APPALACHIA IN ORANGE COUNTY

In my part-time work as a hospice nurse I’m often sent to see patients I know little about. I view it as an adventure and also as an opportunity to put the pieces of a puzzle together. One day in early summer, I was sent to see an elderly lady in Orange County, California, who was dying of end stage dementia. The only information I was given was her name, address, and telephone number. I looked it up on my street map since it was in the days prior to GPS, and made my way there. I turned into an ordinary working class neighborhood of one story ranch style California homes, located the street and found the house number on the mail box at the curb.


This particular house sat at the end of a long driveway and was obscured from view by many fruit trees and tall weeds in the front yard. I retrieved my medical bag and notebook and started down the drive. Lined along one side were several junk cars that seemed to be slowly rusting into the ground. The house came into view and seated in a rocking chair on the front porch was a very fat, old, toothless man smoking a pipe. He smiled at me as I walked up and told me to “just go right on in the house”.

I opened the door and stepped inside. I’d only taken a couple of steps when I had to stop, not sure whether what I was seeing was real or a hallucination. The house was dark, dirty, and dreary. What were formerly drapes now hung at the windows in shreds that resembled ropes. To block out the light, someone had taped big pieces of cardboard to the windows, and old sofas lined the walls of the living room. Once my eyes adjusted to the dim light, I realized there were bodies covered with blankets lying on the sofas. Various bodily noises were frequently being emitted from these lumps under the covers, the odor in the house attested to the origin of the noises.

Trash, newspapers, and junk were piled everywhere. I wondered where I would find my patient in all of this, then finally located her lying in a hospital bed in what would have been the dining room of the home. She was clean and her clothing and bed linens were clean as well, much to my surprise and relief. I took a disposable plastic barrier from my bag and placed it on top of a stack of newspapers so I had a sanitary place to put my bag and notebook. I was getting ready to examine the patient when I heard footsteps coming down the hall. Expecting to greet the patient’s son, I was dismayed to find myself face to face with a man wearing only a towel. He’d apparently just come from the shower. When I inquired if he was the son, he said no, and shouted out the son’s name.

Soon, Billy appeared. He was a younger version of the elderly man on the porch. Billy wore overalls that were filthy, and he didn’t have a shirt, so I was treated to the sight of major chest hair and pretty foul body odor.

Billy greeted me with great enthusiasm and said he was just about to get his mom up to the commode by her bed and then I could do my exam. He lifted the lid of the commode, and I was again dismayed to see it was filled almost to the brim with bodily waste. Apparently it was the real source of the odor in the house. Billy explained without apology that the toilet wasn’t working so he couldn’t empty the contents of the commode. I didn’t bother to ask what the rest of the residents of the house did when they needed to use the toilet.

I finished my exam, checked the patient’s medications, and gave him some more supplies to help him care for his mother. I stood up to write my nursing notes as I balanced them on the patient’s chart, as there wasn’t a clean place to sit. I exited the house as soon as I could.

Billy met me outside with a paper bag. He thanked me for the visit and told me there were homegrown tomatoes in the bag. I thanked him for the gift and said homegrown tomatoes were one of my very favorite things, and I took them to my car. Once home I scrubbed them with soap and water and laid them on paper towels in the kitchen to dry. That’s where they stayed until my husband decided to eat them, telling me I was being silly not wanting to touch them. I couldn’t bring myself to take even one bite, and still wonder what kind of fertilizer grew such beautiful tomatoes.