I hadn't planned to. I'd planned to shave my patient. When I mentally scheduled his "bath appointment" for 1600, he was still alive. But later, when I arrived for our engagement, he was already pretty near dead.
In truth, I really wasn't expecting it. But then, at the same time, I really wasn't that surprised.
I was next door in my other patient's room, helping her on and off of the bedpan when I noticed, via the bedside monitor, that his heart rate had dropped. He had been ticking away at around 83 beats per minute for the majority of the day, so when I saw the big, white numbers dive down into the low 50's, my eyebrows raised.
"Oh, man...is this it? Is he really gonna go for it this time?" I said to myself. I gave him a silent cheer of encouragement.
This might seem like a callous reaction, possibly a heretic. But it was necessary if I freaked out at every dipping vital sign, or critical lab value I see, I'd be a burnt out, nervous, wreck of a nurse. Also, I knew this man's story, and based on countless medical opinions found throughout his chart, he deserved some sympathetic, go-for-it cheering. He'd come to us without a chance in hell of being anything but a mechanically ventilated body. He'd suffered a massive head bleed, and his family had decided against the idea of risky surgical interventions.
Just that morning, the attending on our unit had upped his "Code Status" (aka what we do if someone's heart stops) from "Allow Natural Death," which only excludes chest compressions, to "Allow Natural Death, and Limit Therapy," which means that, in the event of cardiac arrest, we don't do anything at all except make him comfortable, and pronounce him when his heart stops. Pretty much just about everyone had signed off of his case because of his extremely poor prognosis.
I finished up with my other patient and made my way to his room to investigate the monitor's fluky readings. He had done this before - yesterday - his heart had slowed down and then picked back up again, ticking away without a glitch. But this time was different. I didn't even have to look at the monitor or feel a pulse to know that he was dead. In the short time since I'd been gone in my other patient's room, his face had gone from pink and rosy to yellow-ish blue, and he had started cooling down. I ran a cycle of the blood pressure pump-no reading. Thready pulse. Called the resident, and we both agreed...even though this man's heart was still beating 70 times a minute, he was almost completely gone.
It only took a few more moments for it to become official. While the monitor beeped ASYSTOLE! ASYSTOLE! ASYSTOLE! the resident did his death assessment, pronouncing the patient just a few minutes after four o'clock. I did my best to keep our delayed appointment, lathering up his face to give him his last shave, only five minutes late.
Sick? No. Weird? A little. But let me explain. When a patient dies who is a family member to anyone - girlfriend, niece, daughter, wife, brother or cousin - the best thing that can be done is to make he or she look as normal as possible. After having looked at their loved one with tubes and drains sprouting from their mouths for the past week, all the family wants to see is that the patient's face has become familiar once again, even if in death.
So, I took out his breathing tube and feeding tube, and the tape that held them in place, and I shaved his slouching face. The cut came out clean; without any life behind it, his face had no reason to resist or turn away from the razor's blade. When I was finished, I took out his IV's, put on a new gown, made sure his hair was in place and laid his hands open on the bed for his family to hold.
It's peaceful to help someone leave this place when it's right for them to go. There's something strangely holy about watching a person's life change from breaths and words, to numbers falling to nothing on a computer screen.
Hospital policy: Patient's families have two hours to come and view the body after their time of death. Two hours passed, and no one came. The resident, who had spoken to the family, told me that they couldn't make it.
No one to see how well I'd shaved him.
