Death is commonplace to me. As a former ICU nurse and now acute care nurse practitoner, I dare say I have seen hundreds of people die. I consider it a sacred act to be there at the time of a patientís passing. Shared that precious moment with family, friends, or perhaps with just the patient themself. While not a religious man I consider death a part of life. Acceptance of death is also a part of life. I consider it once of the most important jobs to give acceptance to family and friends. And at times to the patients as well. At times there is no more that can be done for my patients but to allow them to rest. But what of those left behind?The motorcycle accident victim was my first patient. A young man, he had the world in the palm of his hand. A tragic accident stole him from his fiancť, family, and his future. He would have changed the world. Iím sure of it. And despite that he died. In those last minutes in the ICU before he was wheeled to the operating room to take the organs that would change 7 other lives, I sat with his fiancť and cried. 5 foot 10, 220 pounds I wept for a man I had never met. I felt the pain of his young fiancť. Of the family they would never create. The memories they would never build. The arguments over toast and unmade beds and clothes left on the floor that they would never have. It was there that I learned how we can make the passing easier for family and friends by being present, sharing the moments, Making a difference. In the end she thanked me with a hug and a smile, and I knew she would be ok.Another day; another patient. His family gathered around him in the dark ICU room. Afraid to touch him, they stood like statues staring at the monitor on the wall. Perplexed I walked in and asked them a question. Would anyone like to hold his hand? They looked at me as if I just shared the winning lotto numbers. We can do that, they asked? Of course you can. I lowered the side rail and his wife sat in a chair and grabbed his hand. I asked if anyone had a story to share. Something embarrassing would do. Something he would like to hear and laugh about in these final minutes. Of course there was one. Or two. Maybe ten. By the time he passed, there was laughter, tears, and acceptance bellowing from the room. Some of it from me. This family shared their intimacy with me and it allowed them to let go. It also allowed the patient to know they would be ok without him and that he could finally move on.Death seems such a taboo topic to many of the nurses I have met. I see so many nurses huddled outside the room, not wanting to bother the family, frustrated, angry, yet keeping those emotions bottled up inside. I believe this is a disservice to keep the emotion inside. Loved ones need help accepting the horrific idea that their loved one is leaving them. Whether the patient is 20, 40, or 99 doesnít matter. They are leaving someone, somewhere, behind. And itís not fair. So who are we to make it harder for everyone to accept by not being there? We are nurses. Game-changers. Earth-shakers. We are the voice of the voiceless in the middle of the night. I tell families all the time that death is just the next step. Itís a process. And they should help their family member or friend get through it. Tell stories, hold hands, laugh, cry, sing, pray, tell jokes or horrible stories, in the room, in front of the patient. Dying patients need to know their family is there, prepared for what comes next. That itís ok to move on. Patients need to know that the ones they are leaving behind will be ok.The bullet hole in my sleeve is a badge worn with honor. It is a hole put there by the hundreds of death Iíve seen. It reminds me that I have a small window to make a difference in those last hours. A small window of time to plant the first seeds of acceptance. Acceptance of finality, that tomorrow will still come, that life will go on for those left behind. I will never sew that hole closed because I dare not forget the power I have as a nurse. Of being the voice of my patients. Of making a difference. I dare you to do the same.