured I might as well publish some of my work here on my blog!

Moving Along the Illness-Wellness Continuum over a Lifetime

Danielle Tantone

Department of Nursing, Grand Canyon University

NRS-434VN: Health Assessment

Geraldine Bazzell, RN, MSN

1/31/21

Just over a year ago, I was enjoying a peaceful September afternoon at the park with my youngest daughter in the midst of a crazy stressful life: three kids, nursing school, working nights at the hospital as a nursing assistant.

The blazing summer heat had broken, and it was finally cool enough to enjoy the outdoors in Arizona. My cell phone rang, and my doctor gave me the life-changing news that I had breast cancer. But I was neither shocked nor alarmed. I was high-risk and had gone in for a biopsy two days earlier after my mammogram showed some microcalcifications.

I had done my research, so when she told me that the biopsy had revealed high grade, Stage 0 ductal carcinoma in situ, the earliest form of breast cancer, my mind went right toward making a plan and focusing on all the silver linings, of which there were many.

I had just turned 45 and I was at a healthy weight, eating a healthy diet and exercising regularly. I decided almost immediately that the best treatment option for me was a bilateral mastectomy with reconstruction. Yes, I could have chosen “just” a lumpectomy, but by choosing the double mastectomy I avoided chemotherapy, radiation and even hormone therapy, all of which, to me, were far more invasive than simply removing the breasts which had served me well but were no longer strictly necessary.

I believe that the healthy mental attitude I chose to adopt during this health ordeal was just as important as my physical health, and despite my serious disease diagnosis, I stayed in a state of overall wellness throughout the entire ordeal.

Wellness has many components: physical, mental and emotional. Though it can be pictured as a continuum, along which we all move back and forth throughout our lifetimes, it is actually a multi-dimensional concept that is hard to completely understand on a one-dimensional model. One can be sick in terms of disease, but rate high in terms of overall wellness, or one can be free of disease but not enjoying a state of overall wellness at all (Wellness, 2018).

The goal is to be not just free of disease, but in a state of optimal wellness as much as possible over the course of a lifetime. As nurses, it is important to be aware of our patients’ – and our own overall state of wellness and not simply look at whether or not we are experiencing symptoms of disease.

The origins of the Illness-Wellness Continuum

The health-illness continuum, originally conceived and published by John Travis, MD, MPH in the 1970s, provided a nice picture to show how optimal wellness was achieved by moving past simple absence of disease to higher levels of wellness. The idea was a combination of the Lewis Robbins’ health risk continuum created by Lewis Robbins and Abraham Maslow’s concept of self-actualization.

However, the model makes it hard to understand the fact that it is possible to be physically ill but oriented toward wellness, or physically healthy but suffering from an illness mentality, and the continuum is rarely a perfect line. Even if someone is sick, in a disease state, they can still be doing very well in terms of overall wellness (Wellness, 2018).

More About the Illness-Wellness Continuum and Travis’ Work

Moving from the center to the left shows a progressively worsening state of health, while moving to the right of center indicates increasing levels of health and wellbeing. While medical treatment such as drugs, herbs, surgery, psychotherapy, etc. alleviates symptoms and brings a patient to the neutral point, the wellness paradigm can be utilized at any point on the continuum, and directs a patient beyond neutral. This idea of true wellness does not replace treatment, but works in harmony with it (Wellness, 2018).

A state of emotional stress can lead to physical and mental disease, even cancer, and true wellness is not a static state. In fact, it’s not as important exactly where a patient falls on the spectrum so much as in which direction he is headed. Even dying can be done from a place of wellness (Wellness, 2018).

The Importance of Understanding the Continuum in Patient Care

The health-illness continuum also interacts with the continuum of patient care. In a healthcare system that is often criticized for focusing on acute conditions rather than wellness and prevention, thinking of wellness in terms of a spectrum has advantages for everyone involved. A truly patient-oriented system of care “spans an entire lifetime, is composed of both services and integrating mechanisms, and guides and tracks patients over time through a comprehensive array of health, mental health, and social services across all levels of intensity of care” (American Sentinel University, 2020).

Such a system would provide high-quality and cost-effective care for patients using community-based services such as home health nurses, telemedicine, disease management programs, informatics, and case management. Nurses are essential within this continuum of care. They support treatment, help educate and guide their patients toward better health outcomes (American Sentinel, 2020).

Nurses must consider not only the continuum of care, but also pay attention to where each patient is within his own health-illness spectrum, always remembering to look at the patient holistically. A nurse’s role goes far beyond simply treating disease. She can have a tremendous value in promoting overall wellness on every level.

Nurses’ Personal Place Along the Health-Illness Continuum

On another note, nurses must pay close attention to where they, themselves are along the continuum as well, since they can’t very well take care of others if they aren’t taking care of themselves first. Studies have shown that nurses experience more musculoskeletal disorders, depression, tuberculosis, infections and occupational allergies than the general public. Nurses’ shift work was shown to lead to sleep deficiency, lack of exercise, cardiological and metabolic problems, and even cancer (Letvak, 2014).

And while the nurses’ health is important, it is not just about them. Studies also show that nurses who work with physical and mental illness experience more medication errors and patient falls, and offer an overall lower quality of patient care provided (Letvak, 2014).

According to the ANA, “A healthy nurse lives life to the fullest capacity, across the wellness/illness continuum, as they become stronger role models, advocates, and educators, personally, for their families, their communities and work environments, and ultimately for their patients” (Letvak, 2014).

The ANA offers many levels of support for nurses on their own journey along the health-illness continuum.

Health is in a Constant State of Change

A person’s health is always in a state of continual change on every level, moving from health to illness and back again. His condition is rarely constant. The health-illness continuum (see figure 1-1) illustrates this process of change. Each individual experiences various states of health and illness throughout his life. But it is actually the individual’s response to the change, rather than the change itself, that affects his health most profoundly (Brookside, 2015).

Figure 1.1 (Brookside, 2015)

Adaptation to a chronic disease can be considered a state of wellness. If one person is in great physical condition, but suffering from depression or substance abuse and unable to go to work, while another is living with a chronic disease like diabetes but functioning fully within his life, which one is at a higher level on the health-illness continuum (Brookside, 2015)?

Where I See Myself on the Continuum

I have always thought of myself as an overall healthy person. I know my body well and I take care of it. However, I have not ruled out the possibility that the physical and emotional stress I was under in 2019 actually led to my breast cancer. I was dealing with a lot and I was working the night shift, which has been proven to throw off the body’s circadian rhythm. Some studies even show a link between shift work and cancer (Yuan, 2018).

So, in that moment, I was heading toward illness. However, the fact that I was being regularly screened and took prompt action to treat the cancer, and the fact that I chose to see all the blessings in my diagnosis turned me around toward the wellness end. Facing illness with eyes wide open, trusting God and having a strong support system are huge in terms of wellness.

Conclusion

As an aspiring nurse, I find it encouraging that we are learning about the health-illness continuum. I feel very strongly that good healthcare is so much more than simply eliminating disease. As nurses, we can have an impact of the overall wellness of our patients and the entire community. The patient care experience, like the human experience itself, is about so much more than just staving off disease. Nurses can have an impact on a person’s entire life through their compassionate caring, empathy, education and love. A good nurse can encourage, inspire and comfort her patients, promoting dignity in the most embarrassing of situations and helping a patient turn back in the direction of wellness no matter how sick they are.

It is important that nurses do not forget to treat themselves as their most important patient, taking care to get enough sleep, exercise, healthy food and mental, emotional and spiritual stimulation. It is a stressful and important job we do. We hold our patients’ lives in our hands. We must never take our own health for granted or think that it is unimportant.

I am grateful that I got cancer. I am glad I got to experience what it is like to be a patient. I am grateful that they caught it early and that through my journey, I have been able to encourage so many others – to get regular screenings, to not be afraid of bad news, but to welcome it because getting the news lets them do something to fix it, and to face their challenges with grace and faith.

References

American Sentinel University. (2020). What is the Healthcare Continuum of Care and What Are the Different Nursing Roles Within it? The Sentinel Watch. Retrieved from https://www.americansentinel.edu/blog/2020/02/15/nursings-role-in-the-continuum-of-care/

Brookside. (2015). The Health-Illness Continuum. Nursing Fundamentals 1. Distance Learning for Medical and Nursing Professionals. Retrieved from https://brooksidepress.org/nursing_fundamentals_1/?page_id=115

Letvak, S. (2014). Overview and Summary: Healthy Nurses: Perspectives on Caring for Ourselves. OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 3, Overview and Summary. Retrieved from https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-19-2014/No3-Sept-2014/OS-Healthy-Nurses.html

Wellness Associates. (2018). Key Concept #1: The Illness-Wellness Continuum. Retrieved from http://www.thewellspring.com/wellspring/introduction-to-wellness/357/key-concept-1-the-illnesswellness-continuum.cfm.html

Yuan, X., Zhu, C., Wang, M., Mo, F., Du, W., Ma, X. (2018). Night Shift Work Increases the Risks of Multiple Primary Cancers in Women: A Systematic Review and Meta-analysis of 61 Articles. Cancer Epidemiology, Biomarkers & Prevention. Retrieved from https://cebp.aacrjournals.org/content/27/1/25

Danielle,

Thank you for sharing about your diagnosis and a bit about your journey with breast cancer; this is a perfect example of how emotional health impacts our placement on the continuum. Good discussion of each section of the assignment. This is one of the best submissions I have had for this assignment. See comments throughout for learning opportunities.

Geri

 

Believe

Believe

Believe. That one little word has always been a powerful and important one in my life. But it took on a whole new level the Monday before Christmas 2003, when I silently asked God if a little Jewish girl from Scottsdale, Arizona could suddenly start believing in Jesus and become a Christian, if it was OK and right for me to do this preposterous thing, how I might actually go about doing it, and most importantly, how I could ever tell my mother.

I was speeding down the I-10 freeway in Phoenix, heading home to the cute little South Scottsdale house my sister and I shared, lost in a thoughtful conversation in my head with God, or some Godlike version of myself. I looked up from my reverie and saw my answer emblazoned on the rear license plate of the car in front of me. BLEEV. Just believe.
OK, I thought. I will. I do. I’ll just believe.

Goosebumps peaked up the flesh on my arms and I took a deep breath, knowing that God himself had just spoken directly to me. That license plate felt like my own burning bush. And every time I have shared that story with a Christian, they get tears in their eyes or chills through their body, so dramatic and miraculous a testimony it is.

But I rarely share the story with the Jewish people in my life, or my nonreligious friends. It’s embarrassing, even heretical to my Jewish upbringing. And realistically, practically, objectively speaking – I know that the license on some random person’s car, which I happened to look up and see at just the moment I asked God what I should do, was a mere coincidence.

But. I have always believed that everything happens for a reason. That God is real. That there are no mere coincidences. That the things that come into our lives and consciousness and have meaning for us are not random, and are meant specifically for us, even if everyone else can see them too. That God is everywhere, and he can and does use signs and tiny miracles, even today in this seemingly un-miraculous time we live in.

There’s a lot more to the story. But I realized that today was the 17th anniversary of the day this happened, the Monday before Christmas, and just thought I’d share this little part of my story. Maybe someday I’ll get to the rest of the story!

The license plate in the picture is actually my license plate today. Mike ordered personalized plates for us both last year and was able to get BLEEEV. (Had to add an extra E since someone else already had BLEEV.) Maybe someone will look up at my license plate and feel a ray of sunshine, hope or inspiration, or get the answer to their question. Just believe. It’s usually a good answer.

Final Breaths and Other Small Things

Final Breaths and Other Small Things

His breaths had slowed to such an interval that by the time they stopped, I stood there for several minutes with my hand on his chest to be sure that it was no longer rising and falling.

I wasn’t entirely sure he really was gone until the nurse came in with her stethoscope and confirmed it. And even then, as I stood by his bedside a few minutes later and watched him, I kept thinking I could still see his chest rise ever so slightly.

Though I had previously sat with both family members and patients close to death, and had even had the strangely beautiful honor of bathing and caring for tiny babies who had died in utero when I worked in Labor and Delivery, this was the first time I had actually seen a person take his final breath, watched him cross over from life to death.

Being the one who stood by his bed in the moment he passed was a blessing and an honor to me.

His death was expected. He was on hospice and had been making the slow decline for months already.

I had only been caring for him for six weeks, laughing as he turned his nose at the pureed meals we tried to feed him and demanding instead a steak, a cheeseburger, a coke.

I couldn’t blame him. Those scoops of pureed food plopped on the plate were anything but appetizing. It seemed a cruel reality that in his final days he couldn’t enjoy his favorite foods, but he had no teeth and couldn’t chew or swallow well. He would aspirate if we tried to give him the foods he so desired.

Thankfully we were able to get him some soda. He would close his eyes and a smile would spread over his face as he sucked up a sip of ice-cold coke through the plastic straw we held in his mouth for him. I wondered what memories the spicy bubbly drink brought back for him.

Sometimes he would share bits and pieces of his life, and I could see glimpses of the man he once was, but it was like trying to imagine technicolor on a black and white drawing, or putting dialogue into a silent movie.

Laying there in that hospice-provided bed in his room in the long-term behavioral care facility I had been working in, I knew he was just a shell of the person he once was.

He could be taciturn and cranky these last few months as he declined. But I loved him anyway.

Even though he rarely wore more than a hospital gown anymore, he often asked me to check his armoire and count his clothes. I guess he wanted to make sure they were all still there. He wanted to wear his glasses and his watch, even though there was nothing much to see and he had nowhere to be.

Sometimes he called me Mama, and other times he told me I was a pretty girl and asked if I was married, praising me for my gentle care. Still other days he angrily swatted at me as I tried to change him or clean him up. He said he wanted to go home and demanded I call his parents. (I didn’t know his exact age, but I was fairly certain his parents were no longer alive.)

In the last few days leading up to his death, he was no longer drinking his Coke or Ensure. We would only moisten his mouth with those little pink swabs dipped in water. The nurses had alerted the hospice that he was in the active phase of dying. It would be a matter of days at most.

When I came in early that morning and checked in on him, I could hear the crackle in his breath, like there was liquid in his lungs – “the death rattle,” the nurse confirmed. He was close.

I asked her if he had any family who would come today. In the days of Coronavirus, imminent death is the only time patients can have visitors, even when they weren’t dying of Covid-19. But no one would come for him, she said.

“I guess we are his family then,” I said, my voice breaking just a little and tears forming in my eyes.

“Yes, I guess we are,” she said, smiling.

At that moment I decided it was my job to make sure he didn’t feel alone or afraid. And so, throughout the day, I peeked in on him frequently even though he was not one of my assigned patients.

I sang to him as I helped the other CNAs give him a final bed bath and change his linens and gown late in the morning. He was still breathing peacefully when they asked me to do a double shift, and I was happy to stay and be there with him, even though it would mean a 16-hour day and missing out on Friday night family time.

A few minutes into the afternoon shift, the nurse told me it would be anytime now, maybe only minutes, so I paused my rounds to stand by his bed and sing some more.

Aside from the hum of his roommate’s oxygen machine, his TV news reporting the latest Covid-19 stats and campaign briefings, and his light snoring on the other side of the curtain that separated their beds, along with various voices and noises from the hall as life went on out there, it was quiet and peaceful in that room. It was hard to even pinpoint the moment when he crossed over from life to death.

I saw him take a slow breath, then many moments passed before he took another. He was staring blankly toward the window, no longer squeezing my hand in recognition when I held it. He was slipping away. I said a quiet, neutral prayer and sang a few more songs.

There was no dramatic final breath. I just watched and waited for another rise and fall of his chest that never came.

After his death was confirmed, the nurse made the necessary calls and arrangements and we gently closed his eyelids and wedged towels under his chin to keep his mouth from gaping open. A few staff members came by to pay their respects.

I had other work to do, but I stopped into his room frequently over the next few hours until a van from the mortuary came to pick up his body. I was the one to answer the call from the front desk that someone was there to pick him up, then run over to the other side of the building where he had pulled up and direct him to the circular drive outside our unit instead.

Such simple, small tasks, but they seemed so important to me.

And then he was gone and his bed was empty. And I went about my day, taking care of all the other residents.

Serving then cleaning up dinner. Finishing the puzzle we had started in the day room earlier that week. Cleaning up messes. Diffusing anxious behaviors. Helping everyone to bed. Charting. Sitting for just a few minutes to visit with a resident and at the same time rest my tired feet. The hours passed quickly.

The next day after sleeping in following my double shift and emotionally draining experience the day before, I attended a virtual memorial service for a woman from my church who had also just passed away. She had been a missionary in Africa for many years – teaching a course called Mending the Soul to people who had endured trauma and abuse, before getting sick with metastatic breast cancer last year. I had only met her a handful of times, but had found her life and work so inspiring.

I had the privilege of visiting her at home a few weeks earlier as she battled her illness. I prepared a few simple meals for her while she rested in bed before my evening shift at the nursing home. I’m so glad I followed my instincts and said yes to the request to serve her, even though I was busy. I wanted to visit with her more that day, share our stories with one another, but she was very tired and I wanted to spend some time with my family before work, so we said we would do it another day. I was sad to hear that she died before I got the chance to visit again.

The memorial was a beautiful celebration of her life of service and love. And as I listened and watched from my comfy couch at home, contemplating her life, my patient’s life and my own life, I thought about how I’d like to be remembered when my time comes.

As I think is common in times like this, I felt both inspired and chagrined by the impact she had made on the people she touched. I felt like I’d only barely begun to make a dent on the great things I’d like to accomplish with my own life, and I wasn’t sure if I had made much of a difference so far.

But toward the end of the service, the speaker shared an African proverb which eased my anxious and constant pursuit to do big things and reminded me that what I was already doing every day was meaningful and important.

“Many small people, who in many small places, do many small things can alter the face of the world.”

I think this is a great reminder to us all to just be present where we are right now.

To do what we can even if it feels small.

To feel all the emotions and not try to numb them.

To love even the unlovable and to do the hard things.

To find and create acceptance, joy, delight and peace in the little things.

To take a breath when we are tired or overwhelmed.

To notice the beauty around us and then take another breath.

It was a reminder that the smallest things are sometimes the greatest things.

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