I don't know how you nurses deal with death

[Poochiewoochie]

Today I sat and watched as my mother lay dying in her bed at the NH. Horrible-not like in the movies at all. I sort of knew what to expect but actually seeing someone die is a lot harder than most can imagine. Her lungs were so full of liquid and she rattled when she breathed. Then, at the exact moment she exhaled for the last time, all that fluid came up and out of her mouth and after a few seconds I knew she was gone. I am sad that will be my last image of her. Did she look peaceful when she was gone? No, she was just "gone". I've read so many stories about how peaceful they look at time of death and was a little shocked that it wasn't like that. It was a surreal experience and I will never forget it.

Yet in spite of it being so sad I am happy I was there at THAT moment. My Dad had gone out to have a smoke and the hospice nurse and chaplain were out of the room for a minute. I was the only one there when she died.

That being said I don't know how you guys can deal with this on a daily basis. I watched the hospice nurse and it was amazing how she helped my Mom so she didn't suffer. I have a new respect for the nursing profession-I know I couldn't to this every day.

[Poochiewoochie]

My condolences on the loss of your mother-in-law. I don't know if anyone has told you this, but often I see that people seem to "plan" their moment of death -- often when families have stepped out for just a moment, or other times after that last grandchild finally makes it to say goodbye. I've seen it too many times to discount it. I would like to think your mother-in-law picked her moment, too, knowing how you would feel about being the one with her. Perhaps because the others would have felt differently.

Now, to the topic at hand. I'm sure others have said much of what I'm going to say, but I thought I would share anyway.

I think in North America we are one of the few cultures in the world that doesn't easily accept death. I'm not saying that *you* don't, but as a society it is something we have come to fear, where other cultures accept it for what it is and though the death of a loved one is always a sad time, it's also accepted as part of life. Over here I think we grow up feeling that death is scary. It's unknown and we are afraid of it.

Nursing is it's own sort of culture, too. When I began my career, I didn't know how I would handle death and dying. I remember during our hospital orientation prior to our first acute clinical experience, one of my classmates burst into tears when we were shown the morgue. I actually don't remember the first death I was involved in, oddly enough now that I am writing this, though I know it must have happened when I was a student. I do remember the first death of my own patient after I graduated. The man died and minutes later, down the hall, a baby boy was born. I thought that was kind of fitting.

After almost seven years of practice, I've seen lots of death. It's always sad, though some cases are harder than others. No matter what, a life has ended, and people mourn. Death is a part of life, and at the end of life, like in the beginning, people are at their most vulnerable. For me, and I think for many nurses, we feel honoured to have been a part of that ending -- not because we enjoy seeing people die, but because helping somebody die with dignity, in peace and comfort, is one of the greatest things we can do for another human being.

The easiest way to say it is you "get used to" death, though that isn't exactly it, either. I think somewhere along the way, I started seeing death in a different way. I'm sure it would be different if I was holding vigil around the bed of my own family member, but I can't say for sure. When my grandmother was dying, I had a couple of years of RN experience already, but my parents decided not to call me until she was already gone (they felt I couldn't *handle* it, which saddens me more than I can express). As I said, it's always sad. It's harder when it is a young person with children at home than for an elderly person who has lived a long life, but regardless, that person meant everything to somebody.

I said above (and I'm writing this on the fly, so I apologize for any repetetiveness), that loved (or lonely) person deserves nothing short of peace. I see death not as an end to a life, but as an end to pain, to sickness, to all things which wear on us in life. Sometimes dying is peaceful without our help. People go to sleep and just don't wake up. And sometimes it isn't, and that is where I, through my training and experience as a nurse, can help. More than that, I am honoured to help. When my patient passes in comfort, because my coworkers and I have done everything we can to make it so, I am not sad. Not in the way I would be if that were my loved one.

I am relieved, gladdened that their death, which would have happened with or without my care, happened in relative peace. Honoured, as I've said, to have been a part of this moment. Some nurses welcome people into the world, and some wish them goodbye.

I always open a window, did you know, after they have died.

It isn't always peaceful, and those deaths are difficult. Sometimes even with all that is available to us, we just can't take away all the pain. Even in those deaths, though, there is that relief at the end because, no matter what, you know for certain there is no more pain. I do regret, in those cases, that I couldn't do more. The families, too, the ones that have such a tough time accepting that their loved one is dying -- I wish I could help them see it differently. Some are relieved, in the end, and some are broken. In those moments, caring for them is just as important as caring for the patient.

I don't know if I have made any sense or not, but there you go.

Thanks, it was my Mom not mother in law-I've never had one of them.

[Poochiewoochie]

Strangely enough, over the years I've had hundreds of people tell me they grieved more for their pets passing than their own family members.

I was with our dachshund when we had to put her to sleep in '95. That was so peaceful. And yes, I can certainly understand people grieving more for their pets than a family member.

[Poochiewoochie]

as an aside...

2. in our hospice, we don't 'do' suction...

as the med'l dir and DON strongly felt that suction in and of itself, was terribly invasive,

and that drying agents (scope, levsin, etc) were much more effective (if started at first sign of fluid shift) and less invasive.

i also know that hospices are as varied as the nurses who implement the care.

leslie

They tried to suction my Mom but the secretions were too thick.They used those little sticks with the spongees on the end that you wet and tried to remove it from her mouth that way.

[SaoirseRN]

Thanks, it was my Mom not mother in law-I've never had one of them.

I'm sorry! Somehow I misread that, my apologies, Poochiewoochie.

[Good Morning, Gil]

I completely echo the sentiments of WoosahRN. That is why I do what I do. Of course, the goal is to save a patient's life in my line of work (ICU), but when death is inevitable, I find comfort in knowing that I'm able to provide comfort to the patient and family during that time, and ensure that I can make them as comfortable as possible through suctioning and as needed med administration. Also advocacy for patients when I see that time approaching as they can't speak for themselves. I'm sorry for your loss.

[Poochiewoochie]

I'm sorry! Somehow I misread that, my apologies, Poochiewoochie.

That's okay.

[merrywhiterose]

I work in a long-term care facility & I've watched several people die. Not everyone dies the same way. Some struggle, some fall asleep & stop breathing. I like that I can make dying people more comfortable. There are certain positions that help people breathe easier. Medications can be a great help, too. Suction can be applied for the fluid in the mouth, however it doesn't appear to ease the suffering. It's more for the family so they don't THINK they are suffering as much. Some families don't want to watch the last hours of life. In that case we try to keep someone in the room holding their hand, until they pass. Most of the residents we've known for years. They have become part of our family too, so we may cry too but in private.

[Poochiewoochie]

I work in a long-term care facility & I've watched several people die. Not everyone dies the same way. Some struggle, some fall asleep & stop breathing. I like that I can make dying people more comfortable. There are certain positions that help people breathe easier. Medications can be a great help, too. Suction can be applied for the fluid in the mouth, however it doesn't appear to ease the suffering. It's more for the family so they don't THINK they are suffering as much. Some families don't want to watch the last hours of life. In that case we try to keep someone in the room holding their hand, until they pass. Most of the residents we've known for years. They have become part of our family too, so we may cry too but in private.

IMO I don't know how anyone can say they don't suffer when they died the way my Mom did. People who say this have never been there themselves so they really have no idea and no one has come back to say, hey, even though I looked like I suffered when I died I really didn't.

[SaoirseRN]

IMO I don't know how anyone can say they don't suffer when they died the way my Mom did. People who say this have never been there themselves so they really have no idea and no one has come back to say, hey, even though I looked like I suffered when I died I really didn't.

Many people do pass peacefully, and we know that because they are calm and exhibit all the signs of comfort. People tell us a lot without ever saying a word.

However, there are who don't pass peacefully, whether it's because of inexperienced doctors and nurses, or sometimes, despite our best efforts they just do. My worst was a man in his forties, whose symptoms I just could not manage despite maxing out his meds and multiple calls to his physician.

I am sorry this was the case with your mother. I would like to think the nurses did everything they could, even if it did not take away all of her pain. It is because of these people, those like your mother and the man I mentioned above, that I am taking a course next week on end of life care, so maybe I can bring back with me some new techniques and knowledge that will only benefit those for whom I care.