And He Will Die...
Nurses provide care for families in times of death. Who will care for the nurses so they can continue to grow? How can we, as nurses, support the profession to assist other nurses to continue to be able to provide care when it is extremely personal, such as when death arrives for a family members of our patients. How do we relate to our patients and their families. How do we view death?
Words that are heard by many family members when a catastrophic event is going on in a bed nearby. The lifeline they have held on so firmly is being cut by a doctor who knows the physiological condition of the loved one in the bed.
The doctor walks out. His message has been delivered. He has allowed 30 seconds for questions by the family. They were too stunned to respond except with a quick inhale and the internal la-la-la-la-la of denial throbbing in the head of at least one of the family members. As the tears begin and the sobbing starts the door is quietly closed. Privacy is afforded this family.
The family quickly regroups. No, this can't be real. They want to ask questions of that doctor. Only the vapor trail of the doctor remains. The door to the outside world slammed closed behind the MD as he ran so as not to be there when the questions hit.
The family scans the surroundings. There are no familiar faces close by. They know they cannot approach just anyone and ask the tough questions. They will be directed to talk with the nurse assigned.
Suddenly there is calm in the air. The nurse walks over to the doorway. With a slight smile and with just a hint of sadness showing the nurse takes charge. The important questions are asked. Did the family understand what the doctor said? A quick recital of some of the more important parts are shared. Words like 'brain death', 'incompatible', 'stop heroic efforts', 'no chance' are expressed. More tears. Tears move into sobs and the family tries to stop the flood of emotions. Embarrassment. Shame. Hurt. Fear. Shame? Where did that find its way in? More tears as the family expresses horror that they had not gotten to the hospital sooner. The terror they feel now and the blame they place on themselves for things left undone, unsaid.
Thankfully the nurse stays steadfast. Death is not a new thing for the nurse. For the doctor it is always the foe: The challenge to be beaten. But for the nurse death is a reality. Not always the enemy. Not always a friend. But always a possible outcome, a destiny for many who are cared for by the loving hands of the nurse. The nurse does not run out the door. There is no vapor trail to note the exit line. The nurse stands with the family. The family is encouraged to talk about the person. They are encouraged to donate for others. They are offered grace in a time of turmoil.
The end of life comes to many under the care of such a nurse. Day after day, hand hold after hug the nurse stands for and with the family. The nurse brings bottles of water, reminds the family that they need to rest, offers chairs and warm blankets so the grieving family members can remain with their loved one and wait until the machinery can be removed, a prayer may be offered, "and he will die" becomes reality.
Who comforts that nurse? Who brings the emotional blankets to soothe? Who makes sure dehydration does not set in and add headache to the heart ache suffered with each tough case?
Grief by the family can take many forms. Grief by the nurse is often not even recognized.The nurse goes back to do the same thing day after day, always hoping for a good outcome. The toll? Nurses get tired, worn down, seen as cold, unfeeling, uncaring.
You watch those babies, children, youth, young and old die day after day you get no sympathy. Not only do people fail to recognize your pain, they laugh about the fact that some nurses could feel that pain.
If we cannot support each other in the pain of end of life care then we will die. We will be called burnouts, hard, harsh, and cold. We may still put on our scrubs and we might continue to work until it becomes overwhelming, but lack of support when doing end of life care will end with: The nurse will die. It could be mental health, physical health issues or suicide. Drugs and alcohol take their toll. No matter what we lose a great nurse. That nurse who stood steadfast and supported that family when those terrible words were said needs the same support offered the family. With that support a great hospice nurse can evolve. "And he will die" is no longer a phrase to be feared. It is a part of the life cycle that is faced by the nurse each shift. It is not the foe, the enemy, the horror. It is an opportunity to do what nurses can do. Be present.Last edit by Joe V on May 2, '12
AKY spent many years in many kinds of nursing. The things that come back are the kindnesses done by nurses at her darkest hours. This article is a form of thank you.
TopazLover has 'a life time' year(s) of experience. From 'Delaware. River and State'; Joined Jun '08; Posts: 8,005; Likes: 23,038.May 2, '12 by leslie :-Dthank you for this, kathy.
this touched my core.
it was poignant, bittersweet, and sensitively portrayed.
and i am (slightly) smiling.
leslieMay 2, '12 by nerdtonurse?So true. We are so busy taking care of everyone else, checking on everyone else, nobody notices when we're the ones that aren't okay.May 2, '12 by VivaLasViejas, ASN, RN GuideThis is a magnificent piece of writing, AKY. And the fact that it comes from a soul made wise and tender by life experience, only makes me respect and admire you more.May 2, '12 by sharpeimom, MSN Guidethank you kathy! thank you so much for your sharing and caring always.May 2, '12 by flyingchangeThank you for this article. I completed my preceptorship in Oncology and one of the hardest things was explaining to my peers was the toll of being the strong nurse, even when the death was expected or welcomed.May 2, '12 by inthemoodI love being a nurse. For all our faulty humanity, yet we still walk everyday right on the border of transcendence. There should be more of us, the enlightened of us, in administration and elected office. We would be on our way to a much better world if that special place we inhabit was brought into the public sphere.
Thank you for a beautiful essay.May 3, '12 by GinaDecorRNThank you for this well written article.
Compassion Fatigue was the topic I just presented this week for my RN to BSN Capstone class.Last edit by tnbutterfly on May 3, '12May 3, '12 by not.done.yet, MSN, RN GuideWonderfully said and, for me, well timed. I had my first patient this week who had made it clear they were ready to go home and be done. Not to LTAC but home. Declined all further blood glucose testing and insulin. Declined a few meds that were making this individual feel poorly in some way. Signed DNR. And I, a brand new baby nurse, assigned to the overnight shift to care for said patient and their spouse during their first night after making these massive decisions.
To say I was intimidated would be an understatement. I felt inadequate and frightened. I have been through that decision myself with my child and yet facing this family I felt helpless and like a deer in headlights. It is probably not quite the same thing since this patient did not die on my shift as did in the OP's article, but their entire family was coming to terms with the decision and were so so sad. The patient was peaceful, calm and very conversational, moreso than had been in weeks according to the spouse. The spouse was tearful, reminiscent....I was amazed that it only took a question or two to open the door for them to start talking together about their 50something years of marriage and how much they learned from one another along the way, there in the dark of night by the light of an IV pump. It was sacred and special and I feel privileged to be part of it....and yet I feel sad and wore out too. It was....intense.May 3, '12 by TopazLoverGina, I just stopped by your site. It is beautifully done.
Actually I am not a hospice nurse so I really have little to add.
This article was written as a thank you to all the nurses who cared for my husband and our family during those terrible days. It was him I heard those words about. It was the nurses who cared enough to hold us when we were falling apart that I hope this piece honors.May 3, '12 by TopazLovernot done yet, Thank you for sharing this experience. It is the real reason why I felt I wanted to write the piece. Good nurses feel these experiences and have so few ways of dealing through it.
As I have written in another thread this is a love letter to the nurses who cared for my husband. Of course they are nameless and faceless. They are you, and you are any one of them.
It is intense. Blessings to you for waht you do.