Present at death

Published

hi everyone

long time reader, little time poster, yada yada!

i work in older people's health, we are basically a medical ward in a general public hospital that caters for 65+, and theoretically we are supposed to be an a, t&r ward - but we all know how much the official title matters, right? people are people, people get sick, and people need us to care for them.

anyway, we've had a 'character' in the ward over the last couple of years - recidivist smoker, lives in tenous social circumstances, multiple medical problems, including severe pvd with consequences including a R) BKA. her mobility was shocking, and she was not able to stand for more than 10 seconds with the help of 2 assistants.

it was acknowledged during the several times she was a patient on the ward that she was not an easy person to nurse, due to her social circumstances and her adamant and vocal nature. (euphemisms, i loves ye!)

anyway, tonight, she was my patient. when i had left her last night, she had had an episode of malaena, and told everyone concerned, including medical staff, that she was DNR, and didn't want anything done.

when i got to work today, i frankly did not expect her to be there.

when i arrived at work, she had two iv lines going, and had received 40mg iv omeprazole, 2 units of FFP, 2 units of RBC and was due another unit of RBC. also she was having continuous fluids throughout this time.

anyway - after the third unit of blood, she seemed to be holding her own. no further malaena, her colour looked far better than it had the night before, but i knew we were in the 'see saw'. in fact, the consultant asked me what i thought, and i heard the words ' circling the drain' come out of my mouth.

i went to my dinner break, and when i got back to the ward i went in to visit her. she told me she felt sick, and then proceeded to spectacularly vomit bright red blood everywhere. i called in the other senior RN (her and i were the 'grown ups' on that night), and over the next half an hour, we stayed with her and soothed her as she continued to vomit large amounts of fresh blood, and continued to pass PR malaena.

the on call house surgeon came, and our fantastic consultant arrived too. i stayed at my patient's head, and attended the ongoing (and frankly, terrifying) gouts of fresh blood issuing from her mouth, and the other RN and the consultant helped turn her, and make her comfortable. the end was inevitable, and as her respiratory distress increased, we gave her some morphine, which went a long way to soothing her. she knew she was dying, and yet was incredibly calm and resigned about it. she passed away, calmly, half an hour after she initially started vomiting.

i felt privileged to have been there, and a part of this complex event. her family situation was complicated, to say the least, and even though we had spelled out her condition over the day, none of them wanted to be there.

having known her for a while, and having cared for her over these last few years, the other RN and I felt some sort of, i don't know, completion? in caring for her whilst dying in such an unpleasant and graphic way. she knew who we were, and knew why we were all there, and knew what we were doing for her.

this work is hard. but we are that certain type of person who does it for a reason. i am glad i was able to do this today.

i felt proud to be with her, stroking her hair and soothing her as she transitioned from one state to the next, and i commend each and every one of us who does this difficult job.

thanks for reading. chirst

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Thanks for sharing your experience.

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Specializes in Medical and general practice now LTC.

Thank you for spending time with the patient and ensuring she had a dignified ending.

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gives you that much needed closure and finality.

the circle is complete.

thanks for being there...

leslie

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What a blessing for her and you, both. These situations are why nursing can be so rewarding. It's difficult but you made a huge difference in this person's life. Thank you.

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Specializes in Rehab, Med Surg, Home Care.

I applaud you for carrying out what could have been merely an unpleasant and routine duty with true courage and grace.

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Specializes in CVICU, Burns, Trauma, BMT, Infection control.

Ummm.....Wow How beautifully stated..

You gave her a compassionate and dignified passing,your care eased her. Well done,I'm glad you were there for her.

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Specializes in ER, ICU, Neuro, Ortho, Med/Surg, Travele.

There are moments in our lives and careers that reaffirm our decisions to be nurses. That was truly one of them. Nurses as a whole are amazing. We are there when someone comes into this world and often, like you, the ones there when someone leaves. It is a privilage, if believe to be with a patient as they say goodbye. When families are at a loss and just need us to lean a shoulder to cry on or be their with there loved one because they can't (no matter the reason). I applaud all those who have been there at the end of life. Carry on and know that you are appreciated.

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Specializes in School Nursing.

you are nothing short of an angel ! may god bless you big time ! :heartbeat

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Specializes in CCU,ICU,ER retired.

In your nursing career, you will have patients you will never forget and she will be one of them. I still remember my first one and will have her in my heart until I die and hopefully someone like you will be there with me. I have been a nurse for 30 yrs. now retired. and I have a handful of them. Always right there in my heart. All for different reasons. Keep your campassion close to the surface. If you ever lose it, quit nursing.

I miss working with patients more than anything in the world. I miss the interaction with them. But physically I can't do it any more even a desk job. So take care of yourself and stay there as long as you can.

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Last Monday night we had a 96 y/o patient (eaten up with colon cancer) and the LPN was freaking out because the patient was not able to swallow and acted as though she had a stroke. This LPN felt we should send this woman out to the ER for testing/full treatment, etc., even though her blood was pooling and she was blue from the waist down.

So, she called the doctor, the ambulance, ran and put O2 on this woman (who was showing no acute distress). Rather than die peacefully this woman had to die with this nurse poking at her, shaking her and pleading with her to "wake up and talk to me." High strung is an understatement to describe this (new) nurse.

It was such a shame. This was a sweet old lady and I wish she could have been left alone to die in peace.

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Last Monday night we had a 96 y/o patient (eaten up with colon cancer) and the LPN was freaking out because the patient was not able to swallow and acted as though she had a stroke. This LPN felt we should send this woman out to the ER for testing/full treatment, etc., even though her blood was pooling and she was blue from the waist down.

So, she called the doctor, the ambulance, ran and put O2 on this woman (who was showing no acute distress). Rather than die peacefully this woman had to die with this nurse poking at her, shaking her and pleading with her to "wake up and talk to me." High strung is an understatement to describe this (new) nurse.

It was such a shame. This was a sweet old lady and I wish she could have been left alone to die in peace.

wow...

so many things wrong with that picture.

that pt should have been a dnh.

what did the hospital do for her?

return her to the facility?

why wasn't she receiving hospice?

sounds like that nurse needs some heavy duty inservicing.

sad...

leslie

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