The following name has been changed and the situation slightly altered to protect the privacy of those involved. However, it remains a 'true story' about a lesson learned through an elderly woman
I first met Grace after I had been at the nursing home for about three weeks. I was orienting with the LPN who was on the wing where Grace was going to be staying.
Grace was a very frail little woman. When she stood up, the top of her head barely came to my shoulders, and I am not a tall person. I am five foot five. I could wrap both of my arms around her and could have picked her up if necessary. She had gray hair, in a short curly style like so many of the elderly do. She sat in her wheelchair, with slippers on her feet and a plaid blanket over her lap. She had a concerned look on her face, and she was licking her lips, which I later came to see quite often when she was anxious or worried.
Grace's son was with her and they had just come from a tour of the facility. Grace's son had been with his mother most of the day and was trying to get ready to go home.
I had stepped into the room because Grace's son had pressed the call light. I went to answer the light.
Grace's bed was the closest to the door. She was in her wheelchair and her son was standing next to her holding her hand.
"She has to use the bathroom," Grace's son asked in a polite way.
"Ok," I said, smiling at Grace. "Do you use a walker?"
"Yes," answered Grace in her polite ladylike voice. Her voice tone sounded slightly concerned, which I soon learned was a normal tone for her.
I found a gait belt, made sure Grace had her slippers firmly on her feet, found her walker and helped her out of the wheelchair toward the bathroom.
After I had her situated on the toilet, I stepped out to give her some privacy, smiling at her son.
Her son smiled back at me and then decided to use this opportunity to make his exit. "Well, I have to go now Mom" he called around the bathroom door. "I love you, and I'll see you tomorrow!" He began moving towards the door of the room.
"I love you to" said the little voice quickly from the bathroom, "Don't go!"
I love you, don't go.
Grace's son left, and, as I helped Grace into her new bed in her new room in a new building that was going to be her new home, I thought about that phrase.
I love you, don't go.
How often had families thought those same words, even if they didn't realize it, when they had to make the decision to put their loved one in a long term care facility?
I love you, don't go.
How often had families thought it as their mother or their father would stare them in the eyes and ask, "Who are you?"
I love you, don't go.
How many families asked themselves that as their loved ones gave their last breath?
I love you, don't go.
How many of the elderly thought the same thing about their life, as the decision was made that they could no longer live by themselves?
I love you, don't go.
As they realized their spouse could no longer care for them?
I love you, don't go.
That their spouse had passed away and they could not live with their children?
I love you, don't go.
It is the unheard cry of so many.
Don't go, don't go.
And yet they must go. It all has to go, or seems to go in some way at some time.
We all know this. We cannot all be there for our family, for ourselves, always.
And so the elderly must go. And let go of some parts of their life they thought they would always have.
When they finally let go, however willing or unwilling, they come to the nursing home. And then, they are part of my family.
When Grace's son left the building, I became Grace's daughter.
Oh, I was not her real daughter. We both knew that. I was so busy, in the weeks to come, when I was finally off orientation. I could only see Grace now and then during my shift.
Grace's son came every day and played Monopoly with her. Grace had an amazing and loving son.
But Grace's son could only be there part of the day, and not every day of the week.
At night, when Grace was alone, I saw her. We saw her. The nurses, CNA's and I were her daughters.
You see, we become the other family of those who cannot live with their families. We experience their joy, and their pain. We love them.
And we don't want them to go.
Grace became progressively sicker over the next several months. She had kidney failure, so she had to use the toilet all of the time. Her call light was always on, which made it very hard for the staff to answer every time she needed them. Short staffing is an issue not easily solved.
When I would help Grace to the bathroom, I would joke that we were dancing, the way my arms were wrapped around her.
"Let's leave and go dancing." She would say. "I haven't been dancing in a long time."
I would go and change a dressing on Grace.
"Just call me patches," she would joke.
I would tell her that I had paperwork to do.
"Just forget the paper work," she would tell me. "Let's go play Monopoly."
And I would wish that I could. That I could drop everything, all the other residents who needed me, to just play Monopoly or to dance with this dear little woman named Grace.
One night (early morning), Grace didn't seem quite right to me. I assessed her and her vital signs were within normal limits. Her heart rate was a little on the high side, but still normal. I still thought there was an issue brewing. I told her she was breathing heavy. "I'm fine," she brushed me off. "You know I get like this because I'm up and down to the bathroom all night." I monitored her closely the rest of the night, and passed my concerns along to the day supervisor.
When I came in the next night, I was told that Grace was out to the hospital. Her heart rate had rapidly increased over the next two hours after I left, and it could not be brought down at the home. She had been admitted to the ICU for atrial fibrillation with rapid ventricular response.
Grace came back about a week later.
But she was not well.
I heard from the staff that was standing outside the door on their smoke break before I even entered the building that Grace was back with a fast heart rate.
"Grace is back and has a heart rate of 160" echoed in my head as I swiped my card, walked up the hall and went to put my things in the employee lounge.
I initially entered the floor indignant that Grace was still in the building with a heart rate that fast. My mind was reeling with the impact that a heart rate of that speed would have on Grace's body systems. A rapid heart rate that was not controlled could only lead to complete system shutdown. I felt like screaming or crying as I got report. I did not understand why she was back at the nursing home and not in the hospital ICU.
Until I went down to see Grace.
You see, Grace knew that she had a fast heart rate. Grace knew that she was going to die. And she wanted to be 'home.'
"You don't know how horrible it was" she told me. "I was all alone. I couldn't see anyone, and when I did, they were all gowned up. What kind of horrible place is that where no one cares? Stay with please, just stay with me." She held her frail hands out to me and the CNA's who were caring for her.
"I don't want to be alone. Don't leave me here."
Grace's room was at the end of hallway. I made the decision that she was not going to be alone. We had Grace lie down in her bed, and then we wheeled it out to the nurse's station.
Grace was very restless. I would put the pulse oximeter on her finger and it told me that her heart rate was 159 beats per minute. It was horrible.
Imagine running a marathon and how you feel when your heat is pumping so very fast. Grace's heart was pumping so fast every minute, she was panicked.
And yet she did not want anything medical. She just wanted someone to be there and to hold her.
She clutched a picture of her deceased husband tightly to her chest. She would look at him and then look at me.
She didn't know what she could do to be comfortable.
She would lie down and then sit up.
"I wish I had done more" she would say about her life. "I should have done more."
I would reassure her that raising her family was enough.
"I know," she would say. "My son told me that."
She would quote John 3:16 with me- she remembered it from her childhood: "For God so loved the world, that He gave His only begotten Son, that whosoever believeth in Him, shall not perish but have everlasting life".
She would lean her head on my shoulder and clutch to her chest that picture of her husband.
And I would think angry thoughts about how she could be so much more comfortable dying somewhere else, with maybe a controlled heart rate. But right here was where she wanted to be.
And so, throughout that night, the CNA's and I took turns. We held her, comforted her, and cried countless wet and dry tears for her while doing care on other residents and while holding her.
When I went home after my shift that morning I just cried into my pillow.
Grace held on for about two more days. The night that we took turns sitting with Grace was the last night that she was really alert.
And then she died.
And although we all thought those same words that she had said to her son on her first day with us "I love you, don't go," Grace did go. She chose to die with us, outside the hospital, without maybe a more comfortable way, because she needed love.
Without realizing it, we had allowed Grace her autonomy, her freedom to make her own choice, when she came back to us with an uncontrolled heart rate to die.
So we held her, we comforted her, and we loved her.
And because we loved her, we let her go.
