feet
Is it OK if I look at your feet?
I pulled off her socks, not surprised by the cool, swollen feet underneath. These are the feet of congestive heart failure, and I'd grown accustomed to seeing them; I gently pressed my finger into the skin to leave an indentation, estimating the scale of swelling based on how deeply I could indent. I inspected the heels, a common site for pressure wounds, relieved to feel the skin intact.
Would you like me to rub some lotion into your feet?
She nodded eagerly, and with great effort reached down to the side pocket of her recliner and pulled out a bottle of Aveeno. I smiled as I rubbed the lotion into the thick lines of her heels, like dried up rivers of some ancient landscape; in between her toes, the dried skin flaking off; into the tops of her feet, gently redistributing the fluid; along the bottoms, using as much lotion as her skin would drink.
*
I'd just started my clinical rotations in nursing school and was figuring out what I could and couldn't stomach. People loved to ask what the grossest thing was--blood? Urine? Something worse?
"Feet," I'd reply emphatically. "Feet are disgusting. They're weird, dry, and smell awful up close. Feet are the worst."
I didn't understand then. But I do now.
*
As we get closer to the end, you'll start to notice mottling. Have you heard that word before? This is how I begin to explain the many changes at end of life, to family members who are afraid to ask but desperately want to know, "How will I know it's time?"
Mottling is purplish/bluish discoloration, usually spots. We start to see it right here under the toes. It's not painful. It won't be open or bleeding. It's just the circulation slowing down.
I watch them nodding along, unsure how much they're truly processing. I hold one arm across my stomach, the other across my chest, creating a border around my trunk.
Basically, as we get closer to the end, the heart starts to panic. It thinks, I'm running out of time, so I need to prioritize the vital organs, like lungs and kidneys. I can't be bothered with toes and feet. So it stops circulating to the extremities, and mottling is where we see that blood pooling. Again, it's not painful. But it means we're getting close.
*
The heart may disagree, but the feet I touch are vital.
They've raised families, fought in wars, built homes. They've traveled, they've suffered, they've tripped and fallen and cursed their decline. They've curled up their toes in warm sand, they've stood on fresh dirt while burying spouses, children, friends. They've been fitted for combat boots and cross-country skis. They've been supported by canes, crutches, walkers, wheelchairs. They've walked on this earth longer than I have, and they'll go ahead of me to whatever lies beyond that last breath.
They're often dry, arthritic, bruised, and swollen. But they've served well, carrying a person through a lifetime, whether that lifetime is 45, 65, or 95 years long. When I touch a person's feet, I'm touching their vital past, their waning present, their unknown future. I'm touching the first dance at their wedding, the slow walk home after a layoff, the final stride over a finish line, the shaky first steps after an operation. The beauty is I mostly don't know any of this, but they do. Touching these feet with my hands is a greeting, a goodbye, a gesture of seeing and knowing beyond what I could ever actually see and know about this person in front of me, this person who has lived.
For the most part, we keep our feet covered up; we don't want to look, can't stand the smell. Which is what made the act of feet-washing in the ancient world something for a servant to do; it's what made the act of Jesus doing this for his followers so profound. It's what makes a dying person so grateful to someone willing to kneel in front of them and rub lotion into their feet, in between their toes, the weight of my hand on their feet communicating, "You are not forgotten. You are vital. You're still here."
*
I always check my patients' feet for wounds or mottling or swelling; when I remove the sock and a flurry of dried skin gently falls like snow, the feet long ignored or forgotten or simply unable to be reached, I ask, Would you like me to rub lotion on your feet?
Nobody ever says no.