I don't mean to make light of the subject matter when I say I'm a rookie when it comes to death. But I come from a small family, and one that's stayed pretty healthy for the first 28 years of my life. I've kept this fact nervously in the back of my mind, knowing that I would likely encounter end of life circumstances in the nursing field. I was told you'd never forget the first patient that slipped away from this life, and after my experience yesterday, I would have to say I'd agree.
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He was an elderly patient, unresponsive and on comfort measures only, when I met him at 8:00am that morning. The staff had guessed based on his current state that he would pass away that evening, or perhaps overnight. I was following a kind and compassionate hospice nurse for the day as part of the class I'm in. She asked if I would like to help assess him, and we got to work. The first thing I noticed was his breathing. I watched his chest. I glanced at my watch. 36 breaths per minute, using accessory muscles, with expiatory wheezes in all lobes. The nurse looked up at me and said gently, "this is not comfortable, let's treat this first". She gave him IV Morphine and Ativan, and we went on to care for several other patients.
We returned shortly to reassess him. His son met us in the hallway, and glancing at his father and back to us with anxious eyes, asked "How is he doing?" The nurse explained that we had given him some medication to allow him to breathe more comfortably, and she wanted to see how it was working. The three of us could see the medicine hadn't had much of an effect, so the nurse went to get some additional medication. It wouldn't be necessary.
Several seconds after she left the room, the patient stopped working so hard to breathe, and a long period of apnea began. The son's eyes bulged. I ran to the hall and called for the nurse. With her stethoscope on his apical, and my fingers on his pulse, we watched, waited, listened. There were no monitors, just us. A long pause, followed by the nurse's voice, barely above a whisper, "I'm sorry. He's gone." It was 10:17am.The son knelt down and kissed his father's forehead. The patient's wife of 68 years and several other children were on their way there. "Let's get you looking nice for Mom", the son said softly, and walked out of the room.
What happened next I wasn't expecting. Before I could begin to perform postmortem care, I began choking back tears. The nurse looked up and asked gently if I was okay. I felt my face flush with embarrassment. I thought to myself that it was not my place to cry over a stranger. To lose composure. I tried to answer her question, but holding back the giant lump of a sob in my throat was the only sound that came out. "First...time. Patient...Death." That was all I could get out, but she knew what I meant. She put her arm around me for a moment and told me it was okay. I rubbed my face for a few seconds and went back to work.
I looked down for a profoundly odd moment at the man who was just "there", and was now "gone", and tried to figure out why he's passing had such an impact on me. I had never heard him say a word. Never saw him on a "good day". I didn't even know of his existence until 2 hours before he left this world. I had expected as a part of my training and profession, to feel compassion, to show empathy to the family, to offer comfort. I was not prepared for my own personal emotional breakdown, which followed me home.
As I lay in bed that night, I began to realize that it wasn't specifically that man's passing that had upset me so unpredictably. It was a son's agony and tenderness in watching his father leave him behind. It was the love of a man's life, his childhood sweetheart, wanting to be by his side, and arriving 15 minutes too late. It was standing by while a large, loving family walked into a room to reluctantly face the "goodbye" that they didn't know how to say. It was being intimately in the middle of the frailty of life and the finality of death, and feeling like I had no clue as a nursing student, as an outsider, what my place was.
I talked with my clinical instructor the next day about my emotional response to everything. I was expecting to hear a cliche of comfort, or the ever popular "it will get easier". Instead, I was touched to hear, "Maggie, your level of control and outward response may change, but if you ever get to a day where your heart doesn't break for the breaking hearts of others, it's time to find another line of work." I still have a long way to go in learning how to remain strong in the face of pain, to offer sincere comfort to people I may barely know, and to understand the profoundly important position of a nurse in standing by a patient's side at life's end. Yesterday was a big step, and I will not forget the man, or his family, who allowed a young nursing student in to begin to figure it out.
