SABATTUS – As soon as she saw the woman’s face, Karen Flynn knew she had to cancel the rest of her appointments that day.

The woman was a new patient. Flynn, a nurse for Androscoggin Home Care & Hospice, arrived at the woman’s house at about noon to meet her for the first time. Flynn planned to spend about an hour.

That changed as soon as she saw the blue tint of the woman’s skin, the drawn-out look of her face, the limpness of her body.

The woman was in the process of dying. Her liver had stopped working. She was bleeding internally from every organ. Within hours, she would drown in her own blood. All of her organs would stop working, and blood would likely pour from her mouth.

“It’s like being an emergency room doctor after a big car crash. You have to be prepared for anything,” said Flynn, a hospice nurse since 1998.

Hospice patients generally have a prognosis of six months or less. But Flynn, 49, has learned that few things happen the way she expects.

Flynn had planned to talk to the woman about the other benefits of hospice: the health aides, the chaplain, the social worker, the volunteers. But by the time she arrived, the woman was not able to talk or move.

Flynn lifted her to a sitting position. Then she put a set of darker sheets on the bed so it would be less traumatic for the family once she started bleeding.

She called the woman’s doctor to get permission to increase her morphine. She called the family’s priest. Then she waited.

The woman died at 5 p.m. as the priest was blessing her body.

With other patients, Flynn gets more time.

She has been caring for Bob Morin since March 2003. Week after week, she visits him and his wife, Jackie, at their home in Sabattus to take his blood pressure, listen to his heart and lungs and ask about changes in his health.

During every visit, she makes a note in her file about another sign of Morin’s decline: “acute pain in his back and chest,” “napping every afternoon,” “breath sounds are very diminished.”

She rarely records progress, which is why Morin, who is dying of heart and pulmonary disease, has been able to remain on hospice even though he has outlived his original prognosis of six months.

“At this point, I’m kind of in denial that he’ll ever die,” Flynn said.

A tall woman with long hair and an athletic build, Flynn witnesses an average of 75 to 100 deaths a year.

Her belief that a person’s body gets weaker as their spirit gets stronger makes it easier for her to cope with each loss.

“Death is often a relief,” she said. “With many of our patients, we live the suffering.”

Flynn’s experience tells her that Morin will either have a heart attack and die suddenly or suffer congestive heart failure from the fluid in his lungs. If that happens, she said, he’ll probably have two or three days when he won’t be able to move or open his eyes.

Then, he’ll die.

Flynn will do what she can to be there. The Morins have already told her that she can bring her guitar and sing to them during their last hours together.

Grace Happens’

A nurse for 27 years, Flynn cannot imagine going back to work for a hospital. The back seat of her Subaru Outback is loaded with boxes of bandages, latex gloves, Depends undergarments and other supplies.

One of her bumper stickers reads, “Hospice Cares.” The other says, “Grace Happens.”

“It be would hard to go back to something that is lighter, hard to see someone as just a patient with a wound or heart disease,” she said. “Hospice is still based on having real relationships.”

Sitting around the Morins’ dining-room table, Flynn has heard stories about how Jackie and Bob met at a dance in 1948, how Bob gave up his dream of being a farmer because Jackie didn’t like watching him kill chickens, and how the couple used to take their six kids to Brunswick every Sunday for hot dogs.

Around that same table, surrounded by school portraits of the Morins’ grandchildren and laminated copies of their friends’ obituaries, Flynn has told the Morins about her own three children.

She has told them about her decision to deliver each of them at home, even though home births were considered taboo at the time. She has told them that she loves being a nurse but she would have become a doctor if it was more common for women in the 1970s.

And she has shared the story of the construction accident that left her husband paralyzed from the chest down.

A lot in common

When Flynn is having a bad day, she doesn’t talk about her life with her patients. She doesn’t want them to think she is looking for sympathy.

“But self-disclosure can be a good tool,” she said. “My husband and I have a lot in common with my patients: bowels, bladder, mobility issues, living a life that is uncertain, dealing with a sudden loss and the alteration of things.”

Flynn’s husband broke his back eight years ago, two weeks before the couple was scheduled to go on a kayaking trip.

Now, a nurse’s aide comes to their house in Bowdoin every morning to do the same daily grooming chores that Morin’s hospice aide does for him.

“I have found that the whole experience has made me a better nurse,” Flynn said. “I’m much more accepting of the fact that life doesn’t always give you what you want.”

Hugs

It took a few months before Morin felt comfortable telling Flynn about how much pain he was in and how hard it was for him to sleep.

But somehow, Morin said, she could always tell.

“Every time that I am in jail, she gets me out,” Morin said. “I do what she tells me. She knows.”

Flynn cannot prescribe or carry medication, but she has worked with Morin’s doctor to get him the right pills to ease his pain, his wheezing and his anxiety.

“Last week, everything hurt,” Morin told Flynn during a recent visit. “I was ready to die.”

Flynn leaned closer to him and placed her hand on top of his. Then she reminded him that he could take his anti-anxiety pills every six hours and he could take extra drops of his liquid morphine.

Morin listened, nodded his head, then placed his other hand on top of Flynn’s.

No matter how dizzy he feels or how limp his legs are, Morin never lets Flynn leave without getting up to give her a hug.

One morning, Flynn called the Morins from her office in Lewiston to schedule her next visit. Right before Morin hung up, he said quickly, “I love you.”

Flynn hung up the phone, put her hand on her chest and leaned back in the chair. Morin called back minutes later.

“Umm,” he said, shyly, “Sorry about that. We are just so used to saying that when we hang up the phone with our kids.”

Flynn assured Morin not to worry. The feeling was mutual.

“You can’t be a good hospice worker unless you fall in love with your patients,” Flynn believes. “You fall in love with them, knowing you are going to have to say goodbye.”

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