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 L&D, Hospice.

WOW! I am deeply touched and impressed by your story! My heart goes out to you

For the past 3+years I am working as hospice nurse; it was a logical choice for me after my Dad passed and I realized how little we do for the dying. Unlike birth there are no classes to prepare us, no one talks about dying like we tell birth stories. This is why we need nurses like you, to share the difficult labor out of this world again. We do not think about life as a terminal "disease", for us life for the most part brings a lot of joy and pleasure and we try to prolong it at all cost. May be we are too selfish to let our loved ones go on to the next phase, may be we buy into modern medicine and life prolonging, what ever the reasons most of the population is not aware of it until it hits home. I believe we can learn a lot from other cultures who rejoice when a loved one passes on, despite the pain of loss we feel. The longer I do hospice work the more I envy my patients who are allowed to leave this physical world - don't get me wrong, I enjoy my life and my job and would not want to trade it for any other. I agree wholly with some of the comments made: we have a job to guide, teach and help others deal with the pain, the loss and accepting that life is terminal - not necessarily following our plans. It is a privilege to do this work! I want to encourage all of you to keep up the good work! Let us focus on the higher goal and do what is right, no one said it is easy..... God bless!

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

Thank you for this.

As I spend more and more time with the dying these days, I am becoming increasingly convinced that those who are set free from the bonds of earth are indeed the fortunate ones. It's not that I'm in a hurry to leave life myself, but when I see the utter peace on the face of a person who has lived well and then passed on in as much comfort as I could provide him or her, I know that there is nothing to be feared in death.

Losing a loved one is hard on those of us left behind, because we miss that person's physical presence in our lives. But I am certain that death is not the end; it's merely a passage from one plane of existence to another.

There is a short essay on this topic that I love; I can't recall who wrote it or what the name of it is, but it speaks of standing on the shore waving good-bye to a ship whose appearance diminishes in our eyes the farther away it sails........we say, "There she goes". But on the other side of the horizon, the ship appears in all the same glory that it did on our side, and a joyful crowd takes up the cry, "Here she comes!" And that, says the author, is dying.

Specializes in CARDIAC.

God has a plan for each of us at birth. Sometimes the path is straight and narrow and we fall into line. Sometimes it is crooked and wide with lots of paths leading off. What do we do? Where do we go? Why? So many questions. Eventually we find the path that seems our destiny and we say "All right! I made it. I have found my nitch." I can only hope and pray that when my time comes, I will have a nurse like you. I also try to be that kind of nurse for my patients. I don't work in dying situations but on a cardiac ward where death does come every now and then. I try to comfort the patient as best I can and sit and hold their hand and encourage slow deep breathing so the Morphine or Dilaudid can work. Often I will get pats on my arm or hand or a smile from them. I try to smile back but I know they won't be there tomorrow when I come back. The nurses who work in Hospice are truly a God send to the patients. It takes a special person to deal with death every day that they work. As I said I hope and pray that I will have someone with your understanding and compassion when my time comes.:redbeathe

Specializes in Management, Emergency, Psych, Med Surg.

It is a gift, for both of you that you are able to assist her during her dying process. I am sure that your care and concern brings much comfort to her, and what a wonderful thing to have at the end of our lives. To be with someone who really cares. It is a hard burden to carry but for some reason you have been chosen for this task. Either to learn something or to give something that no one else can do. I do believe that God directs us down the road he want us to go, even though we may not see it at the time (I am of no particular religion and I don't attend church) so I am trying not to preach here. Just my opinion.

Specializes in LTC, Med/Surg, Peds, ICU, Tele.

Thanks for this Marla. You are a wonderful nurse and human being.:redbeathe