I was sitting in Susan’s hospital room today, listening to her breath, staring at the darkened walls. I read some poems to her, and I remember that her brother Steven wanted me to play some Grateful Dead music for her.

But I couldn’t do it.

Susan was in a deep sleep, looking as peaceful as I had ever seen her, and I found myself talking to her about letting go. “You can let go whenever you want, ” Susan, I said, your life is not in anyone’s hands but yours. You are free at last.”

The nurses and lots of other people are always telling me that the dying hear everything, that hearing is the last thing to go, that Susan was listening to me, no matter how deep her sleep appeared to be.

I wasn’t buying it, not at that moment.

It seemed a sacred moment, a moment calling for peace, for the poems and prayers I was reading to her. Yesterday, I think we cheered her up. Today, I felt we would be just disturbing her.

I felt that she knew I was there. Her eyes would flutter open, I thought there was a trace of a smile once or twice. But I couldn’t be sure.

Maybe she heard the songs or my poems; she gave no signs of it. This was different than yesterday. She had gone to a deeper place.

I saw that the kind nurses at the hospital had pinned up a whole wall of the cards and letters she got this week and even set up a desk for her to work on, with her cell phone and some notecards and pens.

How sweet, I thought, how generous, they must know she will never sit at that desk and send those notecards, but the kind nurses and hospice workers never give up, they are all about hope and life.

How else could you do their work? And how important they must be to sick people at the edge of life.

I got a whole bunch of e-mails this week from people who once were friends with Susan, or who wanted to be. They all said she pushed them away, and for many years, she lived a solitary life. Nobody ever came to her house, and she ate takeout almost every night of her life.  Sally was her companion; she had lunch with a friend once in a while.

Susan told me the same thing she told Maria. She didn’t really know how to be a friend.

A few years ago, she was gravely ill in Long Island and nearly died. She told no one she was even in the hospital, she said.

Her college roommates wrote to tell me she was a fun and happy person when they knew her, before one of her bad marriages. She loved to buy tickets to concerts and take her friends.

She told me she never recovered from the second marriage.

So now, she is alone.  She never learned that friendship is often all about helping.

I thought of this because I thought during much of my visit – Susan was in a deep and restful sleep – that I really didn’t wish to wake her up or blast her with music.

My visits are draining, sometimes hard, but always simple. I don’t change the sheets, clean her body, turn her over, change her clothes, give her medicine, take her pulse,  clean up the room, change the catheter back.

I am in awe of these people.

They are the caretakers; I am a visitor who can come and go. Then I thought of the New England Journal Of Medicine story I read this morning stating that the first time in decades, more Americans – 30.7 per cent of those who died – died at home rather than in hospitals and nursing homes.

That is a dramatic change from even a few years ago.

Those statistics, said the New York Times, meant that more and more home caretakers were struggling to take care of their loved ones and still work and live their own lives. That is never easy, especially if you are not wealthy.

If sitting in a hospital room for a few hours is exhausting, what must real caretaking be? I get to go home whenever I wish and leave the really hard and dirty work to others.

But I’ve been to many caretaking homes with my dogs, and I know how exhausting, relentless, lonely it is. It disrupts lives, breeds depression, and always ends in death, however much love there is. No politician in any debate or interview has mentioned it this campaign, or the last.

The reward is only in the heart.

There is nothing more powerful than being a caretaker. Is there anything more lonely?

Insurance doesn’t cover personal care-taking; the government doesn’t support it. According to Atul Gawande (“Being Mortal: Medicine and What Matters in the End“), it takes the average elderly American about six years to die once they get sick. All those people needing to die a home need caretakers.

Medicine can keep us alive for a long time; it just doesn’t take care of most of us while we live. Susan is so fortunate to have ended up at Saratoga Hospital. They are taking care of her.

More and more people want to die at home, which is the way people used to die. In the 1800s, writes Dr. Gowande, older people usually died a few days after they got sick. Caretakers surrender their lives to loved ones for years now.

(Some 1.49 million Medicare beneficiaries received hospice care in 2017, a 4.5 percent increase from 2016, according to the National Hospice and Palliative Care Organization. Still, that is a fraction of the people who died at home. Hospice helps people, Medicare often pays. Call them.)

Susan had no caretaker at home to devote years of their life to her care, and I sincerely hope that is not Maria’s fate with me. But I was thinking of the real caretakers all day, and I want to dedicate this post to you.

I am not one of you, but I do know you.

I do think of you.  And of your spiritual and mental weariness.

From the Mansion aides to Susan’s hospital nurses to the many millions of people, mostly women, who have devoted their lives to caring for sick and dying people, spouses, parents, even friends,  with little help or guidance, I am thinking of you.

You are heroes, unsung, and poorly supported and rewarded only by love and the joy of helping someone you love. But I also know the toll on you is high. In other countries, caretakers are paid and supported.

Not here. You push your lives to the very edge of your existence, your life is no longer your own.

Sitting there in this hospital room, I felt nothing but lucky.

Glad to be of help and hopefully some comfort to Susan, who could never figure out how to help herself. Happy to still have my own life, to be free to go outside and get in my car and do whatever I wished to do.

I might be sad at the sight of Susan dying, bit by bit, day after day. But weary or not, I get to go home to my work, my farm, the animals, my blog.

I couldn’t sing with her today or fill that dark room with music; it seemed intrusive at the time.  I couldn’t call people up and hold the phone to her, hoping she would speak in recognition.

I was glad to see that Susan was holding the pillow we brought her, it was made from her father’s ties.

I don’t care what the nurses say. Sometimes you have to follow your heart.

Tomorrow Susan’s friend Donna is coming to see her and say goodbye. I am certain Susan will know she is there, she and Donna have a very close connection.

If Donna asks me to join her for a bit, I will go. If she wants or needs to be alone with Susan, I’ll stay away.

It is fascinating for me to watch Zinnia process this new kind of work. She comes into the room, lies down next to Susan’s bed, get up to greet the nurses, then lies down again.

I realized yesterday that she is doing her therapy dog work on me, she is comforting me when I need it.

I lifted her paws onto the bed so Susan could see her and touch her, I put her hand on Zinnia’s head, and I thought I saw Susan smile.

But she didn’t open her eyes.