It's Never Too Late

[bewitched]

In one of the free Kaplan eBooks referred to in this thread, Final Moments: Nurses' Stories About Death and Dying, I just read a short story called "Never Too Late" by Rachel Shinabarger, RN. The text of this touching story about a student nurse's first glimpse at death can be read here on Google Books.

The story not only brought tears to my eyes, but actually made me cry openly as I imagined not only my own loved ones, but the scores of patients who have no one to come and visit them, no one who cares enough to be there in their final hours. My mother is a geriatrics nurse with twenty years' experience, but I have always said that I would never work in a SNF simply because it seems too depressing to deal with waiting for people to die and I grow nervous/anxious around patients with Alzheimer's/dementia, due to their unpredictable behaviors.

However, reading Ms. Shinabarger's short-but-so-very-sweet story has made me reconsider the way I think about those elderly patients who have so often been "put in a home" by families that do not have the patience or resources or time or energy to "deal with them." Only rarely do I actually see family members visiting with residents when I've gone in to my mother's various SNFs, and it really hit me how very many people actually die alone. Especially those that we think are "too far gone" to appreciate visitors, as in the case of the end-stage patient in "It's Never Too Late." I still suspect that geriatrics is not for me, but I have certainly gained an appreciation for those geriatrics nurses who, like my mother, will go above and beyond to make sure a patient is comfortable, cared for beyond simple medical care, and knows that there is someone there who cares.

For me, there is another aspect of this story. As someone who has not yet even started nursing school, I often wonder how I will deal with those many nursing firsts--the first clinical, the first bedbath, the first total screw-up over something simple, the first code. But up until now I had not really considered how I would handle the first death of someone under my care. I have lived a life relatively untouched by death--only my grandfather and my great-aunt have died that I remember--but I have witnessed the death of my fiancee's grandmother "A" firsthand.

After many days of not eating or drinking much at all, everyone thought she would be passing soon. So she was released from a SNF to spend her last week at home. The first day home, she showed a remarkable improvement--not only was she up and out of bed, but she was wheeling around the house in her wheelchair, happily sharing a bag of cheese puffs between the dogs and herself. She even asked to go out to dinner, so my fiancee and his mother took her to Cracker Barrel to eat. She enjoyed her turkey-and-stuffing meal, but in the middle of it, she fell asleep, and could not be fully roused again.

For the next three days A was under hospice care. Bedbound, she sunk into a period of semi-conciousness, and after a time, stopped speaking or really responding. She became gaunt, her arms and legs turned purple with a lack of circulation, and by the time I saw her on the third afternoon, she was breathing through her mouth in gasps that came at varying intervals. Not long after my mother and I arrived, A's breathing changed, and there was a gargle in her throat. The hospice nurse told us that her passing was close, and my fiancee's family came from the rest of the house to gather around her. Everyone leaned down to tell her goodbye and they loved her.

Not ten minutes later, A took a gasp and then did not breathe again; for a moment she seemed to be struggling against death, until my fiancee's mother urged her that it was okay, that she could let go, and go towards the light. It seems that A listened, because she calmed, and very soon the hospice nurse pronounced her.

It was my first--and thus far only--first-hand look at death. At the time, I had no idea what was normal for someone dying; indeed, I didn't even really recognize that she was actively dying. It seemed like a fitful sleep she might snap out of at any minute. But in the two years since, I have learned that A's death was very nearly a textbook death, including her lack of eating and drinking, her one amazing day of revitalization, her loss of circulation in the extremities, and what I now know to be termed Cheney-Stokes breathing. I look back now on her passing as a learning experience, as I am sure she would like me to; she was very fond of me and the puppy I would bring in to see her, and I am sure she would support my nursing dream. She always loved her nurses!

I only hope that I can help other patients, who may be at the end-stages of illness, or may simply be passing through the hospital on their way to a full recovery, to feel as though they are appreciated and important and thought about, even if their own family members may never visit them or may, in fact, have predeceased them. There really is no reason that anyone should die alone. I commend all hospice and palliative care nurses who make this their very mission!

Anyways, I highly encourage everyone to check out Final Moments: Nurses' Stories about Death and Dying (Sherman); so far it has been an eye-opening read. It is free right now along with many other nursing reference books and nonfiction through iBooks for iPod/iPhone/iPad through Kaplan Publishing's free book giveaway that lasts until 8/30/10.

Thanks to all who have stuck by to hear my rambling story; I would have posted this in the "blogs" section but that must require a paid membership. =)

Shinabarger, Rachel. "Never Too Late." Final Moments: Nurses' Stories about Death and Dying. Ed. Deborah Witt Sherman. 2009. Print.

[mamamerlee, LPN]

Thank you for your post. You are obviously a caring person, and I am certaain you will be a thoughtful nurse.

Best wishes, to you and your mother!

[ErinDel, ASN, BSN, RN]

Thanks for your post. It reminds me of my pa when he went on hospice for terminal lung cancer. I was with him for every minute through the whole two weeks he lasted on hospice. I remember sitting with him as he ate his last grilled cheese sandwich, asking me how much longer he had to live. He sat there and cried to himself scared knowing the end was coming. I sat with him as he lay in bed hallucinating that his deceased siblings were standing behind me talking to him. I bathed him, watched his hospice nurse give him his meds and explain to me what was going on with his body as it began shutting down. I sat there listening to his horrible death rattle. I would whisper in his ear what i wanted to say to him. His last day alive, i gave him a bedbath getting him ready for family to visit one last time. I told him id b right back, I had to get something in the other room. When I got back, he took his last breathe, he was gone. I will never forget that moment. Atleast I know pa was not alone during his final weeks of life. I couldnt imagine anyones loved ones being alone through that.