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I met Amanda by chance in a lovely local tearoom. There was no aura, no magical vibes, but I was drawn to her. I struck up a conversation. In moments I realized that my instincts had scored. She was indeed a person worth the investment of time and attention.

Amanda is a nurse with a BS and a few years’ experience at a very prestigious hospital. She sees herself and other nurses as important links in the patient’s medical circle. At the center is the patient. Then there are doctors, technologists and diverse specialists who diagnose and treat disease and manage pain. Ideally family members and friends play important supporting roles. Sometimes others, such as chaplains and social workers, form part of the circle. And then there are the nurses. They connect all the others together, closing gaps between personnel, services and the patient.

Most recently Amanda’s work has focused on the care of patients whose time is limited: the terminally ill. By the time they come to Amanda, most have only one or two weeks left to live. Sometimes called late-stage hospice, Amanda referred to her work as comfort care.

Comfort care. An intriguing term. Not “death watch” or “terminal care.” I needed to learn more.

I am not a nurse. I’m not even certain how my kids survived the bumps, bruises and scrapes of childhood. Given the choice, I would gladly pass out at the sight of blood rather than deal with cuts, stitches and broken bones. I may be the only person of my acquaintance who has never even wanted to be a candy-striper.

Yet those words, comfort care, struck such a chord. This professional woman routinely dealt with the dying and their families. Yet she did not sound like a person discussing a routine. Her eyes lit up with a passion I have rarely seen. And she wanted to talk about her life as a nurse.

So we did.

I told her about my mother’s recent death, about my growing fear of hospitals after a recent stay, about the jim-jams I felt every time I watched a TV program focused on healthcare. How could she be a nurse? How did she view patients and their families? What did “healing” mean to her? When traditional healing was not possible, where did she find energy and hope?

I wish you could have been there. Let me share what she said.

First, healing is both a science and an art. Science stands out in the medicines themselves and in the prescribed treatments. They are essential to patient care. But the rest of the healing, and sometimes the only healing possible, has to do with the way medical care is offered. Amanda pointed out that Florence Nightingale, that nursing pioneer, spoke about the art of nursing. After all, there is no one set way to care for a person. So a nurse might be called upon to offer a variety of services that promote, or at least respect, the patient’s life. In fact the word, “nurse,” has its roots in the same words as nurture, nutrition, nourish. Just as nurturance can take many forms, so can nursing. Amanda pointed out that doctors, as diagnosticians and specialists, work in partnership with the nurses who carry out the next steps in healing, whether that be through administering medications, holding a patient’s hand during a lumbar puncture, or sitting and listening to the person talk. It is an art that requires knowledge, insight, sensitivity and discipline. It also requires personal balance. But according to Amanda, the caring is key. That is what people respond to whether the procedures result in physical health or not.

If a disease can present itself through various symptoms, so can the art of nursing. Caring is at the heart of this art. For Amanda, making her patients laugh—or at least smile—is a goal. It shows that she cares enough to kindle some sparkle of joy into a patient’s flickering life, even though she knows that the experience will not change the ultimate outcome. The patient is going to die. “But if for two seconds I can help a person forget that they are lying in that bed, then I’m doing my job for that day.” And sometimes that’s the best and only thing a nurse can do—invite the patient to engage in his or her remaining existence as much as possible. “So often patients want healing, but don’t feel helped. Medical staff can become so busy. Doctors in particular have an unbelievable load to carry. So it is often up to the nurses to extend healing through quiet support, listening, laughter. Just being in a room with someone and truly feeling care for them can bring a degree of healing. Silence, itself, can provide comfort if it comes from a caring heart.” This kind of healing brings peace, even if the body cannot be made whole.

Touch is also important. Especially in the midst of suffering, the patient can feel increasingly isolated and fearful. It can be terrifying to realize that two people separately by mere inches of physical space can be worlds apart in terms of pain. Nurses can help. They have to ask before brushing a cheek or holding a hand. But such gentle contacts forge connections. The patient is no longer isolated. Fear and pain haven’t disappeared, but now the sufferer has companionship in the midst of them. Companionship offers comfort. Solidarity binds nurse and patient together for a brief time. According to Amanda, it changes them both for the better.

What about the family? Families need comfort care, too. The patient may have come to terms with the ending, while the family is still fighting for a life that is going to end. The best, most healing situations are those in which the family can accept the coming loss. Then they can spend their time and energy being present to the loved one. Instead of squandering remaining days or hours, the family can offer company, a loving touch, a word of care, permission to let go and move on. When families become reconciled to the approaching loss, when they take that precious time to express and share love and support, then the real healing takes place. In those moments, Amanda said, death is truly beautiful.

Death is beautiful? How can that be? Amanda corrected herself. It isn’t that death, itself, is beautiful. It’s that love changes how we see death. That’s the beautiful part.

Could she give me an example? I was struggling here! She could.

Recently Amanda cared for a woman struck down by an aneurism that virtually destroyed her brain. The woman was in her prime, but her life was coming to an end. She couldn’t communicate. Her body couldn’t perform even the most basic functions on its own. Her twenty-something daughter had to make the devastating decision whether or not to sustain her mother on machines. The daughter had the legal and ethical responsibility for making a decision her mother could no longer make. She had the authority. Where would she find the courage? Fortunately she was not alone. She and her mother had the loving support of friends and family. Those who could came to the hospital; those who couldn’t sent cards, e-mails, and stuffed animals. The daughter had a special affinity for monkeys—what she called her “rally monkeys.” The room was flooded with them: hundreds of them! Surrounded by care, the daughter was able to care for her mother by allowing her to die. No one was physically cured. Everyone was healed. “I experienced such solidarity and strength! The family came in—they all knew the patient was going to die. But it wasn’t depressing, even though it was sad. There was so much love in that room. It changed me, even though I was not even connected except as a nurse. Yet I felt like I got to know a person I had never heard speak, never seen doing the things she loved. It was a privilege, and it changed me.”

”It is also a privilege to be there for the family—to listen to them, to be with them. It is so special. When a person dies, we bathe them and if the family wishes to be present and to help, we let them. It makes death personal. It’s one last thing that can be done for the loved one. And I get to be a part of that. I get to be a witness to the final acts of love. It is interesting to see how people care for each other at that time, even if it is your parent, or someone very old. I love sitting with the spouse and listening to them talk about their wedding, their children, their adventures together.” Does anyone ever seem disgusted or “creeped out” in those moments? “Those who choose to be part of these last gestures only show tenderness and love. The others choose to walk away.” And that’s OK, Amanda points out. Some people simply cannot do otherwise. “At least they know that nurses will treat the deceased with dignity.”

She continued, “So many people build death up to be so awful, so horrible, a kind of monster—which it isn’t. We know death is inevitable. But some people think it is the worst thing in the whole world—dramatic, disgusting and unnecessary. But I don’t see it that way, even though I see death regularly as part of my living. In my work I never see people in the peak of their health. I see them when they are past all that. Usually they have also gone beyond their most intense fears, and arrived at some level of acceptance. Those last days, the final breath—all that should be celebrated. This person lived. This person made an impact—even on me, the last attending nurse. This person lived up until the moment of death. How wonderful is that?! ”

I had to ask: Then what? Is there something after that final breath, the last good-bye?

Amanda smiled. “I’m not being scientific here. I can only tell you what I think. I believe there is something coming next. When a person dies you can see the person leaving the body—it is so clear when only the body is left. Some of the changes are immediate, like the draining of all color. At this point I can usually tell when a patient is within the last twenty-four hours of life. But I just can’t believe that there’s nothing else. The more I do this kind of work, the more I feel that way. I guess people can make of it what they want—but I believe there is more to it than just this life.”

I looked up at the clock. Amanda had given me more than an hour of her precious time. She needed to leave and so did I. So I asked: Could she offer just some brief words of wisdom? She smiled and said, “Yes, I have something to say. First, let go of the fear. Don’t be afraid of death. It’s part of life. Don’t be afraid of letting your loved one go. That is only a futile attempt to protect yourself. And you can’t. You can’t protect yourself or anyone else from feelings or from death. It will be sad for you. But in the end it is not hard for the person who passes. When you love someone, you face reality with them and help by being there. It’s like stepping aside, holding the door open, and letting them walk through first.”

It sounds a lot like common courtesy. Amanda calls it comfort care. I like that. Thank-you, Amanda. Thanks to everyone who practices the science, and art, of nursing.

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