For volunteer hospice companions, it's all about being there

Nick Rasmussen and Bob Nell sit on the couch watching TV with the peculiar expectation common to "The Three Stooges" fans. In a scene with paint brushes and coffee mugs, they know that Larry inevitably will dip his brush into Moe's coffee. Yet when he does, it's still funny. That's the weird brilliance of the Stooges. Even when you see the joke coming from a mile away, you can't help but smile.

Their own relationship is like that. Nell is dying, which is how Rasmussen ended up on the couch as his hospice companion. Yet despite knowing how their relationship will end, they can't help but laugh.

"Nick is the first young person that I've liked right off the bat," said Nell, 63, who was diagnosed with liver disease four years ago. Their hospice relationship is unusual in its duration, given that Nell has been in hospice for two years. Yet he awaits no cure. "I'm at the point where I just move on to the next phase."

Nell's equanimity shapes how Rasmussen, 34, approaches his visits as a volunteer on the care team. Death, Rasmussen said, actually is more traumatizing "when you don't know when someone will die. This doesn't take a toll. It's a privilege."

We speak of "going into hospice" as if it's a place. It can be, but it's actually a philosophy of care that shifts the focus from seeking treatment to accepting life's finality.

Hospice mostly happens where you are, whether in a nursing home, a hospital or your house. Patients spend their remaining days as comfortably as possible, ideally with a dignity that can get lost amid the mechanisms of modern medicine.

Still, the word scares some people. Most people.

A British woman, Dame Cicely Saunders, developed the idea of specialized care for the dying and in 1967 opened the first hospice. Hospice care in the United States began in 1974 in Connecticut, and has grown slowly, but steadily, especially as the "end of life" movement gained traction in the mid-1990s.

In 2011, about 1.65 million patients received hospice care, according to the National Hospice and Palliative Care Organization. More than four in 10 people who died in the United States in 2011 were in a hospice program.

A volunteer companion's work lies within the creases of care.

Once a week, Rasmussen pulls up to a Brooklyn Park rambler and spends the next hour or so shooting the breeze, admiring Nell's latest wood project, gauging his mood, eyeing his color. He doesn't have a medical role, yet jots notes of each visit for the medical director's use. He doesn't have a counseling role, yet listens to Nell's most personal musings. He is a regular presence in Nell's life, yet is not a friend, not technically, anyway.

"Bob calls us friends, and we're not really supposed to be friends — it's a boundary thing," Rasmussen said, then grinned. "But we're a little different than most."

"I'll give you six questions," Nell answered, then shook his head, quashing the suspense. "It hasn't been pleasant."

"Something your doctor said you might expect, or something different?"

"No, it's just part of Stage 4, part of the routine," Nell said, then couldn't resist teasing Rasmussen. "I thought you knew that."

They laughed, and the conversation moved on to whether Nell had felt up to doing any scroll-saw work. He makes the most intricate cutouts in panels of wood — eagles, wolves, pines — which then become part of lantern lights.

Their conversations often veer into home renovation — Rasmussen is fixing up his house and Nell has done a lot of custom woodwork. They talk about which birds have visited the feeder, about wildflowers Nell intends to plant, about how to get neighbors to return power tools. It's the sort of talk you'd overhear in a barbershop.

"Some people say a quicker death is easier, but some say a longer one is better because it gives you time to address things," Rasmussen said. Nell declined to cast a vote, noting only that "the hardest thing is to go from being able to do everything to being able to do nothing."

Nell appreciates Rasmussen's frankness, and his intentions. "They're all about you," he said of those providing his hospice care. "They're not about themselves. To me, it's very personal."

Rasmussen is honest enough to mention that one of his early motivations to volunteer was that it would look good on his résumé. Now, though, he said, "I'll probably do this until the day I need it."

He added, "You learn from each patient something new about yourself, and that helps you help the next patient. You — I don't want to say 'fall in love' — but you find this piece of yourself when you do this."

The two men are social opposites, yet well-suited.

"When you make a six-figure salary, you pay for it," he said. He's divorced, amicably, and lives with his daughter. A son is nearby.

Rasmussen, 34, is a physician assistant in neurosurgery at Fairview Southdale in Edina. He set out to be a doctor, but grew frustrated with how little time he could spend with patients. He switched to being a physician assistant and admits he often runs late "because I just like to chat with patients." He's engaged to be married, and is intent on introducing his nephews to the Stooges, as his grandfather and father mentored him and his brothers.

He began volunteering with hospice about 10 years ago, after hearing how much hospice helped his grandmother. He said it has made him better at his job.

"It's how I've learned about the death and dying process, which helps when I talk with the family of someone needing surgery for a tumor or brain injury," he said. His ability to lead a delicate conversation helps his hospice work. He may gently probe someone about whether there are fences to be mended — questions that family members may not feel comfortable posing.

Hospice, in fact, works best with a bit of emotional distance. "This person isn't my grandma and it isn't my grandpa," said Nevinski, who's worked in hospice for 11 years. "It's Mrs. Olson."

"We get one time to do this. There's no re-do."

Rasmussen and Nell sat on the couch, laughing. As expected, the society ladies in "The Three Stooges" sat down in the chairs that Larry, Moe and Curly had just painted. But then the scene continued, with the women walking to their cars, chairs still stuck to their backsides.

Sometimes, things go further than you expect.

Rasmussen never knows whether he will know a hospice patient for days, weeks, months or, in Nell's case, a couple of years. Yet the inevitable certainty of death hasn't inoculated him from the apprehensions of human nature. "I'm still afraid of my own death," he said, with a slight shrug. "Of my fiancée's, or my brothers'."

For various reasons, he has never gone to a hospice patient's funeral. For one, he's not family and, as he noted, he's not even supposed to be a friend. Yet, he said, he will be at Nell's. Like one of their favorite episodes, they see it coming from a mile away.