Holiday Epiphany

Susan K K RN

What has helped you become a better nurse?

In my transition from teacher to nurse, holidays were at the center of the change in my life. In the 23 years that I taught, I had never worked holidays. I had a big extended family, and I was the baker and cook, especially at Thanksgiving and Christmas. Having to work at the hospital at these times changed my family dynamic. The big festivities were at someone else’s house, and without me.

My little sadness over missed holiday celebrations disappeared abruptly as I witnessed patients and families missing their cherished celebrations, often at the bedside of a seriously ill or dying loved one. There was not much fun, not much laughter, and often, looming death for these families. In addition to feeling quite humbled in watching these families cope with their real problems, I began to witness and become aware of how people go about dying.

Many dying patients I’ve been with have been mostly unconscious, for several days to just a few hours prior to their last breath. While caring for consciously dying patients though, I started to wonder about the death process – but not physiologically. As a former high school Chemistry teacher, I once read a book about the Chemistry of dying, which chronicled the steps of bodily shutdown and decay. While a bit gruesome, it was fascinating.

So now, as a nurse, I started to wonder instead about the other unfolding processes: intellectual, psychological, and spiritual. What was going on in their minds? Was it something different than before they were dying? Were there any similarities with all other dying people?

My thoughts in this realm were likely due to a lecture from a guest professor in nursing school speaking about how to help dying patients have a ‘good death’. Unknown to me, her words would change me. She spoke of all the ways that nurses work to ease the course of dying: pain relief, comfortable room conditions, a peaceful environment. And she asked us to consider other factors:

Was the patient’s dignity being upheld?
Were their preferences being honored?
Was the patient allowed their choices regarding treatment?
Was there frankness about the impending death, or was it being hidden?
Was the DNR status based on what the patient wanted, or what the family wanted?

But this guest professor, back when I was a nursing student, near the end of her lecture, talked about reports of dying patients having visions and sometimes discussions with people who were not in the room. This was a new concept for me, and she had my attention. Were these events merely hallucinations? Delirium? A morphine-induced fugue? Wishful thinking? Did they really happen? I had been a science teacher for 23 years. How could I believe this? But then, what about being open-minded? I just didn’t know what to think.

Since that lecture in nursing school, I’ve spent time with many dying patients, as well as four of my elderly relatives that died in my presence. Three of them were conscious until nearly the end. My Dad talked a lot in his final hours, and at one point asked me to keep the family together. Yikes! This would be a daunting task. We were a troubled family. But in that moment, my thoughts were about whether he could reveal some deathbed mystery as he neared that boundary between living and dying. It didn’t happen.

Some years later, working on Christmas Eve, I was caring for an elderly dying man named Harold. He didn’t say much over the few days that he was my patient. His delightful, boisterous wife and her two sisters were in the room each day, chatting and watching daytime talk shows on the TV. On this day, I had discharged two of my four patients, and so had extra time to spend with Harold. I pulled a chair up to his bedside and started to talk to him. I wasn’t sure if he was awake or even conscious. I talked to him of little things, with no response from him. So I decided to ask him questions instead – was he comfortable, warm enough, did he want water, was he in pain? And surprisingly, with his eyes still closed, he answered. I had asked him if there was anything at all that he wanted, or if he wanted to say something. His answer was “Yes”. At that moment I remembered that guest professor’s lecture, and once again wondered if dying people see things we cannot, or if they have any privileged information to reveal.

In the meantime, the three ladies were in the room, talking and laughing, with the TV on in the background. It was noisy.

I moved closer to Harold, so I could hear him better. He was whispering, “Yes, I want to say something.” I was feeling anxious now. Was this going to be a deeply meaningful declaration, maybe even a spiritual moment shared with Harold in his final moments? Was I going to be privy to some secret mystery revealed? I leaned closer. “Yes? What is it, Harold? What is it that you want to say?” And Harold answered.

“For once, just once in my life” Harold whispered slowly – I was sort of holding my breath – and he continued, “Just once, I’d like to watch WHAT I WANT on the TV.”

It made me laugh, and I was a little dumbstruck. Not about what Harold had said, but by the ridiculous things I’d worked myself up to thinking.

I explained to the ladies that I was going to change the channel to what Harold wanted – he’d asked for ESPN- and sent them to the coffee shop for a while. As I continued to sit there with him, I stopped talking so he could hear the program, but I was shaking my head at my own foolishness. My vision of a deathbed revelation was just a contrivance, borne of an absurd wish to find the meaning of life in death.

And yet, on that Christmas Eve, as I continued to sit there with Harold, it occurred to me that Harold had given me something precious indeed – a wonderful Christmas gift. I remembered when my father was dying a few years before. My Dad’s final words weren’t about someone long dead that was coming to pick him up and accompany him somewhere beyond the veil. Nor were Harold’s last words the epiphany I was expecting. No, the true epiphany – Harold’s gift - was the memory and my sudden recognition of what my father was asking for in his dying words: that we be good to one another, that we take care of each other, and that we all stay together. What could be more intellectually, psychologically, or spiritually meaningful than that? It was a lovely Christmas.

Publications and References

Strodtman, L.K. and Giacomazza, M. G. (Producers). (2006). Evan Mayday’s “Good Death” [DVD]. Ann Arbor: Regents of the University of Michigan. The University of Michigan.

A Dictionary of Hallucinations

pinkdoves, BSN · Jan 26, 2022

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Holiday Epiphany

What has helped you become a better nurse?

About Susan K K RN

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