The first memory that comes to mind is the sound of oxygen at night. It was my second week as a hospice nurse. I had just arrived at a humble home on a cul-de-sac, the type of place where wind chimes resonate off deserted sidewalks. Within, a man in his seventies was succumbing to end-stage pulmonary fibrosis. He was surrounded by loved ones, but it was that gentle hiss—steady and rhythmic, resembling an artificial tide—that grounded the room.

His breathing was labored yet serene. His wife sat next to him, holding one hand. I positioned myself on the other side, lightly grazing the sheets. I didn’t do anything remarkable that night. I adjusted his medications. I provided reassurance to his children. I monitored his vitals even though we both understood the trajectory they were on. And then I remained.

We don’t discuss enough about the act of remaining.

Hospice work is often envisioned as a form of angelic service—soft melodies, candlelight, a tranquil departure. Sometimes, yes. But more frequently, it consists of kitchen tables overflowing with pill bottles, late-night phone calls, and the profound silence that envelops the room when someone inquires, “How much longer?” and you genuinely do not know.

In my eight years in hospice—as a field nurse, subsequently a manager, and then back to field work again—I have been present for hundreds of deaths. Each one is uniquely sacred. And each one, if I’m truthful, took something from me. Yet it also gifted me something I did not foresee: a richer comprehension of what it means to truly live.

I learned to relinquish the notion that I was there to “fix” anything. Death is not something that can be fixed. It can only be witnessed. It took me time to realize that presence—steady, grounded, human presence—was more impactful than any medication. I learned to hold a hand, to breathe alongside the anxious, to dwell in silence without the urge to fill it.

I also learned about systems. About the challenges of providing quality care in a world fixated on documentation. About Medicare audits, staff fatigue, and the emotional gymnastics of trying to balance compliance and compassion within the same shift. There were days I felt as though I was spending more time checking boxes than being with patients.

Eventually, I ascended to management. I thought, mistakenly, that I could enact change from within. I could shield my team. I could make the system more compassionate. And to some degree, I did. I advocated. I mentored. I fought for schedules that respected work-life balance and grief support. But I also witnessed firsthand how flawed the infrastructure truly is.

Hospice is constructed on a precarious foundation—underfunded, overregulated, and unequal. I observed patients in affluent suburbs receiving daily visits while those in rural or underserved regions struggled to have equipment delivered promptly. I noticed staff stretched beyond their limits. I saw grief, both personal and collective, swept aside in the name of “resilience.”

There were moments I felt an urge to scream. And at times, I did.

But I continued to show up. I eventually returned to field nursing, yearning for the clarity of the bedside. I missed the intimacy of those final moments, the profound closeness of being included in a family’s most difficult day. And when I returned, I brought along something new—a sense of integration between who I was as a caregiver and who I was evolving into as a person.

Hospice transforms you. It alters how you parent. How you listen. How you argue. How you forgive. After enough time in this work, you cease to worry about minor issues—not from some saintly aloofness, but because you’ve witnessed people pass away with regrets regarding unspoken words. You begin expressing “I love you” more frequently. You start releasing burdens.

The distinctions between professional and personal blur in hospice. It’s impossible to care for the dying daily without contemplating your own mortality. Without pondering how your own narrative will conclude. Without questioning whether your loved ones understand precisely how you feel about them.

Eventually, I began to write. Initially short pieces, then complete chapters. And ultimately a book—Terminal Justice—concerning inequalities in hospice care, especially for marginalized groups. Writing gave form to my frustration. It provided language for the things we don’t articulate often enough in health care: that dying should not be a privilege. That comfort is a fundamental human right. That caregivers deserve systems that uplift them, not lead to burnout.

Now, I find myself in a leadership position again—one foot in administration, the other still firmly rooted in the sanctity of bedside work. I speak at conferences. I train new nurses. I strive to impart what I’ve learned—not as doctrine, but as lived experience.

Here’s what I understand: The work of hospice is quiet. It seldom makes headlines. It’s not glamorous or heroic in the manner we are taught to define medicine.