Life, Death, and Other Matters of Consequence

Some days, it's just not worth chewing through the restraints.......

I am a seasoned long-term care nurse. I deal with life and death matters all the time. My voice is often the last one a patient hears, and my hand the last human touch he or she feels. It's OK most of the time, that's why I was built strong enough to handle the load, and for the most part I feel blessed to have been given the privilege of providing solace and comfort to a soul preparing to leave this earth.

But there are times, like now, when the burden becomes a bit heavy and my shoulders literally ache under the weight of it. We've lost so many residents this winter to pneumonia and other diseases of the age; on my unit and my shift alone, no fewer than eleven have passed on since November. Since we have several hospice beds on my floor, this is not a shocking statistic, but since I'm on a first-name basis with the local funeral homes........well, you get the picture.

But now it's become personal. A very dear lady from the assisted living facility where I worked for 2 1/2 years has checked into one of my hospice beds with a gangrenous left leg; this woman is not only my patient, but my friend and colleague (she is a registered nurse with over 50 years' experience). She told me she "just couldn't do this any more" after undergoing a BKA of the right leg four years ago, suffering a stroke two years ago, and bouncing back and forth between the hospital and the nursing home for most of the time after that. She's been through enough........now she wants to let nature take its course, and to be kept comfortable until it does.

I understand that; in fact, I support her decision, and would in all likelihood make the same one if I were in her place. I'm only fifty, but like my friend, I've lived a satisfying life, and I have few regrets---why on earth would I want to prolong the inevitable and suffer excruciating pain while doing it?

Still, this is harder for me in some ways than all the previous resident/patient dying processes ever were. I'm seeing this woman whom I love and admire slip away a little more every day. I'm watching her become increasingly somnolent and confused. I'm changing her dressings every night and seeing the relentless progress of her disease. I look in her eyes, and I know that even in her Dilaudid haze she knows the truth, though her family is still holding out hope for a miracle. I don't know what to do with all of the emotion that's simmering just under my calm exterior. Some nights I wish I could just run out of the room and cry until there are no tears left.

Now, being a spiritual person, I imagine that there is a lesson in all of this, some nugget of wisdom I'm supposed to glean from witnessing this slow, painful process. I also have to presume there is another one in the shocking, unexpected death of another woman I cared for during a two-month period, a relatively young patient who'd broken her ankle, been admitted for therapies, and gone home just a couple of weeks ago. In fact, she called me just last week to let me know that she was finally walking again and that she'd come visit me at work as soon as she got the doctor to release her to drive again. She reportedly had felt "bad" early yesterday morning and called her home health aide to take her to the ER, then collapsed in the parking lot and died before they could get to her. A bowel obstruction, the ER physician said..........Tell me, how does a 62-year-old die from a bowel obstruction in the year 2009? She hadn't had any bowel problems at all when she was in the NH, and all of a sudden she's dead?! Surely, doctor, you must be joking.

But no, it's a sad reality, and I'll be attending her funeral Saturday morning. This is not my idea of a good time, but I'll be there.......just as I'll be at Eva's services when that time comes, no matter how difficult it may be to say good-bye. Part of me hopes she passes on someone else's shift; but then, if it happens on my watch, I know she'll have received the best of care. I owe her nothing less. And I pray the end comes soon, for her sake: she has indeed suffered enough pain and disfigurement for one lifetime.

As every nurse who ever lived knows, these are the times that make one wonder what s/he was thinking when s/he decided to enter this profession. I could have done without this sort of heartache. I could have gone the rest of my days without understanding that death is not just at the end of life, it is all through it. But then again, helping people and families through this transition may be exactly what I was made for, and it may be why I'm always able to hold it together somehow, even when my heart is breaking. I only hope that someday God will explain it to me.