Grace and Love
A glimpse into a nursing home where an elderly patient makes a decision about death. The staff cares for her while feeling sorry for her. Then they realize they are acting out a core principle of nursing practice.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.Last edit by Silverdragon102 on Jun 1, '11 : Reason: reduce font size to make easier reading
About SarahLeeRN, BSN, RN
I am an RN who works in a nursing home. I learn a lot about life and nursing from the residents that I care for.
From 'Anytown, USA'; Joined Jun '09; Posts: 95; Likes: 498.Jun 2, '11 by vlk70lpn2RNThank you for this post. It reflects so much of what I have felt with the many LTC patients I have been with in their last few months to days over the last 3 years. I am leaving LTC soon to start in ICU, but will never forget the lessons I have learned about loving people enough to allow them the autonomy and dignity to die as they choose.Jun 4, '11 by Chin upVery well written, very compassionate and a beautiful message. Thank you!Jun 5, '11 by amandakashThis is a very nice post. It reminds me of the way my maternal grandmother just passed. She was in the ICU and not LTC, but in the end she knew something we didn't. She knew that it was time for her to stop suffering. Luckily we were all able to visit with her, and some of my family was with her when she passed. She refused all medicine except pain meds and after that decision she was gone in less than 24 hours. Thanks for posting this.Jun 8, '11 by ocmamaWell my morning cup of tea just turned into a morning cup of tears, but thank you for sharing that! I am moved by Grace's dignity, humor and determination and also by your compassion and respect for her. She was lucky that you came into her life and could really be there for her.Jun 8, '11 by SamAcctWow, thanks for the touching story, God bless you! This is exactly why I want to become a nurse, genuine care for people.Jun 8, '11 by SE_BSN_RNWow, is all I have to say. I work in LTC and feel this way about many of my residents, its so hard not to become attached to someone when you know what the final destination is. May I reprint this, just to take to work and share?Jun 8, '11 by mx343momThis was such a touching post. It is the most difficult thing to make the decision to put your loved ones in a nursing home and we all hear horror stories about them . It is so comforting to know there are people who care so deeply about their clients and consider them family. I have had to experience both my parents placed in nursing homes- different ones at different times. It was hard when my mother had a stroke and needed that kind of care. I felt so guilty everytime I left there and never felt like I could spend enough time there .. but she was so well cared for and that was atleast gave me some comfort to leave. It was even more remarkable that her health steadily declined after when the aide who so lovingly cared for her for 7 years developed cancer and could no longer work. My mom had that special bond with her and it was a great loss to her. My father on the other hand had a terminal illness when we placed him and it was the last thing he ever wanted but his pride wouldn't allow me to care for him myself.. it was too embarrasing for him. He declined rapidly but the staff in the nursing home was so wonderful and spoiled him rotten! The day he died several nurses who had not even cared for him that long and didn't even know me at all sat with us for the last 24 hours.. never left my side or his and comforted us both through those last horrible hours while I had to find the strength to tell my daddy it was ok to let go. Those nurses were so wonderful to me and my dad and I was so stunned that they would take so much time with someone they didn't even know and comfort me when I had no one else. One nurse in particular stayed the entire last 24 hours with me.. even her personal time and never left me alone. We laughed and cried like we were family. I never had met her before and I have never seen her again.. but she left the most lasting impression on me about just how caring nurses can be!
And that is what it is all about.. Nursing is caring- with grace and love!Jun 8, '11 by SE_BSN_RNQuote from mx343momThis was such a touching post. It is the most difficult thing to make the decision to put your loved ones in a nursing home and we all hear horror stories about them . It is so comforting to know there are people who care so deeply about their clients and consider them family. I have had to experience both my parents placed in nursing homes- different ones at different times. It was hard when my mother had a stroke and needed that kind of care. I felt so guilty everytime I left there and never felt like I could spend enough time there .. but she was so well cared for and that was atleast gave me some comfort to leave. It was even more remarkable that her health steadily declined after when the aide who so lovingly cared for her for 7 years developed cancer and could no longer work. My mom had that special bond with her and it was a great loss to her. My father on the other hand had a terminal illness when we placed him and it was the last thing he ever wanted but his pride wouldn't allow me to care for him myself.. it was too embarrasing for him. He declined rapidly but the staff in the nursing home was so wonderful and spoiled him rotten! The day he died several nurses who had not even cared for him that long and didn't even know me at all sat with us for the last 24 hours.. never left my side or his and comforted us both through those last horrible hours while I had to find the strength to tell my daddy it was ok to let go. Those nurses were so wonderful to me and my dad and I was so stunned that they would take so much time with someone they didn't even know and comfort me when I had no one else. One nurse in particular stayed the entire last 24 hours with me.. even her personal time and never left me alone. We laughed and cried like we were family. I never had met her before and I have never seen her again.. but she left the most lasting impression on me about just how caring nurses can be!
And that is what it is all about.. Nursing is caring- with grace and love!
MX, I did this for a woman in my clinical rotation. The ambulance came to take the patient to a nursing home, and as they moved him from bed to stretcher, he began taking his last breaths. It was my first clinical rotation, and first patient I cared for. I was the only one in the room at the time with her and her father, the nurse never came in. I stood by her side through it all with my arm around her. She was shaking so bad I thought she was going to faint, and watched as she cried and told him it was ok to go. I told him it was ok, also, and I was the last person he saw. He didn't look at his daughter as she spoke, he looked at me. (I suppose maybe because I was dressed in all white and had my hair pulled back, or maybe because I was a strange voice.) After he was gone, I hugged her and gave her my sympathies.....then had to go to the nurse and see if she wanted me to do anything more. After clinicals, I had to tell my experience to the class. A few weeks later I got called up in front of the class.....the woman had written a letter to the hospital, which was then forwarded to the director of the program. (I thought I had done something wrong and I thought they were going to kick me out!!) But they told me and my clinical instructor, in front of the whole class about the letter she had written and how much she appreciated that I, as the student, took time out of my work to stay with her. And, truly at that time with her, I thought nothing of it. My clinical instructor knew what was happening and let me experience that on my own. (She did ask me if I wanted her to stay and I said no.) And I made a pact from then on I would never let a patient die alone.
I also had to put my MIL in a nursing home....it is not an easy decision to do something like that, at all.Jun 8, '11 by SarahLeeRN, BSN, RNThank you everyone for your feedback. It was an experience that taught me so much. I still tear up when I think of her. I know that there can be a lot of negativity associated with LTC nursing, but I feel that focusing on the special moments (and there are many of them) can help. It is true, patients (especially in LTC) can be like family. I know that there are so many staff in LTC settings that really do care deeply about their patients. I am thankful that I am not the only one!
And lvn2bsoon please, feel free to print this. I would be honored!Jun 8, '11 by VivaLasViejas, ASN, RN GuideThis was beautifully written.........a first-rate story that literally made me cry at my work desk when I read the last sentence. The elderly are dear to my own heart as well, and it's always good to know there are other nurses out there who feel the same way I do about them. God bless you, SarahLee.
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