Lessons in comfort

A student learns that for the dying, listening can be the best medicine.

Published May 4, 2007


Derek Robben spends much of his time in hospitals wearing a crisp white lab coat, learning how to fix people. Before April, the 33-year-old medical student from the University of South Florida had never treated a patient whose illness had no cure. He had never made a house call, never asked somebody how it felt to know they were going to die. He had never understood a patient better than he would get to know 75-year-old Lester Albury. Albury didn't look good on paper. When doctors referred him to LifePath Hospice two years ago, they gave him less than 12 months to live. On his drive to meet Albury for the first time, Robben pictured a fading man, bedridden from his end-stage lung disease. But when Robben pulled up to the little old house on Orleans Avenue, Albury was corralling his pit bulls in the yard with an oxygen tank slung around his shoulder. The tall man wore a cowboy hat, boots and a smile. And Robben realized he still had a lot to learn.

- - -

Albury led him through the house, past mounted animal heads and boar tusks, into a room with wilderness scenes sketched into the wood-paneled walls.

Inhalers and pill bottles cluttered the kitchen.

Already, he knew so much more about Albury than the patients he saw at hospitals.

That's the point of the month-long LifePath Hospice rotation for third-year USF medical students like Robben. They get personal with patients to soothe their physical, psychological and spiritual pain.

The two men settled down at a table, and for the next hour, Robben asked questions and Albury graciously answered, revealing images of a once-vibrant life.

"When they gave me all those breathing tests and I failed them, they said I had no oxygen in my blood, " Albury said, explaining his journey to hospice. Now he was taking 35 pills each day to control the pain symptoms of his breathing attacks.

How do you keep track of all those medications?

"Just cause I'm old and ugly don't mean I can't take them, " Albury told Robben. "I remember. I don't forget nothing."

He had lived here when Seminole Heights was surrounded by dirt roads and the Kmart behind his house was prime hog hunting ground. In his big yard, Albury raised dozens of dogs to help him hunt.

"Nobody had better hog dogs than I did, " Albury said.

But his disease weakened him, and he couldn't scoop their dog pens. He had to give them away. From 26 dogs, he was down to four.

He had to sell his ranch, too; he couldn't run it anymore.

His wife left him seven years ago, and he learned how to live alone. She returned this year, and doesn't let him fuss with the air conditioning. He missed her when she was gone. Now, he sometimes misses his independence.

He also recently lost his son to a car accident.

The man who used to hunt and farm now watches hours of television and falls asleep over his food.

"You've lost an awful lot since you've been sick, " Robben said.

"Everything I lost, " Albury told him, "was everything I loved."

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Hospice patients have a team of people who comfort them beyond their physical pain. A chaplain, nurse, doctor and social worker listen to them talk and console them, so that when the time comes, they die in peace.

Routinely, hospice allows students to be part of that team. Part of Robben's monthlong hospice rotation, apart from listening to Albury's heart and lungs, was to listen to him talk about his feelings.

It was great practice for Robben, who decided after a stint in the Air Force that he wanted to be a doctor, and recently realized he wants to specialize in geriatric psychiatry.

"I really do appreciate you letting me into your home and being open with me, " he told Albury.

"I just get awful nervous, and I shake inside, " Albury said. His deep-set blue eyes began to water. "If I wake up at night, I think about things I used to do in my 20s."

Some things still make his life worth living, like his hunting buddy Charlie, who comes over and drinks coffee every morning.

"I would hate to leave all my friends, " Albury said.

Robben asked Albury how he felt about dying.

"We've got to go some time, " he said. "If it wasn't for hospice, I don't know whether I'd still be here."

On his second visit, Robben noticed his patient was more tired than before. He was having trouble staying awake and focused.

At one point, Albury stood up and started walking around, looking for something.

Robben noticed Albury's shoes were untied. "You want me to tie your shoelaces for you?"

"No, that's all right, " Albury answered.

"I don't want you to take a spill..."

Albury grew frustrated - he couldn't remember what he was looking for.

"I do that, too" Robben said to console him.

Albury sat down and tied his own shoes.

After he put on his oxygen tank, Albury was back to his old self. He wanted to show Robben his yard, and his dog who just had puppies.

The visit ended under a tree, with a hug and some advice to the young medical student.

"Treat people well, " Albury told him. "Don't give 'em no hard time. Just tell them the truth, and they won't hurt as bad."

"Thanks for the advice, " Robben said. "I appreciate it."

- - -

The other seven students in Robben's class also completed two home visits with hospice patients. Last week, they gathered in a conference room and shared their reactions.

Jason Wilson, 28, was amazed at how ordinary life carried on outside his patient's home. A woman next door watered plants on her patio. A cable guy installed lines high on a pole. And his patient was dying.

Heather Carpenter, 28, was surprised by how young and healthy her patient looked. "He could be anyone's dad, " she said.

Waldo Guerrero, 25, came to see death as a process, not a sudden scary thing, but something that could be accepted.

"Death doesn't have to occur at a hospital, " Guerrero said. "It doesn't have to occur alone."

Robben spoke about Albury, and the lessons he learned:

That dying people have many different looks.

That a terminal diagnosis doesn't mean there is nothing more he could do for a patient.

That he could still make people feel better, even if he can't fix them.

Alexandra Zayas can be reached at (813) 226-3354 or azayas@sptimes.com.

"Treat people well. Don't give 'em no hard time. Just tell them the truth, and they won't hurt as bad."

Lester Albury