By Monica Botross
My first volunteer orientation day at the local hospice facility. I was a premed student eager to obtain clinical experience in the wake of a looming pandemic. What even is hospice? I assumed it would be filled with sick patients lying around in a dark, depressing facility waiting around for their moment of death – undoubtedly a welcome release from misery. No wonder I was so scared of what lay ahead. My fears would soon lay to rest.
My first day seeing a patient. I park my car outside the facility and begin the arduous process of donning full PPE. I cover myself, head to toe, in contact preventative protection cloth. My mask shield feels tight against my brows. I walk into the room and see a frail old man looking out the window in his hospital gown, his back towards me. His name is Ronald. The diagnosis: late-stage Alzheimer’s Disease. I wonder what he is thinking behind his blank stare and stoic composition. After several visits, I learned about his remarkable life. He was a mechanical engineer, a Vietnam war army general, and a dedicated husband and father. He always kept his curtains partially closed. Perhaps a metaphor for the concluding chapter of his story. I’m not sure.
Over our visits together, I keep finding an opportunity to connect, but between a Vietnam war veteran and a Middle Eastern immigrant in her early twenties, there was not much overlap. With no success, I walk out of the room with a heavy sigh. My supervisor walks towards me and utters, “Ronald? Have you tried playing cards with him?”
Running out of options for activities, I give it a shot. I obtain the dusty deck of cards from the bottom drawer of the living room cupboard and set up the table. As soon as Ronald catches a glimpse of the cards in my hands, his eyes immediately light up. He gives me a heartfelt, endearing smile. A smile that emanates pure, profound joy. I later inquire about Ronald’s reaction to seeing the deck of cards and the caregiver gives me the context I was searching for. She tells me how when Ronald’s daughter was little, he would play cards with her every night after she finished her homework. It was their favorite bonding activity, and his daughter, now an emergency department nurse, would visit the facility now and then to play cards with her dad like old times. These days she barely comes around due to pandemic precautions. I am hesitant to play cards with Ronald. I do not want to intrude on their special father-daughter bonding activity. At the insistence of his caregiver, however, I oblige. Now, Ronald rolls out his patient dining table at the mere sound of my entry.
Even sunny California gets a winter every few years. With that, an overwhelming gloom settles by residents’ rooms like a morning fog rolling on the beach. I see the sober faces of hospice patients eating their morning bowl of plain oatmeal while watching the trickling rain through a misty window. Their faces light up ever so slightly as the caretaker walks around pouring a few drops of maple syrup into each bowl. Ronald always asks for the most syrup. A mischievous smile follows every request. The caretaker cannot help but give in.
Ronald’s room is small but cozy. Warm beige walls, shelves of military memorabilia, and a small framed picture of him and his daughter when she was a teenager. It smells like a mix of hand sanitizer and strawberry jello, his favorite snack. His hands are large and masculine: wrinkled, yet strong. Remnants of past military adventures and rough hobbies. I later found out that he used to be an avid boxer.
Our games never make any coherent sense nor have any logical rules. His idea of playing goes something like this: snatching the deck from my hands, carefully and repeatedly shuffling the cards making sure that no two numbers were on top of each other, and distributing around ten cards to each of us as we took turns arbitrarily putting cards down. At a seemingly random point (random to me, though never to him) he excitedly proclaims that he won and that I lost. I almost never agree with his judgments, but the child-like joy on his face never fails to conquer my competitive nature.
I never could have anticipated just how quickly our connection could grow. Our bond is a peculiar one since it isn’t built on repeated meaningful conversations or a shared hobby. Yet despite our relationship being limited by neither of us fully understanding the other, we’re able to develop a bond that far supersedes anything I thought possible. I like to think that it’s a soul connection.
To the horror of the other residents, outbursts of anger and irritability become the norm for Ronald. The caregivers and nurses’ exhausted efforts lead them to turn to the only other member of the care team who may have luck in calming his mood. The process starts with an often frantic phone call asking me to come in to help soothe Ronald. As soon as I arrive, I walk to the living room and pull out the deck of cards. I run over to his room, smile, and place the cards in his hands as I pull up a chair close to his bed. Most of the time, the mere sight of the cards in my hands is enough to alleviate the fits of frustration. Other times, no amount of games can calm the storm.
Ronald is declining. He’s not the same since I first met him a few months ago. Our usual routine: I sit beside him and clap the deck of cards into his hand. That was his cue to start shuffling. He looks up at me, confused. He hands the cards back to my lap and looks out the window. Now I’m confused. “Does he not remember how to…no, surely he does.” I lay the cards down on the table at the start of every visit and eagerly await Ronald to miraculously remember how to shuffle. He never does. Exacerbation is a more likely course of progression than reversal.
It’s been six months since he stopped playing cards with me. I feel like I am back to day 1 with nothing to offer. No ace up my sleeve. I brace myself for whatever else of his peculiar, yet endearing mannerisms was now also at risk of becoming a distant memory. It doesn’t take long before our games become a shadow of what they once were. Before I know it, Ronald stops participating in our games. I distribute the cards to each of us, but he doesn’t even know what to do with them. Every startled and confused look on his face anytime I put a card down leaves me grieving a memory of the past. All we do now is sit across from one another with the empty playing table between us. Silence; except for the sound of him snacking on green grapes.
As I sit across from Ronald, I ponder whether our interactions are meaningless now that he doesn’t care for playing cards anymore. I now understand why there is often a hesitation to express vulnerability among healthcare workers. A certain amount of self-preservation and detachment is arguably necessary. At the same time, I do not regret playing cards with Ronald even though he likely does not remember much of our games. It is human connection that sustains us and imbues the work we do with meaning, however short-lived that connection is. It is what drives us to meet a fellow person’s suffering with compassion and seek to alleviate it, or at the very least share in it, if momentarily. This is what it means to be vulnerable; to willingly let oneself be open to hurt and pain. My bond with Ronald opened me to vulnerability.
After more than a year of shuffling cards and board games, war stories, and window panes, Ronald sighed his last breath on a cold mid-December morning. I was supposed to visit him later that afternoon to play our usual game of cards –at that point less of a game and more an act of looking at and holding what to him were probably nonsensical objects. In one moment, dozens of visits, card games, and conversations seemingly vanished. I never took any pictures with Ronald, and he never gifted me anything; the only tangible reminder that remained of him was the old dusty deck of cards that has become noticeably more worn out now compared to this time last year. Ronald’s grieving daughter also did not have many sentimental items left of her dad, so the facility decided to give her the cards. She did not know my role in caring for her dad until after his passing. “You must be the angel of cards! Thank you for giving Dad something to look forward to,” she tells me after the funeral, her face exuding something between a grateful smile and a sullen look. I get the sense that she is caught in between two emotions; joy that her father had something to look forward to in his dying days, and guilt over not being the person most there for him in those days. Her words ring in my ears every time I visualize Ronald’s priceless smile. How I wish to see that smile one more time.
Now every time I see cards, I am reminded of Ronald. The simple act of shuffling carries with it a strange range of emotions that I never once thought was possible for such a trivial act. When I look down at a joker card, I can hear Ronald erupting in his usual exaggerated laughter whenever either of us would put down this card. It is in this way that Ronald taught me that even the most insignificant objects and simple acts can carry profound significance when regarded in the light of loving connection. I have not been able to look at a deck of cards the same way since.
Monica is a second year medical student at the Burnett School of Medicine at Texas Christian University. In 2021, she graduated from the University of California, Irvine, with a Bachelor of Science in Neurobiology and a minor in Art History. In her spare time she enjoys writing, baking, and visiting local museums.