SABATTUS – Bob Morin rarely asks to see his hospice workers on days when they aren’t scheduled to visit.

But on a recent morning, after the rain and cold temperatures had trapped him inside for nearly a week, he asked his wife, Jackie, to call the nurse and see if she could visit.

“What’s the matter?” Jackie asked.

“I want to ask her for a pill to make me feel better,” Bob said.

Jackie knew right away that her husband wasn’t talking about the shooting pains that begin in his sternum and travel to his back or the burning in his chest or his swollen, sore legs.

Over the 14 months that Bob has been receiving care from Androscoggin Home Care & Hospice, he has learned how to use his morphine to deal with these aches and pains and make himself comfortable.

This time, something else was bothering him – something more difficult to explain, something inside his mind, something in the way he felt when he woke up to face another day of not being able to go fishing or see his grandchildren’s sports games or cook dinner for his wife.

A faster rate

“I don’t think you always feel like yourself,” Karen Flynn said to Bob when she got to his house later that day.

Flynn, a hospice nurse who has been visiting the Morins’ home in Sabattus since March 2003, rubbed Bob’s hand as she spoke. She knew from her own observations and from reports from the aides who visit Bob every morning that he had taken a turn.

His health seemed to be declining at a faster rate than it had over his first year on hospice. His heart and lungs were continuing to fail, and his 75-year-old body was breaking down.

He had lost more than 30 pounds. He was having more trouble breathing at night, and he had started needing more morphine to ease the pains in his chest.

As a result of these physical changes, he was sleeping more, doing less. He didn’t feel like joking around as much and he noticed that he had been getting confused, often forgetting people’s names and the day of the week.

All of this was making him frustrated, sad, a bit down.

“He tries to keep things to himself, but I can tell when he’s having a bad day,” Jackie said. “He’ll just sit there and he has that sad look, and sometimes his eyes tear up.”

A personal question

It is common for terminally ill patients to become depressed. Flynn sees it happen all the time. As a hospice nurse, she considers the treatment of a person’s mental condition as important as the treatment of his physical symptoms.

“Way before people die, they have to grieve all of the things that are changing about them,” she explained to Bob.

Then she asked if she could ask him a personal question.

“Go ahead,” Bob said.

“Do you ever want it to happen quicker?” she said. “Do you ever want to just die?”

“No, I wouldn’t go that far,” Bob said quickly.

“No, no, that’s not him,” Jackie added.

“I can deal with this once in a while, but it would be good if you could give me a break,” Bob said.

Flynn nodded her head and smiled. She had a few ideas.

Not enough oxygen

The first thing that Flynn did was to borrow the Morins’ phone to order another oxygen tank. Bob had only been using a portable tank that required him to breathe through his nose in order to get oxygen.

It worked fine during the day, but it wasn’t sufficient for nighttime because Bob breathes through his mouth when he sleeps. As a result, he wasn’t getting enough oxygen at night, which was making him confused in the morning.

“Sometimes I wake up and don’t even know where I am,” he told Flynn.

“I think, with this new tank, we’ll find that you’ll feel better in the morning,” Flynn said.

Then she asked if he would consider taking antidepressant medication.

A retired millworker who worked two jobs for most of his life to support his wife and six kids, Bob has survived some rough times. He never needed antidepressants, and he wasn’t interested in trying them now.

“Oh, no,” he told Flynn, “I don’t want that. I don’t want to take any more pills.”

Time to review meds

Flynn didn’t push it. She simply reminded him that it was always an option.

Knowing that he was tired of taking so much medication, she also told him that she would review the long list of pills that he takes for his heart and lungs and talk to his doctor about taking him off the ones that his body may no longer be processing.

She explained that some of the pills may be causing unnecessary side effects and affecting his mood.

Bob liked the sound of that.

“I trust you,” he said. “Whatever you think.”

As Flynn was talking with the Morins at their dining-room table, the rain stopped and the sun started to come out. Jackie was the first to notice.

“I think you are going to be able to go out on the porch later, Hon,” she said to Bob.

“That’s what I’m going to do, then,” Bob replied, grinning.

Before Flynn left, she took Bob’s blood pressure, listened to his heart and lungs, and asked if she could check the swelling in his legs.

Bob lifted his right leg and pulled up his snowman pajama pants.

“You know,” he said to Flynn, “I don’t show these legs to all the women.”