Sarah and I knock on the door of a somewhat dilapidated house in a rugged part of Fortuna. There’s no answer.

“There’s a pool table in the front room,” Sarah reports, looking through the glass pane in the front door.

“Nice!” I retort. Here’s a person with recreation as a priority, I think to myself.

I ring. We wait.

“Call him,” Sarah recommends. She looks up the number in the electronic medical record. I dial. Tom, our patient, answers eventually. I put him on speakerphone.

“Hello, this is Carl, the spiritual support counselor with ResolutionCare. I’m here with Sarah, the community health worker. She made an appointment to see you this morning at ten-thirty?”

“I don’t want to see anyone. I don’t feel well,” the gruff voice responds. “Who are you anyway?”

Truck painting

Painting by Nancy Poucher

“We’re from Dr. Fratkin’s office,” I reply. “We want to see how you are and how we might help…”

“I don’t wanna see nobody,” Tom replies.

“Could we come back at a better time?” I ask.

Sarah shakes her head. “I need to see him now,” she whispers, putting her hand out for the phone.

I hand her the phone, but Tom has hung up.

We walk off of the property, down the gravel drive. I feel that I’ve let Sarah down. It’s my second day on the job, and there’s a lot to adjust to, coming from a highly regimented hospice venture in a very wealthy part of California. ResolutionCare is an innovative, new format of in-home palliative health care, and Humboldt County is rural, less affluent, and much more unpredictable than what I’ve been used to.

Just as we arrive at Sarah’s car, a brown pickup truck pulls up next to us. The driver, an older lady with white hair pulled back hastily in a ponytail, leans out of the open window. She is wearing cat-eye glasses, and is all business.

“Who are you?” she asks, peremptorily.

She’s facing southbound in the northbound lane of this little road. Sarah turns her hair behind her left ear and smiles.

“We’re just looking for an address,” she says calmly. “1837?”

“That’s my address,” the woman says. “It’s that run-down house next door.”

“We’re looking for … Tom …” Sarah says, revealing as little confidential patient information as possible, mindful of the Health Insurance Portability and Accountability Act’s patient privacy provisos.

“That’s my son,” the woman says. Instantly, she turns from hostile to vulnerable. Mimicking Sarah’s gesture, she pushes a strand of silver hair behind her ear with a trembling hand. Silver hair or not, she looks too young to have a son who is dying, and the death of one’s child at any age is a hard grief to bear.

“There was a robbery at this house,” she says, nodding towards the white clapboard where Sarah and I have been knocking. “He’s a musician who records other musicians, and all his electronic equipment was stolen. That’s why I was asking who you were.”

“We’re from ResolutionCare,” Sarah says. “Dr. Fratkin’s office. We are looking for Tom. I made an appointment for ten-thirty?”

“Oh, I need all the help I can get,” says the woman in the truck. “I’ve looked after my father when he died, and my mother, and my husban’ …   Seems like I’m always the one looking after someone when they die …”

Truck painting

Painting by Nancy Poucher

Again her hand shakes as she tries to soothe her hair.   Her eyes are shiny with unshed grief.

“You’re the one they turn to at the end,” I say. “You’re the one they know they can count on; a safe haven.”

“I guess so,” she says. “But I don’t know what to do with him. He can’t hardly breathe, and all he does is just curse every time he does get his breath. He just says the F-word over and over …” She looks at Sarah imploringly.

Sarah steps forward and puts her hand on the woman’s denim covered forearm where it rests on the windowsill of the still running truck. “Can we see him?” she asks. She’s such a kind-hearted and capable person, I just wish everyone who finds themselves facing a life-limiting illness could meet her and experience her care. I haven’t worked with a community health worker before, but Sarah is making a believer out of me.

The woman shakes her head, as though to dispel the tears standing in her light blue eyes.

“I don’t know,” she says. “He don’t want to see anyone. He don’t want no help.”

“What’s your name?” Sarah asks. “I’m Sarah and this is Carl.”

“Emily,” the woman says. “Let me get out of this traffic. I’ll go back there and see if he’ll see you.”

She pulls the truck onto the gravel shoulder and does a tight U-turn, hauling the big wheel around on this pre-power steering behemoth. Emily heads back to her house, where she turns into the driveway. Sarah and I follow on foot.

We walk halfway up the drive behind the brown truck. Emily has gone inside. Several minutes pass as we wait on the driveway, next to the chain link fence. The old house is a small two story, with shingles on the exterior walls in several shades of color from previous paint jobs.

Suddenly, a tiny dachshund comes out the front door and approaches the chain link gate where Sarah and I are waiting. It gives a few vigorous yaps and then subsides. Emily appears.

“He won’t see you,” she says. “He looked out the window and thought you was some kind of Jehovah’s Witness.”

Sarah is an athletic blonde who likes to surf and scuba dive. Her hair is bleached by the sun in golden streaks. I am darker-skinned, showing my African-American father’s genes, with a grey beard and eyeglasses. We are both on the casual side of professionally dressed, which is close to formal wear in this part of Fortuna. Together, I can see how we might look like Witnesses, but we are evangelists of a different sort, proclaiming a gospel of “quality of life” in the face of life-limiting illness.

“How is he doing?” asks Sarah, her natural community health worker tendency coming out. Community health workers are generalists, helping people to find resources, get to appointments, or manage their medications, as well as providing body care and a listening ear.

“He’s worse,” says Emily, leaning on the gate. The dog is still at her feet. “His lungs sound terrible. He can’t hardly breathe, but he won’t take help from anyone.”

“I’m sorry,” says Sarah.

“That’s hard,” I say. “Do you have some good support?”

“That’s a laugh!” Emily responds. “Support! He’s got two brothers locally who come and talk to him once in awhile, but they don’t do nothin’. My one son who was worth a stick of dynamite to blow him to hell lives in Nevada …”

“Far away,” I offer.

“Too far,” she says.

“We’d like to come back a different time,” Sarah says. “We’d like to help, if we can.”

“He’s got an appointment this afternoon with his oncologist,” Emily says. “We’ll see how that goes.”

“Here’s my card,” Sarah says, handing it over the fence. “Call me when you know more.”

“Thanks,” says Emily, brushing a tear from her cheek with the back of her hand.

“Can I give you a hug?” Sarah asks, just so gently.

“Yes!” says Emily, and she puts her arms out, and Sarah hugs her over the chain link fence. For a moment the two women stand heart to heart, the little dog and I witnessing the connection of two humans who have known suffering and expect to know more.

After the hug is complete, we start down the driveway.

“Call me!” says Sarah, over her shoulder.

“I will!” says Emily.

And she does, just the very next day.


Truck paintings courtesy of Nancy Poucher