Hallway to Heaven: life’s final steps at an in-home hospice

(Cecilia Ruiz)

Maria and Manuel had shrunk. As bodies usually do, theirs diminished with the passing years. Maria stood rod straight, just smaller, while Manuel stooped, first over a cane, then a walker. His once-tall frame was pulled down by gravity stronger than his spine. The only evidence of his previous height could be seen when he was stretched out in his blue recliner, as he frequently was. There he relaxed and napped, especially during soap operas, his daytime sleeping pill.

My entry point into the lives of this endearing couple was as Manuel’s in-home hospice nurse. When Manuel became my patient, Maria had been his bride for over 50 years, and they had just celebrated her 80th birthday. Even though she was almost twice my age, I would get breathless watching her as I sat on their sofa finishing my paperwork. Manuel dozed on and off all day, but Maria puttered around the tiny house without a break. Dust bunnies feared her. Weeds avoided her flowerbeds. Throughout her chores, Maria sang the refrain, “We do not need to go to a nursing home.”


Manuel knew the “we” in her song was really him and loved her even more. The idea of a nursing home didn’t frighten him, but he told anyone who would listen that he felt blessed to be cared for so well and so enthusiastically by his wife. As long as the house was perfect, she could proclaim no one could care for him like she did. He, however, admitted readily that he needed care as much as she needed to provide it.

Her self-imposed workload would have sapped anyone’s strength. She managed to hide the signs of fatigue well from others, if not from him. Manuel knew her face much better than the one he glanced at in the mirror while shaving. He could measure the toll his care was taking on her by the shadows beneath her eyes and the slightly watered down smile she gave.

Manuel did not like to see how tired his little Maria was, but otherwise it wasn’t so bad getting old, even dying. He had always felt he was a simple man, and what could be simpler than this? He certainly hadn’t expected to live on this earth forever. When he was healthy, he had gone to Mass every Sunday and would have remembered if the priest had mentioned eternity on earth as an option. He believed in God and thought that God returned the favor. Death was just the next part of life. He talked sometimes about what he had done with his life and always said he wouldn’t really change it. He mentioned heaven sometimes, too, but always said he would just have to wait until he got there to check it out. The only thing Manuel feared was the next step, the literal next step.

The Enemy Within

When his walking became tottering, resembling the gait of their newest great-grandchild, Manuel accepted a cane. Other grandfathers had them, and at first it seemed more of an accessory than a necessity. Walking down the hall between the bathroom or bedroom and living room with a cane in one hand and the wall on the other side was comfortable for a while. Then one day his knees gave way, and there was just nothing in the hallway to hold onto. Clawing at air, he went down. It happened in a split second that lasted forever. Manuel anticipated the crunch of his bones breaking, as he heard Maria scream. As suddenly as it had started, the downward momentum stopped. He heard the thud of his body hitting the floor. He felt only carpet and gratitude. Looking up into Maria’s fear, his heart pounding, he managed to say, “I’m okay.”

Maria called hospice for help, not 911. Paramedics had ambulances that could snatch people away from their homes. Hospice didn’t. One of the evening nurses checked Manuel out and determined he had been humbled but not seriously injured. The next day when I was back on duty, I stopped in for a visit. Reassuring Maria was at the top on my list, closely followed by ordering a walker for Manuel. With his pride and his joints still aching from the fall, he gladly traded the cane for a walker. Like the cane, it sufficed for a while.

All too soon, however, pulling his weight up from the recliner to his walker became like lifting another man along with himself. It had once been feather light to give two or three of the kids a piggyback ride at the same time. Now, even though he was a fraction of his former weight according to the scales, pulling that weight from the recliner to the walker was like pulling a truck forward with the emergency brake on. Grabbing the walker, he would heave forward, only to fall back into the recliner a few times in failed attempts. While he tried, Maria would be tugging on whatever part of him she could reach, saying, “You’ve got to get up Manuel. I can’t do this for you.”

He couldn’t recall Maria saying those words about anything else. She never said she couldn’t do anything. With strength he didn’t know he still had, he would once again stand up.

“Manuel,” I asked on one of those rare occasions when Maria was not hovering nearby. “What was more frightening? Fighting in the South Pacific during World War II or walking down your hallway from the bedroom this morning?”

Without hesitation, he answered. “This hallway, no doubt about it. You see, in war the enemy is out there,” he said, waving a gnarled finger around in the air. “Now, the enemy is in here.”

He was patting his chest with his hand, his meaning clear. The enemy was age and cancer and weakness. There was no reprieve from any of them. Like a soldier, he struggled to drag one foot in front of the other, the enemy within more deadly than any threat posed by a foreign power. He had to keep walking. Maria needed him to do it. The fear of placement in a nursing home, the loss of their perceived independence was everything to her, as it is to most of us. Manuel was past that. His courage was born of love for her.

The day the enemy claimed Manuel’s ability to walk, I wrapped Maria in my arms, while I ordered a hospital bed and requested around-the-clock hospice staff. Then I told them both what I always tell patients and families. As the body gets weaker, the spirit gets stronger. Manuel proved this theory by letting go. He did not want to burden his Maria.

Down the Hall

The funeral was simple, just like the man it celebrated. Mass was held in the church he and Maria had attended for years. The pews were filled to capacity with family and friends, the crowd resembling that of an Easter Mass rather than the funeral of an octogenarian. After Mass, invited by the family, I returned back home with them. Even with the large family filling every space, the small house felt empty without Manuel. In spite of the limited standing room and lack of seating, his blue recliner went unclaimed.

As we ate and talked and talked and ate, the mood lifted. Everyone had a favorite story to tell about Manuel. While we laughed and sometimes cried over the stories, one of the youngest great-grandsons demanded attention. Grabbing first one adult’s sleeve, then another, he persisted in his attempt to be heard.

“I just saw Grandpa Manuel,” he said to anyone who would listen.

“Yes, we saw him at the funeral,” or “Sure, honey,” was the repeated and condescending reply.

Not easily silenced, he continued to try to get the attention of the adults, tugging on anyone within reach. At last he caused enough disruption to stop the conversation. Unwilling to discipline a child after his great-grandfather’s funeral, his mother simply said, “What is it?”

Looking up at each of the grown-ups, verifying he had our undivided attention, he pointed one little finger down the hall Manuel had bravely navigated so many times in the past year. Then he said, “I just saw Grandpa Manuel in his bedroom, only a minute ago. And he can walk all by himself! And he’s smiling!”

No more canes. No more walkers. No more suffering. Manuel was simply walking in heaven, and smiling.

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William Rydberg
3 years 4 months ago
It's sad when a daily communicant has to miss out on Eucharist due to being unable to attend their local Parish. I sometimes imagine all the good that stay-at-home Catholics could do as extraordinary Eucharistic ministers to their brother and sister Catholics. For Eucharist is the par excellence way to encounter the person of Jesus-God come in the flesh. Here in Canada there are Community Care Access Centres that are providing a lot of help and direction in support of those in need. Our provincial government is serious about this issue. As Ontarians want access to home care so that they can recuperate or spend their last days surrounded by loved ones in a setting that is familiar to them. Let's pray that articles such as this one spurs us to more discussion and action on both sides of the border and in each particular Church, because we human beings are all composites, body AND soul... Thanks Linda so much for sharing, in Christ,
ed gleason
3 years 4 months ago
My wife and I, in early eighties and she with Alzheimer's for 4 years are helping to organize a support group for Alz. couples who want to avoid a placement in a nursing home.' . Beside the fact that the 'home' is beyond almost every income bracket, staying put where they live is the universal wish. The author gets the fact that it's a spiritual journey.to slowly fade. And watching the care giving spouse and the fading one slowly growing into better caring people is the blessing that makes us accompaning each other a blessing. The support group started just meeting weekly,as social friendly inter-action,with museums ,parks etc. and stopping for coffee at the end. 'We finally realized it was the long lunch together is what keeps us going and involved. Walks and events seemed contrived and hard for some.;so we now think the long lunch together is the best and fits all the eight couples. Watching how the others cope is worth more then any educational program can provide... Willaim R. is right the oldsters need more discussion and ACTION and show the spiritual flag to a culture that fears the end times. . . .
Winifred Holloway
3 years 3 months ago
This is a beautiful essay, Linda. Beautiful, because true. I am a retired nurse and now a Hospice volunteer and I see these saints frequently, ordiinary people, so I call them the saints of ordinary time. None will be canonized, but I think all of us know who they are when we encounter them. Every one of them reflects the face of God. Manuel doesn't want to burden his wife, but his wife wants to support and care for him until his final day. Love is the basis of the Law. Bless all those who do God's work in the world.
Richard Currie
3 years 3 months ago
The "youngest great-grandson" is gifted with an innocent, trusting faith we all can but aspire to. His vision was not his imagination; multiple people attest to hearing my mother standing outside the church after her funeral laughing with her inimitable laugh. I have read of other examples of this. Manuel was telling those mourning to go and laugh with the funny stories of his life because he was "ok"; he too was laughing -- in eternal joy in heaven! What a beautiful memorial story of a very blessed couple! Thank you for sharing, Linda.


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