Life, Death, and the Nurse In Between
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.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.Last edit by tnbutterfly on Sep 20, '13
I'm a native Pittsburgher who started with a degree in journalism, before finding my passion in nursing a little further down the road. I graduate in Spring of 2014, and hope to land a job somewhere in the field of pediatrics.
From 'Pittsburgh, PA, US'; Joined Jul '12; Posts: 9; Likes: 72.9Sep 20, '13 by Always_LearningNicely written. Although I have worked in ICU and Hospice - both of which involve life and death - there are some things you don't get over. I am calm and collected with families during their time of mourning. But...there is this sound. It's a guttural, reverse-gasping sound that a family member makes when you tell them their loved one has died. It's like they're trying to choke down this overwhelming grief. That sound has always gotten to me, and still does.5Sep 21, '13 by tnbutterfly, BSN, RN AdminQuote from Do-overFor me, there is nothing more special (I can't come up with a better word - important?) than caring for people (and their families) at the end of life.
I think "special" fits this situation perfectly. I feel honored to be able to share those moments with the patient and their family.1Sep 21, '13 by Breck girlWonderfully written. I have yet to experience my 'first', though I've been present before and after. I graduate in December, and am inspired reading of your career. I have been an English teacher of 25 years and now am now diving in to the nursing pool. So glad to know I'm with fellow swimmers like you and those most excellent hospice nurses out there. I've shared some invaluable time with one, as well and learned so much in a few moments.Last edit by Breck girl on Sep 21, '13 : Reason: grammar! and wanted to add more content regarding hospice experience2Sep 22, '13 by nrsang97Nicely written. I still remember the first patient I had who died. I remember how my preceptor and I tried to make her comfortable.
We just had a code where the patient didn't make it and hearing his wife be told he didn't make it was heart wrenching, especially since it was sudden and unexpected. I have been a nurse for 12 years and it has never been easy when a patient passes away.2Sep 22, '13 by MauraRNWell done. Caring for the dying and the family is emotionally draining at times, but you really do learn how to assimilate that grief. Every death is different, every patient in some way chooses their own passing. Some wait until family arrive, some wait for family to leave. Keep your compassion and empathy intact, you will be a blessing to the families that you encounter.