A Horse with No Name

There has been much debate about the meaning of the song “A Horse with No Name,” written by Dewey Bunnell, by the group America. A lot of people think it’s about heroin, since a slang term for heroin is ‘horse.' But Dewey has explained that it was “a metaphor for a vehicle to get away from life’s confusion into a quiet, peaceful place.” Though many heroin users may be seeking that very thing, Dewey wrote this song while sitting in his room in rainy England, reminiscing about his childhood experiences in the American Southwest through the Arizona and New Mexico deserts.

I grew up on the East Coast, mostly in North Carolina, and always thought Arizona seemed like a strange and wonderful alien land. From Washington, D.C. to Charlotte to St. Louis to Miami, I’d mostly lived in more urban areas. Then I moved to Tucson for work, and learned that everything I imagined about the desert was true. The energy, the wildlife, and the landscape are truly amazing. Having lived in the concrete jungles of one city to the next, moving out to the desert was a huge change-not just a geographical one, but a shift in perception. The house I rented was near Saguaro National Park, situated on 3.5 acres of desert beauty and surrounded on all sides my the crater-mountains that encircle Tucson. The only neighbors I could see where cacti, coyote, and javelinas. I spent most of that summer sitting out by the pool, in my quiet, peaceful place. The desert still feels more like home to me than anywhere else, with the plants and birds and rocks and things...

A while after I moved to Denver, I took a home health Hospice position. Not long after I started there, we admitted a patient named George. He had tons of health issues, but an infection from a surgical wound was his most acute issue. The first time I went to see the family, George was able to carry on a basic conversation, though it was difficult. His daughter Kathy had moved in to help. George’s wife had rip-roaring dementia, and possibly due to family dynamics, Kathy was desperate for help, more so with her mom than George. Kathy and her mother would constantly bicker and fuss, and bustle around in George’s room with nervous energy not knowing what to do. This first visit, I changed his dressings, got a feel for their general history, reviewed medications and talked about some coping mechanisms and ways to alleviate everyone’s stress, including some self-care for Kathy.

About a week later, I received a call from the Hospice that the family was very concerned and that George’s breathing and mental status had changed. I had finished my other visits for the day, so I made my way to their house to assess. George was definitely different. He was bright red and feverish, and his only verbal communication was mostly in the form of moaning. He tossed around a bit, seemingly unable to get comfortable. Assessing mental status is one of the duties of a Hospice nurse, so I attempted to get a response from George, calling his name and gently touching his arm. Then George’s face changed. He sort of grinned, and started singing “A Horse with No Name.” As per usual, I started singing it along with him, finishing the lines he couldn’t. That was the only verbal response I got from George that day. Then I took his vital signs, and sat in his room talking to Kathy for quite some time. She administered a dose of morphine while I sat there. George’s work of breathing eased a bit, but he still seemed uncomfortable. I reviewed the ‘comfort kit’ medications with Kathy. She questioned whether she could give him too much. Having worked with our Hospice providers for a bit, I knew that they wanted to be called for every 0.25 mg increase to any medication, even while a person was actively dying, so I told her she could alternate between the morphine and ativan and use other meds as needed. I told her, “the ordered dose of these is 0.5 mL every 2 hours, but since there is no legal limit to how much can be prescribed at end of life, you can’t really give him ‘too much’ and I’m happy to call the doc.” Kathy understood. I understood that George was still uncomfortable. Kathy’s nervous energy also made her seem very uncomfortable, and she paced around his bed asking what to do, worrying about her mom and other things.

I sat quietly for a bit, then I politely kicked Kathy out of the room. Having been with people struggling to achieve their physical death for many years, I’ve often seen people have difficulty when their loved ones are anxiously standing around on ‘Death Watch.’ Unsure what to do, families often just stand around and stare at their loved ones, waiting.

“A watched pot never boils,” I told Kathy. I told her it was time that she could give him another dose of his comfort medications, and then she should go sit in the living room with her mother, or do something to relax. I assured her that she’d done everything she possibly could, and that he knew he was loved, as she’d been there with him for weeks, leaving behind her life to be present at the end of his. I also told her that I was going to leave. I explained to her that many times when I leave, especially when the person is left in a comfortable state, they pass pretty soon after. Kathy said she was more than ready for this suffering to be over. I packed my things, said goodbyes to George and then said goodbye to Kathy and her mom, who were now in the living room, watching TV and attempting to relax.

15 minutes later my phone rang. George had died moments after I left. I turned around and went back to the house to do the official death visit. Kathy said she could finally breathe. She and her mom were both so relieved that George had stopped suffering. They were still unsure what to do. Kathy’s friend arrived at the house, so I told them to visit and enjoy finally being able to breathe. She seemed thankful for the permission not only to be relieved by George’s death, but also to be able to take some time for herself. I told them I’d sit with George until the funeral home arrived to pick him up. As I sat at his bedside, there was a stillness and peace in the room. It was as if time stopped for a while. We sat alone, in that quiet, peaceful place, George and I.

Having also worked with dementia and other altered states for almost 20 years, I’ve not only learned with my logical mind that music and song is one of the last things to go at the end of life, and the sense of hearing, but deeply know in my inner being that this is one of the best communication tools with anyone or anything. Many times people with dementia or strokes can’t get out what they want to communicate, so I learned that music and cursing (swearing or expletives-more emotional forms of communication) come from different places than regularly used language, so pissing someone off or singing with them become amazing communication tools. Perhaps in singing “A Horse with No Name” George was telling us he needed some space and a little peace and quiet to connect with his higher self and complete his transition…much like I began to find MYself out in the desert.

George died in February. The following June, one of my favorite bands, Dirtwire, was playing at a festival I attended in Colorado. They played their new song, a cover of "A Horse with No Name" (Feat. Blake Colie). As I watched Chris Dyer's artwork for the single dance across the big screen, even surrounded by the crowd, I was transported to that quiet, peaceful place George and I shared in our virtual deserts. A month later in July, I unknowingly (at the time) watched Chris making his art at a conference in Florida. The desert had turned to sea.

Nobody should have to die alone, but that doesn't necessarily mean that everyone has to stand around the deathbed anxiously waiting on that last breath. Just like other animals, some people may need space to turn inward for this process. It can also mean being held in a supportive, loving, and comfortable container, radically accepting the natural process of the cycle of life and turning towards it, and being given the chance to do your work, whatever that looks like for you.