Letting Go of A Loved One

This article is from the perspective of a loved one and deals with the issue of their code status and the difficulty of being a nurse in the midst of such an issue.

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I'm in pain, mama. My body is failing me. I've lost my ability to speak. The hole in my throat helps me breathe - the most basic bodily function vital to our survival. The nurse comes in when the blue number on that monitor over there starts falling - he'll know that means that in some way the delivery of oxygen to my blood cells is hindered. My body constantly pulsates with pain, and I can't let you, the nurse, or anyone else know that. So I lay here, lost in the haze of what used to be my mind. Remember what the doctor said? Massive intercerebral hemorrhage. A pipe in my brain burst and the blood flooded and damaged a lot of what was inside. Hearing you sob for me was painful enough - but hearing you cheer me on with hopes that I will somehow get better is gutting. The doctor asked you to make a decision of what should be done if my heart were to stop. You chose the route that would mean everything possible would be done to keep me in this world.

The nurse smiles kindly when he talks to you in the room. But behind his gentle smile I can see the sorrow. He feels deeply for you. I can see him taking our pain and making it part of his own. He turns me, he sets up my tube feeding, he cleans me when I'm wet. He smiles and talks to me knowing I can't respond. He stands by me when I have one of my seizures, ready to intervene if it's one of my big ones. You ask him if there's any chance I'll recover. That question comes from a desperate place in the mind - one that subconsciously knows the painful truth, but does not yet know how to accept it. The nurse pauses, looks down, looks back up at you. I can see him hastily sifting through the words in his mind, trying to find the most gentle arrangement to say to you. He imagines his own mother asking that same question should he ever suffer such a debilitating diagnosis as mine. "I'm not sure," he says almost in a whisper, "right now we should take things day by day". You thank the nurse for his answer, but somewhere you're not satisfied with it.

Letting go is hard. Remember when I was six years old and you and dad taught me how to roller blade? You took me to get a shiny black pair of roller blades and watched and laughed as I ran to the checkout counter. The driveway was our practice spot, and my knees wobbled and shook the first time on my new skates. You told me I should let go of your hand, and I couldn't imagine doing it. Your hand gave me safety, it was the only thing between me and my inevitable demise on those roller skates. But deep down I understood that if I didn't let go, I would never be free to skate around our sun lit neighborhood. And when I finally let go of your hand, I truly understood that when you asked me to let go, it was because you loved me.

I know you want me to stay close to you, mama. But I want you to know that right now, all of me hurts. Every pressure sore, every infection, every time I hear you begging and praying for things to go back to how they were. I'm still that boy you taught how to roller blade, except now it's your turn to let go.

My name is Arbaz Ahmad. I'm an RN on a neurology unit and have just completed my first year on this journey of learning and growing.

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Axgrinder

256 Posts

Specializes in Adult MICU/SICU.

If only people could understand the reality as it is, instead of as it was. But that is an awfully big burden for the human psyche to comprehend. Denial is not just a river in Egypt - it's also a safe place for a traumatized mind to hide.

klcrn1987

65 Posts

Specializes in med/surg---long term---pvt duty. Has 30 years experience.

As an RN for 29 years, I have seen more people die than I can count. I have seen ones that have passed quietly and peacefully in their sleep. I have seen ones that have lingered and suffered, often because the family just can't say goodbye. Thankfully, I have never been put in the situation to have to make "the decision" but I pray I would have the strength to make the right one.

Sometimes, no matter how hard it is.... you have to love them enough to let them go.......

banterings

278 Posts

I just had to deal wth the passing of a loved one. She chose to let nature take its course (at home, surrounded by loved ones, without any interventions). We accepted and supported her choice as the dignified way to go. She fought hard hard until the end. I think that she fought so hard that when she did pass, there would be more happiness from us that she is finally at peace. In my agony I remembered the words of Dylan Thomas:

Do not go gentle into that good night,

Old age should burn and rave at close of day;

Rage, rage against the dying of the light.

Though wise men at their end know dark is right,

Because their words had forked no lightning they

Do not go gentle into that good night.

Good men, the last wave by, crying how bright

Their frail deeds might have danced in a green bay,

Rage, rage against the dying of the light.

Wild men who caught and sang the sun in flight,

And learn, too late, they grieved it on its way,

Do not go gentle into that good night.

Grave men, near death, who see with blinding sight

Blind eyes could blaze like meteors and be gay,

Rage, rage against the dying of the light.

And you, my father, there on the sad height,

Curse, bless, me now with your fierce tears, I pray.

Do not go gentle into that good night.

Rage, rage against the dying of the light.

I rooted for her at the end, not that she would ever recover. The fight she put up was admirable. We were wishing for her passing well before she was.

The death was beautiful. Those of you who work in LTC or hospice know what I mean when I say this.

NotReady4PrimeTime, RN

16 Articles; 7,358 Posts

Specializes in NICU, PICU, PCVICU and peds oncology. Has 25 years experience.

Twenty-seven years ago I sat at my son's bedside torn between wanting to keep him with me forever and wanting him to be free from suffering. The multiple ischemic strokes he'd developed weeks after a liver transplant were the least of his problems; his kidneys weren't functioning, his "new" liver was severely injured, he was septic and having seizures. Between the pleural effusion around his left lung and the RUL and RML pneumonia, his gas exchange was poor. His backwards heart (repaired TGA) needed both pressor and fluid support to keep his blood pressure up. There came a point where I looked to Heaven and said, "I'm done. I can't do this any more. If You want him, take him. But please don't let this continue." At the bedside, I whispered in my boy's ear, "If you're ready to go and be with God, go. Don't worry about me, I'll be okay. If you want to go, please just go." He stayed. I won't lie and say I've never regretted His choice, because it has been hard. Really hard. That's what guides me when faced with a patient who is obviously suffering with a poor prognosis. There's a parent-to-parent connection that makes it easier to have those conversations. Easier, not easy.

Ruby Vee, BSN

67 Articles; 14,022 Posts

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

Letting go is perhaps one of the most difficult things we can do. I've watched people letting go (or hanging on) for four decades as a nurse. I've also let go of both parents, stood next to my best friend as she let go of her husband and my husband as he let go of his sister. Nothing, though, could be worse than letting go of a child.

MamaKitty13214

32 Posts

Specializes in Med Surg,Hospice,Home Care, Case Mgmt.

Going through this kind of a situation right now with a co-worker who was an ED nurse before she became a Case Manager. She is the primary care giver for her mother whose heart and kidneys are failing. She cannot accept that Mom is dying and that she won't get better at age 85. She texted our lead nurse that doctor said Mom had 2-3 more "years" to live but we all kinda think it is probably more like "weeks" or "months" at best. Complicated emotional ties and denial. It's a huge strain on her and on all of her co-workers who were already stretched to the limit by chronic short staffing. The next crisis is always just around the corner and we don't know if she will ever be able to come back to work. That's our problem. We'll deal with it.

Her problem and the saddest thing about the situation is that this nurse will not ever give her mother permission to die because she is so emotionally dependent on her. I don't know if daughter can ever understand how painful that will make Mom's much needed exit. It is heartbreaking and we coworkers are doing our best to support her and guide her into understanding the ultimate reality that Mom is going to die. We are deeply concerned that she will never be able to get beyond the Denial stage of grief. She is caught up in the minutiae of Mom's labs as they reflect her organ function and prognosis. She frantically prays that Mom will rally and be OK with med changes and come home and everything will be "normal" again. DNR/DNI will probably not be an option because, even though daughter is an RN, Mom is not allowed to die.

Family dynamics are very complicated and our technophile "solution for everything" medical culture discourages the basic understanding that the bags of flesh and bones that we live in for a finite time wear out eventually. Denial is a very wide river and it is all upstream.

I pray for my colleague and her mother that they can both move into a higher level of understanding of the process of life and learn to go with the flow instead of resisting it. Mama Pacha knows what she is doing.

MamaKitty13214

32 Posts

Specializes in Med Surg,Hospice,Home Care, Case Mgmt.

Heartbreaking experience for a mother. He had to go. He's watching out for you and I'm sure he's thankful that you gave him permission to leave and accepted that he wanted to do so. That's HUGE. Thanks for all the work you have done and continue to do. Peds nurses are the BEST!! Love you!

LadysSolo

411 Posts

I had "the discussion" with my son when my mom died, about me being a DNRCCA, he was not happy but he knows. I also asked him what HE wanted done should something happen (God forbid, as I cannot imagine losing my son, but he could be in a car accident, etc.) He told me he did not want to be kept going on machines, and to let him go. I just hope if it is ever necessary that I have the strength to carry out his wishes, but it DOES help to know what he wants done.

FranEMTnurse, CNA, LPN, EMT-I

2 Articles; 3,619 Posts

Specializes in LTC, CPR instructor, First aid instructor.. Has 26 years experience.

God has mercifully kept me alive through viralencephalomengitis when I was just 19. My grandmother thought I was surely going to die then.

Several years later, I suffered anaphylaxis from a medication. Then the numerous doses medication that was used to treat the anaphylaxis triggered a PE that nearly took my life. (I had an out of body experience with that,) but the dosages of the steroid that was used to treat the anaphylaxis continued to be used along with a blood thinner to dissolve the embolus in my right lung.) It soon became difficult for me to breathe, and I could barely hold my eyes open.

At the time, (I had a doctor who doubted what I was telling him, and he relied on what he saw on the machine instead.) My feet dropped in a position that wasn't normal, so the doctor ordered special boots to hold my feet straight. I became so weak I could barely move. In fact, the staff who cared for me had to even move my weakened body back and forth to care for me.

I was soon discharged to go home with my daughter. She refused to take me home unless I could have some oxygen for breathing.

Home care was ordered, but the people caring for me told their supervisor that I was too weak for them to care for, so I was sent back to the hospital.

My doctor then sent me to a rehab hospital, and ordered my oxygen and my pain medication discontinued. A very short while after the oxygen was removed, I began to have chest pain. I asked for some pain medication, but instead, rapid EKG was ordered.

I was sent back to the regular hospital where I was slowly weaned off of the steroid that made me so weak, and after a couple weeks stay there, I soon regained my strength by having physical and occupational therapy. That ordeal lasted six and one half weeks, and it took its toll on my daughter.

A couple years after that, I suffered a heart attack. I was asked if I was afraid, and I told everyone who asked me that I was not. I was transferred to a trauma center for treatment. After a six day stay there and a fantastic procedure by an excellent Cardiologist, who removed the arterial blockage in the notch of my coronary artery along with a secondary one. Then after an overnight stay after the procedure I was discharged to go home. My family was so relieved.

Specializes in OR 35 years; crosstrained ER/ICU/PACU. Has 47 years experience.

I've been an RN for almost 40 years, the past 32 of them as an OR nurse. I've seen it all, been through it all. I was also a Medic for 10 years, seeing more of the stuff nightmares are made out of. Last January, I got a call that my 43 year old daughter's house burned down, & she was badly burned over 85% of her body. I rushed to get a flight to NY, not knowing what awaited me; but nothing prepared me for this sight: my daughter was intubated, in a medically-induced coma, swathed in gauze, Kerlix, & Ace wraps from shoulders to feet. Her face was so red, with the blisters of 2nd degree burns all around. She didn't look like herself. I've taken care of thousands of patients in my career who were terribly sick and/or injured, but it certainly becomes a whole other story when it's your child. All I could do was sit by her bedside in the Burn Unit, stroke her hair, speak constantly into her ear, hold the 1 hand that wasn't totally bandaged. I had such a feeling of deep & utter sadness, for her to be in this condition, her family to lose everything, & I couldn't do anything to fix it, like a nurse & a Mom should.

She had surgery to debride the 2nd & 3rd degree burns after about 5 days. The doc was encouraged, & hoped to start weaning her off the ventilator, & bring her out of the coma in about a week. However, that wasn't to be. As I had surmised all along, they misjudged the thermal & smoke damage done to her lungs by being in the smoky house for too long. She developed pneumonia, despited being on antibiotics prophylatically. Her temp soared to 107, & her organs started shutting down. Urine output was minimal, despite Lasix, & she retained so much fluid she looked totally different. Many meds were administered in attempts to reverse it, but with kidneys shutting down, everything else, it was almost useless. She then coded several times, but came back. A cardio doc spoke with me (her husband was too distraught to make any decisions), they wanted to attempt ECMO as a last-ditch effort to save her, but with only a potential 30% chance it would help. At that point, you know there won't be any good in prolonging your child's life. Brain function would've been questionable after the fever, organ shut-down & cardiac arrests. The Mom in me turned into the RN in me & said DNR. Let her go in peace. I'm in tears right now, because after bringing that child into the world, the hardest thing to do was to let her go out of it. There are no words anyone can say, even we as nurses can only stand by & be there for the family. That decision is a hard one to make, but many times, it's the best one to make. I still wonder if my daughter knew I was there with her, if she heard me. My only consolation is knowing my parents were there to welcome her as her spirit left her body. Heed the words in the original article that started this thread. Like I said, the right decision is often the hardest, & as nurses, support the family as they go down that path.

LadysSolo

411 Posts

Spiker, I am so sorry you had to make that decision, I can't imagine how hard it was, but you made it out of love for your daughter. (((hugs)))