It eventually happens to all Hospice workers. They get a patient who falls well below the usual age range of the typical Hospice patient. One gets assigned someone young; by this, I mean someone under fifty-five, not necessarily a child.  My first "young" patient was 53, uncomfortably close to my age. I realized that I was using the advanced age of my patients as a crutch, as an excuse to suppress my outrage at the unfairness. This kept me from realizing that I subconsciously wanted to fix my patients to some extent rather than accept them and their path entirely.

Most of my patients are in their 70s and 80s. They have had a long time to enjoy life and explore the world. There is not a strong sense of unfairness in their impending deaths. There is just the concern that they are comfortable while they go through the dying process and have time to prepare themselves and their loved ones. I can even convince myself that a person dying in their sixties is no great tragedy. Problems arose when I was assigned to Jeff. Jeff was 53 years old when I met him.

When the volunteer coordinator called me about my new patient, she cautioned me, "This will be a hard one. Your first younger patient always gets you thinking." Initially, I thought I was being assigned a child. She told me it was someone in their early fifties. I did not understand her warning until I was face to face with a man about my age.

Jeff did not speak so much as grunt in monosyllables. He did not respond to stimuli in any predictable way. Drool continuously oozed from his partially open mouth. He was confined either to bed or an elaborate wheelchair. Jeff had advanced-stage Alzheimer's disease. When I first laid eyes on him, the thing that struck me was that he looked young. Jim was young. Then it hit me that he was my age, that I could have been looking in the mirror at the same slight grey at the temples, the similar not-so-perfect skin, the beginning of a middle-aged paunch. 

I had to force myself to be chipper, bright, and cheery around Jeff. I worried I would look like I felt, which was really sad for him. I felt deeply sorry for him and his family, who I met when they visited him in the nursing home. I was terrified because it was so easy to see myself in him. We even liked a lot of the same music from the same era.

I would read poetry to Jeff and play 80's and 90's rock classics on my phone for him. I would keep up a constant banter with Jeff, and sometimes he would smile or breathe fast and rock to and fro, but it was hard to tell what elicited any given response. We went for strolls around the block, with me pushing the massive wheelchair that kept him lying back, so his head (which was poorly supported by his neck muscles) did not loll forward. 

After my first visit with Jeff, I was exhausted. It was not so much that it was hard work in the physical sense. It was hard to stay so upbeat. It was hard not to hug him and cry while I told him how sorry I was that this had happened to him. It was difficult to stare at the reality of what - however, minute the possibility - could happen to me, to anyone my age. It struck me as incredibly unfair. 

That unfairness was driven home when his wife told me that just three years earlier, Jeff had been a Marketing executive at a high-flying startup company. He and his wife were preparing for the big time, the opportunity to live large, a real chance at generational wealth. Their immediate future looked bright, very bright indeed. Then Jeff got lost on the way to work one day. He couldn't explain it. And another day, a few weeks later, he went to work in his pajamas. He was seen wandering around the building, unable to locate his office. The strange behavior and incidents of forgetfulness increased from there.

After visiting a neurologist and ruling out things like brain tumors, Jeff was diagnosed with early-onset Alzheimer's. The prognosis was devastating. The doctors concluded that it was progressing rapidly. He would quickly become unmanageable at home and have to be placed in a full-time memory care facility. 

"Jeff got worse so fast. I started noticing the differences from week to week. He would have unexplainable mood swings and wander around the neighborhood and not come back for hours. Often he was brought home by the police or neighbors. I would lay in bed at night wondering what terrifying thing would happen the next day. After only 18 months, he stopped talking. I really had hoped there would be more time," said his wife, Carol. She and I spoke for a half hour before she introduced me to Jeff. Hearing her description of how she watched her husband melt away was heartbreaking. 

I visited with Jeff once a week for about five months. In a way, he had the child-like innocence that many people long for, though it came at a terrible price. My good friend Rabbi Levin would tell me everything, even in this situation, is part of the Divine plan. He would add that we can not hope to understand that Plan of Plans. I won't pretend it was easy to accept being with Jeff the way he was. I would dread the visits because while I was there, I felt like I was working extra hard. I found it exhausting. I felt like I had just run a marathon when I left the facility. I worried that I lacked compassion and empathy for work with the severely disabled.  

On one visit, I found Jeff in the day room, staring at a potted plant with a couple of yellow flowers. He whined when I tried to move him to go for our usual stroll around the neighborhood. I tried to read to him, and he shouted "NO" and kicked his feet. This made me self-conscious, as if the other people in the room would think I was terrible at my job for, worse, that I was hurting Jeff. We were both frustrated. I threw up my arms and snapped, "Fine. Let's stare at this plant all day!" And that's what we did. We just stared at the plant and did not say a word or move the whole two hours I was there. 

At the end of our visit, I got up to leave. And then something miraculous happened. I looked over at Jeff, and he was smiling at me. He was genuinely smiling at me. I could feel it.

It took me a while, but I finally realized I was fighting Jeff's condition. I was searching for a response from him, looking for a connection, hoping for some sign that I was making a difference. I would read to him with purpose and intensity as if I could force those words to make sense in his mind. I was, in my own naive way, trying to fix Jeff. I was trying to drag him from the path he was on, trying to define his part in the Divine plan for him and myself. I wanted to see the purpose of this terrible thing that happened to Jeff. I wanted an explanation. None came. 

Finally, I started to let go, to accept Jeff the way he was. 

I started feeling energized by our visits. It became a kind of meditation, with Jeff as my zen master. I let him guide me instead of the other way around. I learned to simply be with him. I was able to join Jeff in his peace. Instead of feeling sad, I felt joyous and connected. 

We still went for walks and read poetry, but in a much more relaxed way, without expectation. Colors popped. Simple things like a breeze on our faces became like the breath of the divine. Every visit was a spiritual retreat. After our visits, I would leave exhilarated and full of energy and hope. 

One of the last times I saw Jeff (he was taken off the Hospice service I volunteered for), we sat in the day room. He was in his wheelchair, and I was beside him in a lounger chair. His left hand was resting lightly on my right hand, and we were staring at other residents as they milled about and read and played with puzzles and finished their snacks. I felt utterly at peace. I felt Jeff's gaze change, and I glanced over at him. He looked straight into my eyes, gently squeezed my hand, and smiled. We saw each other entirely in that moment. Our minds, souls, and hearts were so briefly but completely entwined that I knew that he knew me, and I knew him. We were in sync.

For a while, for far too much precious time, I tried to wrangle a relationship with Jeff. I was overwhelmed by my desire to control the situation, to actively force some connection with Jeff. He taught me to let go and let the relationship happen as it would. He also showed me that there can be some element of the divine, of enlightenment, in all of us, especially those we would least suspect. Finally, I gained perspective on how the age of my patients affected my level of outrage at their disease and the effect on their lives. When I was with my elderly patients, I was not necessarily accepting of their path. Instead, I was accepting of their age. I had this desire to fix patients waiting in the wings for a person of sufficient youth. Spending time with Jeff has improved how I approach my other older patients. I am learning how to truly accept my place and my patients' place in the Divine Plan. This is all because I crossed paths with the most unlikely of Zen masters.

Addendum

I think that trying too hard is an issue, but the real problem is not noticing what is right in front of us. Often we are so caught up in what we want and expect from others based on their appearance or their station in life that we miss many lessons. It is important to remember that we can learn and grow from every relationship. I try to constantly remind myself to view each person I encounter as an angel sent from heaven. There is a Zen story that captures this sentiment.

The Holy Man

Word spread across the countryside about the wise Holy Man who lived in a small house atop the mountain. A man from the village decided to make the long and difficult journey to visit him. When he arrived at the house, he saw an old servant inside who greeting him at the door.

“I would like to see the wise Holy Man,” he said to the servant.

The servant smiled and led him inside. As they walked through the house, the man from the village looked eagerly around the house, anticipating his encounter with the Holy Man. Before he knew it, he had been led to the back door and escorted outside.

He stopped and turned to the servant, “But I want to see the Holy Man!”

“You already have,” said the old man.

“Everyone you may meet in life, even if they appear plain and insignificant… see each of them as a wise Holy Man. If you do this, then whatever problem you brought here today will be solved.”