I had an amazing experience today.

[HappyPediRN]

This morning I went into work after being off and found I would be caring for a patient who had just become care and comfort. He suffered for a long time with cancer and very slowly deteriorated at our hospital. His son and daughter were with him most of the day and around 1 I went in with another nursing assistant to change him, turn him and give mouth care. The daughter went for a walk and the son waited outside. His breathing had been labored and rapid throughout the day despite a morphine drip, and as we turned the patient the nursing assistant began humming "Eagle's Wings" to him. I joined in singing and just as we finished the comfort rounds his breathing changed dramatically, as if he finally relaxed, and I had a gut feeling he was about to pass away. I ran out to his son and told him to please come back because I didn't think it would be much longer. This was a surprise to him because he had just become comfort measures. Just as the son reached the bedside he took his last breath and passed away.

I cannot stop thinking about this. I've cared for many end-of-life patients but this experience touched me so deeply. I've never had that gut feeling before, and I'm so glad that his son made it to the bedside just in time because he really wanted to be there for his dad in his last moments. I feel so humbled and grateful.

[HappyPediRN]

A wonderful hospice nurse told me that, sometimes, people wait until their family has left the room to die. And by golly, if my beloved auntie didn't go and do that when we were outside the room for just a few minutes.

Very sweet story. Thanks for sharing it.

When this patient's daughter came back from her walk she was upset that her father passed away while she was gone and told me that her mother did the same thing. I told her that patients often wait to pass away for reasons we can't understand, but that it seemed to me even in his final hours he still wanted to protect his little girl so he waited until she went for a walk. She began crying again but I think she knew exactly what I meant.

[BelleKat, BSN, RN]

Yes,it's my experience that they wait for their family to leave the room too.

It's wonderful that you made him comfortable enough by taking care of him and gently singing to him that he chose that time. Very good,you can be my nurse anytime.:redbeathe

[lpnstudentin2010, LPN]

Wow that is truely an AMAZING story. My eyes are welling up with tears.

That song always does me in. There was a police man I was VERY close to (and had known since I was 2) who passed away about 3 ago (I was a junior in highschool). My school had a memorial mass for him because the family would not let ANYONE else come to the funeral (alot of people in the community were upset by this he was widly loved) and we sung this at his service. Oh boy do I miss him. I actually thought of him just last night as a matter of fact.

He actually waited for his wife to go before him. She had been bed bound for 20 years and he cared for her. He was ill himself (diabeties complications) had toes removed and all. about 6 months after she passed so did he. I think he felt his mission on earth was fulfilled and felt at peace to leave this world for the next.

[jlmb214rn, BSN, RN]

I also had an amazing experience recently. I am orienting a new nurse to the floor who at this point is ready to be on her own. It was her second to last day so she was doing her thing and I was there for support. She took the entire load of patients so when the ICU wanted to send me a palliative care patient, I took her as my "only patient". I love end of life care and was glad to have the opportunity to be able to devote all of my attention to this patient and her family.

It was an 89 year old woman who had come in for an pleural effusion in the rt lung. Her condition on arrival was grave enough that she recieved a chest tube and was sent to the ICU. She was placed on BIPAP where she stayed stable for a week, but with no improvement. On the lady's 90th birthday, the family decided to remove her from the BIPAP. The ICU staff took her off with the family gathered around, but to everyones surprise, she kept breathing on her own... effectively. She required oxygenation but only with a nasal cannula. She was still unresponsive at this point. The decision was made to transfer her to the floor and put her on palliative care. Her transfer orders were for diet as tolerated, (she was unresponsive), NS @ 10cc/hr to KVO for Morphine 2mg hourly as needed, 02@2liters, and q2 turns. The chest tube was put to waterseal and that was that.

When they brought her up, I took one look at her and just knew that the transfer from the ICU bed to our bed would be it. Transfers on patients that looked that bad were always it. But she survived the transfer. During our fourth turn of the night, she opened her eyes. I stayed in and did a neurological eval on her. She was not verbally responding to me but she would follow me with her eyes, and could nod her head. The Hospice nurse had already been in to discuss with the family expectations at the end of life so they understood that there is often slight improvement before the final decline. But something felt different to me about this one. I let the rest of the night ride out just taking care of her but not pursuing anything aggressive.

When I came back the next night, the nurse reporting to me said "I just don't think this is it for her." I had had that same feeling the night before. I took her as my only one again that night and when I went in to do my assessment, she was in a semi fowlers position and alert, looking around the room. I asked her how her day had been and to my suprise she said "I feel terrible, honey." !!!

Granted her speech was VERY garbled and difficult to understand (she had been lying for 10 days with her mouth open and didnt have her teeth in) but I could make it out. I proceeded to talk with her and ask her some neuro check questions and she was oriented. She was a little confused about the dates obviously and a little foggy on EXACTLY what hospital she was in, but was easily oriented!! She told me that it was 2008 and Bush was in office and asked me if she had had a stroke!! I was flabberghasted at this level of improvement. The family had no idea what to think. They couldn't understand her speech so I had to interpret. Everything she said was so appropriate and she even joked around and told me stories about her late husband and their gardens and her baking pies... just 100% oriented and I was amazed! I sat in there all night. She was stiff so I exercised her legs and she expressed an interest in her daughters ice cream. She ate a half cup of that. Drank some water. Then wanted some Pepsi. I just couldn't believe what I was seeing. We tried to get her teeth in so we could understand her better but her mouth was so dried out and they wouldnt stay in place. She was able to voice things that made her uncomfortable, tell us that she didn't want so much Morphine. I was so excited to be able to pamper her that night and spend so much time with her and the family. Closer to morning, she told me to go to her house and get her tan shoes ("they are the only ones that fit right") and her rolling walker because she wanted to walk!!!

Keep in mind, ALL we are doind for this woman is 10cc of saline per hour and iv morphine. Better bet after that night I was on the phone with the docs getting her fluids increased, getting the surgeon who put the chest tube in back on her case, getting things ordered to support her if she was gonna turn her bus around and head back our way! As I left that morning, she was sitting up in bed eating cream of wheat and thickened OJ. I told her that I was going to be off a few days (going on a weekend trip) and she squeezed my hand tight and said "Thank you, precious, for taking such good care of me." I teared up like a baby, but I had spent a LOT of time with her. And I figured that when I got back to work that case management would have already had her home. She teared up, the daughter teared up... It was so touching... When I got back from my trip I dropped in to see if she was still there. She was. I walked back in the room and she had her little rolling walker and was sitting in the chair in her tan shoes eatin oatmeal. Her face lit up like Christmas. She had her teeth in and talked as plain as you or me. Chest tube was gone, she was on po pain meds and she was headed home that day!!!!

To me, that situation was miraculous. To be a part of it and have a hand in it was just amazing. Things like this are unforgettable and they make you realize why you do what you do.:redbeathe

[BelleKat, BSN, RN]

I also had an amazing experience recently. I am orienting a new nurse to the floor who at this point is ready to be on her own. It was her second to last day so she was doing her thing and I was there for support. She took the entire load of patients so when the ICU wanted to send me a palliative care patient, I took her as my "only patient". I love end of life care and was glad to have the opportunity to be able to devote all of my attention to this patient and her family.

It was an 89 year old woman who had come in for an pleural effusion in the rt lung. Her condition on arrival was grave enough that she recieved a chest tube and was sent to the ICU. She was placed on BIPAP where she stayed stable for a week, but with no improvement. On the lady's 90th birthday, the family decided to remove her from the BIPAP. The ICU staff took her off with the family gathered around, but to everyones surprise, she kept breathing on her own... effectively. She required oxygenation but only with a nasal cannula. She was still unresponsive at this point. The decision was made to transfer her to the floor and put her on palliative care. Her transfer orders were for diet as tolerated, (she was unresponsive), NS @ 10cc/hr to KVO for Morphine 2mg hourly as needed, 02@2liters, and q2 turns. The chest tube was put to waterseal and that was that.

When they brought her up, I took one look at her and just knew that the transfer from the ICU bed to our bed would be it. Transfers on patients that looked that bad were always it. But she survived the transfer. During our fourth turn of the night, she opened her eyes. I stayed in and did a neurological eval on her. She was not verbally responding to me but she would follow me with her eyes, and could nod her head. The Hospice nurse had already been in to discuss with the family expectations at the end of life so they understood that there is often slight improvement before the final decline. But something felt different to me about this one. I let the rest of the night ride out just taking care of her but not pursuing anything aggressive.

When I came back the next night, the nurse reporting to me said "I just don't think this is it for her." I had had that same feeling the night before. I took her as my only one again that night and when I went in to do my assessment, she was in a semi fowlers position and alert, looking around the room. I asked her how her day had been and to my suprise she said "I feel terrible, honey." !!!

Granted her speech was VERY garbled and difficult to understand (she had been lying for 10 days with her mouth open and didnt have her teeth in) but I could make it out. I proceeded to talk with her and ask her some neuro check questions and she was oriented. She was a little confused about the dates obviously and a little foggy on EXACTLY what hospital she was in, but was easily oriented!! She told me that it was 2008 and Bush was in office and asked me if she had had a stroke!! I was flabberghasted at this level of improvement. The family had no idea what to think. They couldn't understand her speech so I had to interpret. Everything she said was so appropriate and she even joked around and told me stories about her late husband and their gardens and her baking pies... just 100% oriented and I was amazed! I sat in there all night. She was stiff so I exercised her legs and she expressed an interest in her daughters ice cream. She ate a half cup of that. Drank some water. Then wanted some Pepsi. I just couldn't believe what I was seeing. We tried to get her teeth in so we could understand her better but her mouth was so dried out and they wouldnt stay in place. She was able to voice things that made her uncomfortable, tell us that she didn't want so much Morphine. I was so excited to be able to pamper her that night and spend so much time with her and the family. Closer to morning, she told me to go to her house and get her tan shoes ("they are the only ones that fit right") and her rolling walker because she wanted to walk!!!

Keep in mind, ALL we are doind for this woman is 10cc of saline per hour and iv morphine. Better bet after that night I was on the phone with the docs getting her fluids increased, getting the surgeon who put the chest tube in back on her case, getting things ordered to support her if she was gonna turn her bus around and head back our way! As I left that morning, she was sitting up in bed eating cream of wheat and thickened OJ. I told her that I was going to be off a few days (going on a weekend trip) and she squeezed my hand tight and said "Thank you, precious, for taking such good care of me." I teared up like a baby, but I had spent a LOT of time with her. And I figured that when I got back to work that case management would have already had her home. She teared up, the daughter teared up... It was so touching... When I got back from my trip I dropped in to see if she was still there. She was. I walked back in the room and she had her little rolling walker and was sitting in the chair in her tan shoes eatin oatmeal. Her face lit up like Christmas. She had her teeth in and talked as plain as you or me. Chest tube was gone, she was on po pain meds and she was headed home that day!!!!

To me, that situation was miraculous. To be a part of it and have a hand in it was just amazing. Things like this are unforgettable and they make you realize why you do what you do.:redbeathe

Wow! Holy smoke how inspiring!!

[HappyPediRN]

Wow. WOW! I'm speechless right now...words just can't do a situation like that justice.