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I have a pt right now that has been actively dying for about 2 weeks now. I was super surprised when she lived through last weekend and she is still alive as I type. She has had her final religious blessings and she has seen all of her family. I have also been told that people "hang on" because they are in pain (she seems to be well-controlled) and sometimes they want to die alone so I tried to give her some time alone last night without abandoning her.
What are some other reasons you have experienced?
In some cases, I almost view dying patients in an "Eriksonian" developmental light. Some people just seem to have things (call them developmental tasks, if you will) they need to accomplish before they die, as Leslie's story illustrated. Some people need permission, some need to know their families are okay, and some may need to know they are loved. I think it illustrates what a personal experience death is and how beautiful it can be when properly attended to.
I firmly believe that we do not pass from this life until we complete the task we were given. It could be as simple as just meeting someone to something as complex as discovering a life-saving drug. We never know what our task was until we get to heaven and the Lord tells us. But, until that task is completed, the good Lord does not let us leave this planet. Just keep her as comfortable as you can. We can keep our hands on our patients right shoulder, but, if the Lord keeps His on the left we have no power over the outcome.
I recently had a resident pass who basically was waiting to die for a couple of weeks.
I gave her the first dose of ordered ativan and whispered into her ear, "Its ok to go." And she passed the next day.
Sometimes they just need to hear it from someone whether it be you or a family member. Also make sure their pain is well controlled as mentioned above.
This is how I have always viewed this topic in the past. Purely scientific. The patient will die when their organs and vital processes fail.There's just something different about this lady, but I can't explain it.
a discontented spirit?
(i'm not really asking, as i totally believe that's the answer.:))
leslie
I've had pts like that, ones where you could not believe they were still there when you came back to work. I had one guy who'd fallen out with his son....and I just knew he was waiting for his son to talk to him, heal old wounds, etc. The son wouldn't talk to him (cussed me out and told me not to call him again), so I lied to my patient and told him his son said he was sorry and he loved him and it was okay to go. Guy died peacefully an hour later.
I also had a guy who was the meanest SOB you could imagine...from coworkers who knew him, I learned he beat his wife/kids, stole from his church, cheated his business partners, etc. That man hung on tooth and nail, and I really think in his case it was fear of where he was going. It was the creepiest thing. Often when I'm looking after someone who's dying, there's a sense of peace in the room after they pass away. I was cleaning the room after we'd taken the patient to the morgue, and all of a sudden, all the hair on my neck stood on end, and I had that sense that someone was watching me. I just knew it was my patient...he was still refusing to leave. I'm not a freak who sees spirits in every corner, but I knew he was still there. I said, "Mr. Smith, you've passed on and you don't belong here anymore. You need to go on where you're going. Go away." The creepy "watching" feeling went away, but people kept saying they felt like they were being "watched" when they were in the room when it was empty, and patients said they felt uncomfortable....complained the room was cold and uncomfortable. Finally, one of the chaplains took a Bible, went in the room, and closed the door. Don't know what he said or prayed, but the creepy feeling never came back. We are both physical and spiritual animals and sometimes the spiritual is just as ill as the physical....
I've had pts like that, ones where you could not believe they were still there when you came back to work. I had one guy who'd fallen out with his son....and I just knew he was waiting for his son to talk to him, heal old wounds, etc. The son wouldn't talk to him (cussed me out and told me not to call him again), so I lied to my patient and told him his son said he was sorry and he loved him and it was okay to go. Guy died peacefully an hour later.I also had a guy who was the meanest SOB you could imagine...from coworkers who knew him, I learned he beat his wife/kids, stole from his church, cheated his business partners, etc. That man hung on tooth and nail, and I really think in his case it was fear of where he was going. It was the creepiest thing. Often when I'm looking after someone who's dying, there's a sense of peace in the room after they pass away. I was cleaning the room after we'd taken the patient to the morgue, and all of a sudden, all the hair on my neck stood on end, and I had that sense that someone was watching me. I just knew it was my patient...he was still refusing to leave. I'm not a freak who sees spirits in every corner, but I knew he was still there. I said, "Mr. Smith, you've passed on and you don't belong here anymore. You need to go on where you're going. Go away." The creepy "watching" feeling went away, but people kept saying they felt like they were being "watched" when they were in the room when it was empty, and patients said they felt uncomfortable....complained the room was cold and uncomfortable. Finally, one of the chaplains took a Bible, went in the room, and closed the door. Don't know what he said or prayed, but the creepy feeling never came back. We are both physical and spiritual animals and sometimes the spiritual is just as ill as the physical....
That second story was seriously creepy! Yikes!!
i had a old female dnr pt in icu that had been unresponsive for days, we finally withdrew all the pressers and started comfort care only. we were actually waiting for a room to open up to move her out of the icu. me and another nurse was in her room when she gurgled..made a weak laugh and said "come hug me gloria, have u seen paw" she then took a sigh and passed. the daughter said gloria was her older sister that died when she was a child.
leslie :-D
11,191 Posts
i had a pt that just wouldn't die.
he was cool and mottled, in and out of consciousness...with persistent moaning.
before he had lapsed to semi-consciousness, he had been screaming non-stop.
med'l dir kept on raising his meds to outrageous amounts, yet still...
licsw and i are going nuts, trying to figure out what was going on.
long story short, he feared going to hell.
after digging through his background, he had abandoned his children...and feared he was going to be punished.
licsw tracked down his sister, who tracked down his oldest son.
both sisters came to visit, who had a message to pt from oldest son...
that sons were doing well, had good life, and all was forgiven.
pt died that day...peacefully.
a nurse needs to address all types of pain, and not just physiological.
i believe mental/spiritual pain is just as paramount, and just as palpable.
just something to consider.
leslie