Buttermilk pie on a paper towel

My days routinely started by criss-crossing through the Metroplex to visit the terminally ill patients under my care. There were no cell phones then. There were beepers. Invariably right in the middle of a construction area, and no where near a pay phone the office would signal to provide an unwelcome update. In some of the areas that I entered, three out of four pay phones had been vandalized and were missing receivers, so even treating the beep as urgent meant a delay. Eventually I'd receive the news. Please visit Mr. X in the afternoon this time, or Mrs Y needs you now.  In that case I'd reverse directions hoping to reach Mrs Y in time, and before my beeper changed the days priority yet again.

One  particularly hot Texas day  there had been several urgent interruptions.  I'd left the house without breakfast, thinking I'd grab something quickly. That had never happened and now lunch had to be missed. Mr Z was bleeding.

I'd never met Mr. Z.  He was, I quickly flipped through my book, Martha's admission, and Martha was no doubt enjoying her much needed day off at a water park right now. I did recall what she had shared in staff meeting. He wanted to live his last days at home, but Mrs. Z was so afraid that she was threatening to hospitalise at "every little bump in the road".

As I turned the car around yet again and rushed to follow Mapsco to the crisis,
I wondered absently, What is 'a little bump' when your loved one is slowly dying? Uncontrolled coughing with tiny sips of water? Refusing a special meal? A leaking urinary catheter? Delirium? I was pretty sure that bleeding wouldn't be a small thing if I were Mrs. Z.

It was a 'rough' neighborhood. Meaning, the upper right corner of every page of Mr. Z's chart held this notation: Extra caution for night visits..2 nurses if possible. That's something  no nurse wants to see. Not at midnight, as you're preparing to leave on a emergency call, and not now, when the last thing you will need to be doing is counting medications to assure none have been stolen or sold on the black market for groceries.
At least they have a driveway I thought turning past a collection of neighborhood youths. Almost they looked alike with sleeves rolled up, arms crossed, and their angry, suspicious expressions. As I locked my car Mrs. Z threw open the door and motioned me inside. "He begged me not to call the ambulance until you got here."

Now there is bleeding you can manage easily, and bleeding that you can not. This looked grim. Mr Z's heart rate told me two things. We had a little time to try to manage the hemorrhage. Not long. A little. He was stressed. When he lifted the cloth away from his face to try to speak a thin stream of blood sprayed me. He gagged, spit into the rag and pressed it to his face again. The bleeding was deep from within his nasal airway. Evidently the cancer had invaded a small artery. Mrs Z sobbed and begged me to call an ambulance. I sat on the edge of his bed and took his hand. "Here's the truth, Mr Z, this is a dangerous bleed that might be stopped at the hospital by cautery. Do you understand?" He nodded. "Would you like me to arrange that?" Vehemently he shook his head and with his finger pointed he wanted to stay right here. Right at home.
"This is hard, but I have to ask, do you understand that if you don't go to the hospital we may not be able to stop the bleeding and that this could be the way, and the time?" He nodded, squeezed my hand and met my gaze. When he reached for his wife, she slumped into a chair grief stricken.

"Sit here." I encouraged her. "There are things we can try."

I found my way into their kitchen,  made a couple of ice packs from frozen peas placed in zip locks, and returned placing one across the bridge of his nose, and one across his throat. I took his pulse again. Still time. Vasoconstriction. Thats what I need. There was no nasal spray. Not in either medicine cabinet. I stepped onto the porch. Immediately the gang that had moved from sidewalk to yard was alert.

"I need someone's nasal spray. Strong nasal spray. Right now." Without hesitation three of the five young men procured some. "Take mine. It's.. better" one of them said. I thanked him and hurried back inside.

"The kids in your yard?" I said to Mrs Z, holding up the nasal spray I was given.
"My nephew and his friends." She answered, nodding. I tilted  Mr. Z's head back,  told him not to swallow until he had to, and proceeded to fill both nares with the spray. Then I prayed.

Later, there was time for teaching that bleeding is not painful. Time to prepare them for the next and probably last bleed. There was time for helping to clean away the blood, time for oral care, even time to crush ice as a comfort measure.

By the time I got to my car it was late enough that those loitering young men/deliquent/heroes would have been home from school, if they had attended school. I was dizzy with hunger. As I was backing out of the drive, Mrs Z dashed out, and handed me my breakfast and lunch on a paper towel. A slice of buttermilk pie I have never forgotten.