I think that I have found paradise. This morning I find myself high atop one of the mountains overlooking the main harbor town on the island.  I look westward to see the Sun shining over lush greens, and delicate blues. The clouds are everywhere, making my heart beat a little faster with each moment that passes.

 

I hear the bustle of the island seaport, and the hustle of those people that call it home alive in the town below. I feel the warm touch of the gentle trade winds, like the fingers of a beautiful woman running lovingly through my hair.  Perhaps it is these beautiful surroundings that has me waxing romantic, or maybe – and most likely – it is because I hiked up the trail too fast…

 

Yesterday I made it over to Cruz Bay, St John,  from the St Thomas airport without much difficulty. I bargained my way onto a crowded taxi that was headed to the Red Hook dock located on the far side of the island.  In this process I learned two things  (1) seat belts are a good idea around here, and (2) I surely have some things to learn about when it comes to negotiating my fare.

 

 

From  the dock it was a thirty minute cruise on the ferry across Pillsbury Sound. Once on board I was immediately hypnotized by the vibrant hum of the diesel engine powering the boat below. My attention was quickly transfixed on the hoard of school children who wildly danced around the boat on their way home from another day of learning. This vehicle certainly beat the giant yellow bus that I was accustomed to in grade school.

 

Soon I was carried beyond imagination as I looked around and experienced the grand views of these islands. I was awestruck watching the lush green mountain peaks breaching through the smooth surface of the pristine turquoise sea.  When we eventually arrived at the dock there were friendly faces waiting to greet those who disembarked.  There was even a spot to sample assorted rum drinks for the new arrivals.  This was a genius local tourism ploy.

 

Making my way through the wharfside village, I stepped into a dimly lit and smoke filled bar to get a beverage to celebrate my arrival. Then it happened. My first on-shore beverage was exactly what I needed; a “painkiller”. Made of sweet local dark rum, orange and pineapple juices, mixed with a kick of coconut syrup, and a touch of ground nutmeg – it was a formidable mix. My weapon of choice was now in hand, and I was ready to storm the island. It was time to invite the creature out.

 

Last night was my first night in port. I opted to stay in rented room at the local Westin Resort. Certainly it was a high priced affair; but it was only going to be a couple of nights before I would be settling into a several month commitment  designed to get back on track with my medical training.

 

I needed a good restful sleep, and I fortunately had the money and time to spend. The room turned out real nice with open air breezes through the louvers, and an unblocked view of the pool. There is lots of energy in this place – I can feel it deep in my chest.

 

After a refreshing swim in the warm ocean, another couple of “pain killers”, and  a taste of the wildest mahi I have ever eaten,  I retired for the night. I had to reset my circadian clock, after all I was now re-synchronizing from Irish time.

 

 

 

 

 

Today I started hiking at 7:00 am. Two hours into the national park hiking trails and I’m stoked. I take a deep breath and feel more alive than I have in months.  As I look down on this unfamiliar island that I will soon call home, I open both eyes outward.

 

I become aware of the wooden bench that I am sitting upon. It rests under an unusual four branched tree; certainly a non-native that was transplanted here sometime in the past. It shades my scalding skin, and whispers promises through its budding limbs.

 

The bench reminds me of the importance of taking the time for outward observation. Clearly there is much to be taken in, and in this landscape my eyes are drawn by forces other than my own.

 

I take a deep breath and turn both eyes inward… I begin to meditate on what lies ahead as I make my way over to Altamount Hospice tomorrow. I am scheduled to meet with the Simon brothers and the facility’s staff for dinner tomorrow evening. I feel pretty anxious, but something in their voices over the telephone, seemed very calm and welcoming.

 

In the meantime, tonight is the night to check out the downtown area, and see if I can’t network with some of the locals. From what I’ve seen so far, there appears to be a pretty young crowd around here, and a lot of New Englanders…  Based on what I saw coming of the boat, as long as I wear my trusty, worn in Red Sox hat, I should blend right in…

 

 

 

 

Notes on hospice :

 

I became aware of hospice at an early age. When I was eight years old my mother died. She lived for only a couple of weeks after after experiencing a devastating and totally debilitating stroke. Before she passed, my father brought her home from the hospital for her final days. She was a private person and hated hospitals. He knew that she would have wanted to be at home in the end. I have a hard time recalling all the details clearly, but I distinctly remember the nurse that came to the house.

 

I recall the hospice nurse projecting an alarming calmness – one of those really warm angelic types.  She would always be giving my silently uncomfortable mother medicine that would allow her to rest – and close both eyes. This personal care and thoughtful process  was certainly not something my dad had encountered in his death. His end was quick, unexpected, and fortunately without any suffering. The medical examiners report detailed that he had a massive heart attack resulting in sudden cardiac death.  I knew that he had past heart issues, but never fully knew the extent of his illness until after his death.

 

Given this gruesome family history, it is safe to assume that I should stay out of McDonald’s and lay off the Marlboro’s moving forward. This reality has also driven me to pursue my current path in career, and now to find meaning in this developing adventure.

 

Not wanting to appear as a completely naive medical student, I have jotted down some points of reference to help me get into the hospice mindset as I embark on this new experience. Fortunately there are some good websites that have allowed me to provide the synopsis below….

 

Hospice care is a philosophy and practice of medicine which accepts death as the final stage of life. It focuses its efforts on the palliation of symptoms that someone with a life limiting illness may face as they approach death. Symptoms can be physical, emotional, spiritual, or social in nature. The ultimate goal is to enable patients to continue an alert, pain-free life, and to manage other symptoms so that their last days may be spent with dignity and quality, surrounded by their loved ones.

 

It can be said that hospice care aims to affirm life, and does not hasten or postpone death. It treats the person rather than the disease that they live with. It focuses on the quality rather than length of life. It provides family-centered care and involves the patient and the family in making decisions.

 

Hospice care can be given in a number of settings. It can be provided in a private home, a hospital, nursing home, or private hospice facility. The majority of people who receive hospice care experience it in the home; with family members serving as the main hands-on primary caregiver.

 

Medical treatments that a patient may receive under the hospice benefit are based largely on individual cases. They may even include treatments that may be regarded as curative – like antibiotics, chemotherapy, and intravenous fluids – as long as the goal of these modalities is to improve quality of life and comfort.

 

The main caveat of hospice is that it traditionally is reserved for patients that are diagnosed with a life limiting illness, and are not expected to live longer than six months.  The typical illnesses that people face associated with hospice care are cancer and AIDS, though stroke, end stage heart, lung, and renal disease are diagnoses becoming increasingly utilized.

 

Many hospice organizations have their own inpatient facilities, where care can be  provided for the patients who cannot get it at home. These are often the patients with refractory and difficult to manage symptoms in the home environment, and/or in situations where there is limited care giving support at home. These facilities are run by specially trained staff that is versed in caring for the terminally ill.

 

Some patients believe that remaining in their home to die would be too difficult for the family, or feel a need for privacy in front of their family. Having care provided in a facility allows the family to remain “family” and not assume the role of “clinician and provider” at the bedside.  Some families have no problem providing the nursing care necessary, while others cannot bear the experience of their loved one’s decline and pain or suffering.

 

 

Hospice Foundation

 

Hospice Info

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

By way of Dublin, Ireland I find myself at thirty-five thousand feet above the Atlantic Ocean. Currently we are en route to Cyril E. King Airport on St. Thomas – United States Virgin Islands. It is just over nine and a half hours of flight time (and one short layover) until I am there.

I am deep into the process of developing a strong mistrust for airplane food. As graceful and calming as these flight attendants make themselves out to appear, I am fairly certain they are trying to kill us with these awful prefabricated meals.  I read that low air pressure and humidity can alter taste buds, though I am sure this is a deliberate attempt at misinformation that the airlines have created.  It is certain that the limited ability  to taste sweet and salty flavors at altitude is a clever and convenient myth concocted by some evil genius chef who works for American Airlines.

The wait for use of the bathroom is lengthening. The current line dwellers appear panicked and seem to be quickly growing more restless by the minute. Considering my recent meal, I am concerned that when the inevitable occurs and I need to hit the can, I’ll need to bypass the line… It certainly could get dramatic…

Other than the terrible Dakota Fanning movie playing overhead, the only things keeping my mind off the now deep and horrible sounds resonating from my bowels are the erratic clicks of my pressured typing, and the promise of where I am headed.

My current journey began two weeks ago. After a somewhat inebriated and heated conversation with a stranger took an inevitable turn for worse,  my fate quickly began to change.   I believe it was “lady luck’s” boyfriend that hit me square in the face outside of the Beggars Bush Pub in Dublin. Apparently I insisted on paying my ‘drunk tax’ right on the chin that night. After a well deserved uppercut found my seldom complimented jaw, I saw my chance amid the stars.

In an effort to slow the bleeding from some toothy area in my numbing mouth, a good Samaritan handed me a copy of the Irish Times newspaper. Now I was certainly not a doctor yet, but at the time it seemed like an appropriate pressure bandage.

Somewhere between the rhythmic throbs of a swelling gum line, I caught glimpse of bright red blood dripping onto the “Life and Culture” section. The expanding drops led to a report on a destination hospice retreat that is located in the Caribbean Islands.

As many of my recent late night explorations have led to searching for deeper meaning in the mundane, I stumbled back to my rented studio apartment. There I sat silently and tried to make sense of the article’s commentary amidst the now darkening blood.

The article I read detailed a unique volunteer opportunity geared towards medical students and clinical providers alike. It appealed to those interested in pursuing practical education and training at a palliative medical practice in a destination setting.  The upside for the volunteer was huge. Beyond the obvious amazing accommodations, it appeared to be a poignant and unparalleled immersion experience. I suppose it also seemed that they were looking for some good (cheap) help down there .

At first glance, I read the article as a help wanted ad promoting some upscale death boutique for the classy and unloved. But shit, there I was with a numb mouth, half a pint of Guinness on my shirt, and a fear of impending doom. A remote tropical island, some sense of direction, and a new chance at perspective on life – What did I have to lose?

The following day I emailed the contacts cited in the article from the Times. Peter and Andrew Simon were two brothers from Maryland, who are the physicians and co-medical directors of Altamount Hospice Inc. – USVI.  In the article they came across as truly passionate about what they’ve created.  It read as though they are really enthusiastic about teaching others what they do.

Serendipity revealed herself as our email thread grew. They had a spot open for a learner, and the post-doctoral psychologist from Chicago (who was supposed to be joining them) suddenly couldn’t make it.   After several more emails and a phone interview,   I said the right things.  I also had the audacity and means to get on a plane in a moment’s notice. The window was opened!

 

 

 

 

Next stop warm weather…

Now with this prospect, I feel as though there is charge coming back into my batteries. What about this notion that things happen for a reason? I mean hell, the bloody Irish Times, a newspaper that two months earlier ran my father’s obituary in it… I realize it’s a stretch, but I am chalking this coincidence up to being a good omen…

This sabbatical that I am floating towards among the clouds creates the perfect environment for a new and heightened anxiety.  Will I be able to handle it??? I am not sure. I haven’t really been open to acknowledging my fears lately. I haven’t even cried since my father passed. I guess this trip could grant me some way back into my life and future career, and hopefully back into my right mind.

One of my present fears is more about the culture in the islands. Clearly I had a hard time connecting with the good people of Ireland. My own blood – from a common ancestral home. How am I, an awkwardly nervous white boy, going to fare with a bunch of irie feelin’ natives?

From what I can appreciate by the virtue of Google, and an obsessive compulsion for detail, Altamount Hospice is situated on the Island of St. John, in the United States Virgin Islands. The facility appears to have been born from a subdivided estate originally owned and operated as a sugar plantation in the distant past.

On four acres of seaside land, it supports a reconditioned six bedroom villa, and four associated cottages. There is evidence on the website of a giant infinity pool, and of magnificent terraced gardens throughout the grounds. It appears to sit on a westward facing peninsula that invites the soft Caribbean Ocean tides and a blessed view of the sunset over the neighboring island of St Thomas.

According to a Wall Street Journal article that I found online, “since its inception in 2005, Altamount Hospice has provided expert and compassionate support and accommodation to those who desire an end of life experience in paradise…” The article went on to describe that the actual main villa as being “the first of its kind,” being designed by architects, palliative care physicians, and its clients to be purpose built for those transitioning out of this world.

Sounds classy… I suspect, in this era of open access care and increasing numbers of wealthy “for-profit” hospice facilities emerging, that this place doesn’t cater to those who define the masses of society. The clientele must already have enjoyed the collection of tangible treasures that wealth brings to a person.

As the sleep aid I took thirty minutes ago is beginning to kick in, I realize I’m out of whiskey. My typing is becoming errant, and I’m longing for the rum. I reach for the antacid in my pocket and press the call light…

The rest of the flight should be a breeze…

 

From time to time, in the challenging moments of intense self-reflection, people will look deeply into themselves. They search for evidence of those experiences that may have granted them hope in the past. We naturally scour over our memories, trying to identify and reconnect with those instincts that served to get us through tough times before. Perhaps these strategies, if summoned, could help us again…

Often if we are patient, we can remind ourselves of our personal capacity for these instincts; though other times, someone or something else does the reminding…

 

When my father unexpectedly died of a massive heart attack last year, my mind went blank, despair rolled in, and I surely needed  some reminding. I quickly found myself looking back upon my life for answers to questions that I had not yet built the courage to ask.

At the time of his death,  I was at the tail end of my second year of medical school. By all objective accounts I had been doing well for myself up until that point.  It was this event that triggered my own downward spiral.  The once manically wide-eyed, curious, and energetic version of myself quickly devolved into something much less ideal.  I started  turning inward, isolated, and angry. The world that I had created, full of promise and hope, was suddenly changing.  With my sense of purpose waning, and my illusion of control completely dissolved, I got scared. I was truly terrified.

My initial reaction was to take a temporary (and voluntary) leave of absence from my studies. This was in an attempt to regain mental composure.  During this hiatus, I moved into my father’s house 25 miles north of  Boston – on the North Shore.  It was a modest and appreciated inheritance that revealed itself after the execution of my father’s will.  Without siblings or a living mother, the keys, the deed, a life insurance check, and the remains of a home came sliding across the lawyer’s desk and into my trembling hands.

Within only a few months, this strategy seemed destined to fail… I couldn’t stomach it. Being “home” was nice and all; there was plenty of distraction to help with my anguish, but it just wasn’t the right place for my healing. I desperately needed to approximate the wounds of my now open heart, but my sutures were somewhere just out of reach.

It eventually got tough to breathe. Winter’s chilling winds and pervasive darkness made me want to jump head first into the ocean and keep swimming. I had to get out. I had to see things differently and challenge my mind. Say what you will about the delights of daytime television and cracking a cold beer on a Tuesday afternoon, but the brain that I had just spent two years and a hundred thousand dollars on was slowly beginning to rot, and I could smell it.

My static soul was out of oxygen, and I became desperate for inspiration. I followed my instincts and ran. In an attempt to get some fresh air, and to go looking for something that I knew certainly wasn’t in my past, I planned an extended trip to somewhere I had never been.  I set my sights on Ireland. It was an ancestral homeland that I had always intended to visit with my family, but never did. I thought perhaps my remedy would be found there.  It turned out eventually that I was partially right.

As a creative outlet and coping  mechanism, I have always kept track of my thoughts in writing. Being an only child growing up in a home where the parents didn’t subscribe to  television’s stimulating potential, I had to make quick friends with pen and paper. It was my only reasonable option. Every time I scratched some fleeting thought into one of my notebooks, my sense of isolation and anxiety would slowly diminish.  My imagination and concrete reflections would reliably provide all the company that I needed.

When I take the time to look back at my stories, reflections, rants, and raves  – I am usually amused, always interested, and occasionally horrified.Writing continues to be my preferred energy outlet and my personal vehicle to achieve balance. By journaling about my experiences, I have been able to document, look upon, and make sense of, that certain insanity that drove me from Boston, to where I am today.

Over the course of the eight months that I spent at Altamount Hospice in the U.S. Virgin Islands, I wrote with more purpose than ever before. It was here that I came to realize that this, once upon a time, mechanism for connecting to something outside of myself was now my strongest, and most reliable ally.  I have been able to capture some very important lessons that were granted there…

They were lessons of love, and of love lost…

They were lessons of the timeless and endless nature of this life…

They were the important lessons; but they were also not the easy ones…

I could not have imagined that what started in December 2007, as a grief and a chemically induced numbing of my senses, would lead to something so profound. It has lead me back to stable ground upon which I once again was able to regain my footing.  The experience allowed me to return to my studies with more purpose, inertia, and understanding than ever before .

 

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Heaven is eternal, earth everlasting.
They endure this way because they
Do not live for themselves.

In the same way, the wise person
Puts himself last,
And thereby finds himself first;

Holds himself outside,
And thereby remains at the center;

Abandons himself,
And thereby is fulfilled.

– Lao Tzu … Translated from the “Tao Te Ching”

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This blog  is a work of fiction. Names, characters, businesses, places, events and incidents are either the products of the author’s imagination or used in a fictitious manner. Any resemblance to actual persons, living or dead, or actual events is purely coincidental.

© 1 April  2016