Life, Death, and Other Matters of Consequence

Some days, it's just not worth chewing through the restraints... Nurses Announcements Archive Article

I am a seasoned long-term care nurse. I deal with life and death matters all the time. My voice is often the last one a patient hears, and my hand the last human touch he or she feels. It's OK most of the time, that's why I was built strong enough to handle the load, and for the most part, I feel blessed to have been given the privilege of providing solace and comfort to a soul preparing to leave this earth.

But there are times, like now when the burden becomes a bit heavy and my shoulders literally ache under the weight of it. We've lost so many residents this winter to pneumonia and other diseases of the age; on my unit and my shift alone, no fewer than eleven have passed on since November. Since we have several hospice beds on my floor, this is not a shocking statistic, but since I'm on a first-name basis with the local funeral homes...well, you get the picture.

But now it's become personal. A very dear lady from the assisted living facility where I worked for 2 1/2 years has checked into one of my hospice beds with a gangrenous left leg; this woman is not only my patient but my friend and colleague (she is a registered nurse with over 50 years' experience). She told me she "just couldn't do this anymore" after undergoing a BKA of the right leg four years ago, suffering a stroke two years ago, and bouncing back and forth between the hospital and the nursing home for most of the time after that. She's been through she wants to let nature take its course, and to be kept comfortable until it does.

I understand that; in fact, I support her decision, and would in all likelihood make the same one if I were in her place. I'm only fifty, but like my friend, I've lived a satisfying life, and I have few regrets---why on earth would I want to prolong the inevitable and suffer excruciating pain while doing it?

Still, this is harder for me in some ways than all the previous resident/patient dying processes ever were. I'm seeing this woman whom I love and admire slip away a little more every day. I'm watching her become increasingly somnolent and confused. I'm changing her dressings every night and seeing the relentless progress of her disease. I look in her eyes, and I know that even in her Dilaudid haze she knows the truth, though her family is still holding out hope for a miracle. I don't know what to do with all of the emotion that's simmering just under my calm exterior. Some nights I wish I could just run out of the room and cry until there are no tears left.

Now, being a spiritual person, I imagine that there is a lesson in all of this, some nugget of wisdom I'm supposed to glean from witnessing this slow, painful process. I also have to presume there is another one in the shocking, unexpected death of another woman I cared for during a two-month period, a relatively young patient who'd broken her ankle, been admitted for therapies, and gone home just a couple of weeks ago. In fact, she called me just last week to let me know that she was finally walking again and that she'd come to visit me at work as soon as she got the doctor to release her to drive again. She reportedly had felt "bad" early yesterday morning and called her home health aide to take her to the ER, then collapsed in the parking lot and died before they could get to her. A bowel obstruction, the ER physician said...Tell me, how does a 62-year-old die from a bowel obstruction in the year 2009? She hadn't had any bowel problems at all when she was in the NH, and all of a sudden she's dead?! Surely, doctor, you must be joking.

But no, it's a sad reality, and I'll be attending her funeral on Saturday morning. This is not my idea of a good time, but I'll be there...just as I'll be at Eva's services when that time comes, no matter how difficult it may be to say good-bye. Part of me hopes she passes on someone else's shift; but then, if it happens on my watch, I know she'll have received the best of care. I owe her nothing less. And I pray the end comes soon, for her sake: she has indeed suffered enough pain and disfigurement for one lifetime.

As every nurse who ever lived knows, these are the times that make one wonder what s/he was thinking when s/he decided to enter this profession. I could have done without this sort of heartache. I could have gone the rest of my days without understanding that death is not just at the end of life, it is all through it. But then again, helping people and families through this transition may be exactly what I was made for, and it may be why I'm always able to hold it together somehow, even when my heart is breaking. I only hope that someday God will explain it to me.:(

Specializes in Wilderness Medicine, ICU, Adult Ed..

Thank you for what you wrote.

Yes, she has suffered enough for one lifetime. However, she has also been granted relief and comfort through you. In the face of tragedy, it is easy to question God: "If you are there, and good, then why do you allow such suffering!" We might be better off asking, "In light of how evil the world is, and how unworthy of Your love we are, why do you allow us comfort, relief, the solace of love and friendship, or any other good thing?"

God's blessings are free, but they are never cheap. The care and comfort you provide your patients is more precious than gold. However, there is a price to be paid for anything of such value. When you feel that weight on your shoulders, and the wrenching in your heart, remind yourself that you are paying the price for something more precious than gold. And, as for "where is God when my friend is suffering?" He is in the same place He was when His own son suffered worse pain for people as unworthy as us. And He is there with you, and with your friend, now.

Specializes in LTC, assisted living, med-surg, psych.

Thank you for this thoughtful and eloquent response, CountyRat.

Being a lifelong student of the ways of the Creator, I learned long ago that He doesn't "allow" suffering, war, evil and the like. To my simple mind, He is Good and thus doesn't make these things happen. But He can and does use them---to instruct, to work miracles, to grow His children more in love and faith. Even the death of my second child, 25 years ago tomorrow, changed my life for the better, though I certainly didn't believe that at the time. It made me more compassionate, more tender, and much more aware of life's frailty.....traits which have served me well both in my career and life in general.

I still have a long way to go to become the person I want to be, however, so I know there are lessons to be learned from this sad situation, which is deteriorating by the day. One by one, my friend's systems are shutting down; she no longer recognizes me, and the disease process with its pain and its unpleasant odors is robbing her of the dignity she once held so dear. Things have arrived at the point where death is no longer something to be held at bay as long as possible, but a deliverer.........and all her family and friends can do is pray that she is called home soon.

Thanks again.

Just want to tell you all that as an OLDER student nurse who is graduating in May, I am so blessed by the comments I have read tonight. I have an interview with a hospice agency next week. That is where I truly believe the Lord is leading me...I have felt that since I entered nursing school. I have always asked HIM what he wants me to do...and have followed where I truly believe HE is leading me...why else at my age (54!) would I be doing this...Just want to say how wonderful it is to read all of your comments

Much appreciation for this.We are holding a Cancer Care Symposium in April,2009;one of the highlights of the day is a case study similar to what is presenrted here.The terminally ill cancer patient told the nurses that she wanted to be left alone,the husband asked God to do His will,but he came back later and asked the Medical team "to do everything".Even as the patient was being transferred to the Croitical Care unit,she was resistant and kept writing notes to be left alone.It was a trying moment for the nurses.She finally rested last week.I find comfort in the words...the nurses' hands and talk are the last human experiences the dying patient has...we need to remember this and give it to our patients.

Specializes in Med/Surg; Office; Oncology.

Your thoughts are very much appreciated. I have been a Certified Oncology Nurse for 12 years and understand the emotions and burdens you carry. We have learned well to store those thoughts away when our patients die as we have other patients who need our care. Usually, it takes a small situation to bring those memories and motions up bubbling like a hot spring and we think we are crying for a silly reason, when it is all the suppressed emotions stored away. Most of the time we handle it well....

You state you are a spiritual person. Then you realize we live in a dying world, no way out it. Like a catepillar metaphoring into a beautiful butterfly. You have to die to live.... I thank God He has given me the opportunity to care for my cancer patients, giving them love, compassion, hope, and truth during their journey with me. I learn from them as well. I have learned humility, the love of every single day whether it gives me roses or thorns, and to ONLY take one day at a time, not looking to tomorrow for we have no guarentee of it. . None of us have a guarentee to live old without problems. We can only hope there will be someone who will give us compassion and love when we need it. I pray that someone is like you. Keep on keeping on...


One of the hardest things I have done in my long career was take care of a coworker who had Melanoma.We were working in LTC at the time and I worked with her every evening for 3 years and when she got worse she wanted us to take care of her and die where she was comfortable. She was 32 at the time with 2 small children.It was hard on all of us and she wasnt ready to die and would beg the doctor to try something else. In the end she was blind from the mets and both hips were fx and she was in horrible pain and we kept giving her more morphine but we did the best we could. I was the one who was with her at her last breath and when she died I cleaned her up myself and got her ready for the funeral home.I dont know how I did this but nursing is my gift and I was proud she could die with those who cared helping her make her final journey. Later it was so hard for me to walk by the room every day after that and in 5 months I left there knowing I would never forget this experience and I had peace. Nursing isnt easy but we are stong and sometimes used for divine purposes..Hugs to you...

Very well written. And do I believe that God places other people in our lives to teach us those life lessons everyone talks about. As I get older, I deal with death differently. I have been a direct care aide for three years and only one person passed away. I became an STNA just a month ago, and a resident already passed away. Everyone acted like it was no big deal but I talked to several of the people who cared for her and it was a big deal to each of them in different ways. That's what I wanted to hear, not oh, okay, Betty passed. I hope that I learn to deal with death differently in the coming years of my career.

RE Life,Death, and other matters of Consequence.

What a wonderful and heartfelt article this is. The real shame may be that your friend never got a chance to read it. What a sweet tribute to your friend and to Nursing for that matter.

One day when my turn comes I pray that I have a caretaker such as you.

God bless....


Specializes in LTC, assisted living, med-surg, psych.

Sincere thanks to all of you who have responded to this thread so far.

About 45 minutes ago, the phone call came: it was my colleague, the day shift nurse who had actually worked with this lady for over 20 years. She drew her last breath just before noon, with both her daughter-in-law and my colleague at her side as she passed away into a world where, I have to believe, she is out of pain and whole again, walking on BOTH feet to meet the Savior she was so looking forward to seeing.

I am so incredibly sad right now, but also vastly relieved that the suffering she has been through the past week or so is over. Toward the end, we were no longer able to keep her comfortable without giving her large amounts of medication, and she became confused and agitated; worse, she KNEW she was confused, and that was harder for her to bear than the pain.

Then, two nights ago, I discovered a large stage II pressure ulcer on her bottom that hadn't been there the day before, and that was the final insult to this once-proud woman's dignity. I was SO angry about that, at myself and at all of us involved in her care. Why, oh why, hadn't we thought to use the Geomat overlay that was rolled up in the closet? Of course, when I saw the wound I remembered the overlay and put it on the bed immediately, but it was too late by then. And while my intellect says that she had a terminal condition and was going to die no matter what we did---or didn't do---I wish someone could explain it to my heart. :crying2:

Somewhere in the middle of all of this is a discovery of some kind that will doubtless be of great benefit in the future; I can't imagine feeling the way I do at this moment and having it all be for naught. I can't think about that right now. All I can do is cry my tears and thank God that my friend is at peace.

I'm playing the old Louis Armstrong song "What A Wonderful World" on iTunes as I type this. It's long been one of my favorites, and as I recently learned, it was one of hers too. She even had a copy of the lyrics on her cork board at home. I will never again be able to listen to it without thinking of her.

Thank you all once again.

(((((Marla))))) :redbeathe


Specializes in ICU, Telemetry.

You'll never know what good may come from your post, what lives may be changed, what tired nurse may take a deep breath and find it in themselves to get up and do the next shift because of your words. A friend of mine once told me (when I was doing the "why is there evil in the world?" thing), that life is like a cross stitch where we just see the loose threads, the knots, the chaotic colors because we're looking at it from the underside. When we get to heaven, we see the topside, and can see the picture that was being stitched with our lives.

You're a very, very bright thread in the picture. God bless.

Specializes in LTC, assisted living, med-surg, psych.
You'll never know what good may come from your post, what lives may be changed, what tired nurse may take a deep breath and find it in themselves to get up and do the next shift because of your words. A friend of mine once told me (when I was doing the "why is there evil in the world?" thing), that life is like a cross stitch where we just see the loose threads, the knots, the chaotic colors because we're looking at it from the underside. When we get to heaven, we see the topside, and can see the picture that was being stitched with our lives.

You're a very, very bright thread in the picture. God bless.

Wow.........I'm :imbar

Thank you, you just made my week!!

And that IS why I slog through life, trying to leave what few morsels of wisdom I've gleaned over half a century for someone else to find. I hope it really is like this---that someone who reads something I've written won't have to learn that particular life lesson like I did (the hard way), and at the end of the day I'll have made something better for another human being, even if no one but him or her ever notices. :specs: