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  1. phellandrn

    A Nurse's Thoughts On Death And Dying

    My Brother's Nurse: By Paul, RN I used to think I knew all there was to know about death. Working in the intensive care unit and emergency department presented seemingly endless opportunities to interact with patients who were about to die as well as consoling their grieving families. For instance, I have witnessed a cardiac arrest sneak in between the syllables of a patient's final unfinished word. Many patients have died underneath my arms after prolonged CPR failed to resuscitate them. I have hugged countless family members as they grieve the news that medicine could not keep their loved ones from slipping away. With each new experience, with each death of a patient, my comfort level in dealing with loss climbed. Before I knew it, I found myself bathing in new-nurse hubris, or at least that's what I call it now. I prided my ability to maintain composure in the face of heartbreak. I, the "seasoned" nurse of a year and a half, knew what to say and do to comfort people. However, no amount of hospital experience could have prepared me for the knock at my front door at 12:06 on April 10th 2010. I was out of breath, anxious, and afraid when I opened the door after being woken by the pounding sound of fist on wood. Two police officers identified themselves as members of Banning Police Department Detectives and asked my mother and I if we were Philip's family. Immediately my heart sank, my breath stolen by the realization that only few situations in life would require a police officer to wake a family up at midnight. Unable to tolerate another second in suspense I demanded they tell us what this was about as they were let inside. "I am so sorry to inform you, but Philip took his life around 4:00PM with a shotgun while shooting with his friend". I remember falling to the ground as if I no longer had legs. I started shaking, crying, and begging out loud to tell me this was a mistake. I always associated death and dying with my job. Death, however, had followed me home. As I lay there attempting to appreciate the magnitude of the situation, I could have never pictured that in the coming months and years I would witness a family completely unravel in the face of catastrophe, yet somehow find the strength to try and put the pieces of their lives back together. This is was no longer a patients' family that needed me. This was my family. As I sat on the couch with my mother in our front room listening to the detectives walk us through my brother's final day and moments, my ability to focus was made impossible by the mixture of fear, confusion, and sadness. At one point my mother interrupted the detective and asked "Is this how God answers prayers? I prayed for my child's safety, for Him to watch over my boy and this is how He answers my prayer?" I remember that statement being the only thing that could have increased my fear and anxiety further, for this was a lifelong devoted Christian woman, someone who I had never seen question her faith. With their jobs finished the detectives wished us well and were on their way. My mother went upstairs in an attempt to sleep if at all possible. I sat at our desk downstairs for the next few hours searching my heart and soul attempting to understand what would drive someone to go against the most primal of human instincts that we all posses: survival. What happened next would redefine my perceptions of grief and sorrow, and show me that I only understood the surface of the depth that pain can exist in the human heart. I turned in my chair at the sound of a door opening upstairs. I sat and watched my mother walk down the stairs, pause with three steps left, and look up at me. Her face was bright red, tears flowed, she was shaking, and barely holding onto the bannister. I walked over and hugged her as she began to cry. Words cannot describe the pain radiating from her body and voice. She began to cry out "Mama!" as if seeking her own mother for comfort. As I held her, I thought about all of the patients I had ever held as they cried over lost loved ones. My heart had sustained the emotional challenges that I have witnessed in the hospital. However, when it was my family's turn, when it was no longer a patient's mother but my own, I remember distinctly the moment my heart's defenses were insufficient. My heart had broken. I stood on those stairs for what seemed like an eternity watching the strongest person I have ever known become the weakest. We buried my brother Philip Helland five days later at the age of 25 years old. I used to think often of the family members of patients that have died. I wondered what it was like to lose a brother, father, mother, wife, friend, uncle, or aunt and what life after the loss would be like after the acute situation was over. What the grieving process truly like for them? This is something I have now experienced first hand with my own loss, with my own family. Over the next few months we would return to work and try to resume the lives we lived before. We have learned to pick each other up when one of us has a particularly rough day and have come to rely on each other's reciprocity when in need. It has now been a little under four years since Philip passed away. Even after all that time, I am amazed at the continued lessons in grief his loss has provided. I sit here in my second year of medical school and reflect on all the ways I've been taught to deal with dying patients and their family members. I remember being told that it isn't a matter of what you say, rather the simple act of trying to say anything is what counts. Sometimes all you need to offer is "presence" is another jewel passed along to new grads. One of my favorites is to never, ever tell a patient that you "understand" what they are going through. For example, to tell a patient that you "understand" why they are crying upon hearing a cancer diagnosis implies that you've not only been diagnosed with the same exact type of cancer, but also under the same circumstances as the ones the patient finds themself under. At best we can only humbly admit that we simply cannot imagine, that we really have no clue what they are going through, but that we will be here to help them in any way possible. Having now been on the receiving end I can attest that these are excellent tools. Yet, missing from my education and work experience thus far were the long-term effects of loss, the daily struggles that family members face. Hospital work placed me in the acute phase of death and the grieving process. However, the day-to-day struggles months and years out are something that must be experienced. For instance, each day I wake up and I reflexively think of my family. I hope that wherever they are, my remaining brothers are safe and taken care of. I close my eyes, picture my mom, and hope that her broken heart continues on the road to recovery, wherever that may lead. I try and picture Philip doing something goofy that he used to do. I've learned through trial and error that trying not to think about someone is a lot harder than picturing them in happiness, the latter being far less painful. Some days you wake up with an inherent sadness that necessitates a hard swallow in order to function throughout the day. Other days, the accumulation of those hard swallows is too much to bear, especially when you encounter a trigger. My triggers often surprise me. I will be driving along and a song on the radio will come on that reminds me of Philip. I will travel to a new destination that I know he would have enjoyed. I'll eat at a restaurant that I know he would have frequented. I try my best to picture him in these situations enjoying them they way I know he would, but most of the time the following thought is the terrible realization that he will never get to do, see, or taste the things I picture him doing. Regardless of the trigger, the subsequent feeling is always the same: a very visceral, sharp pain in my heart followed by a loss of breath. Each time I am uncertain if I will have the strength to recover. I usually take a long deep breath and try to focus on what I'm doing. Occasionally I find myself without the strength to do this, to keep going. It is then I am faced with the fact that my heart needs an outlet and I allow myself to cry for my brother. I would guess I run into triggers every other day, sometimes multiple times a day. I've learned that it is vital to allow myself to mourn and weep when they become overwhelming. The final aspect of loss I failed to appreciate is the inevitable hardest two days of the year: his birthday and death anniversary. As each day approaches I try to prepare myself for anything my family may experience so that I can be there for them. Maybe it's a byproduct of being a nurse, but it's much easier to care for others and anticipate their needs as opposed to your own. When he first passed away, I put on my nurse hat and compartmentalized so that I could be an effective caregiver for my family. I've learned to talk about how I am feeling with greater frequency nowadays. It remains a challenge for me to allow others to care for me without feeling like I am inconveniencing them or acknowledging that even I need someone to care for me despite my protests. Even a nurse needs a nurse from time to time I suppose. Naturally I've been asked what the hardest part about losing a brother has been. In all honesty, it's not that Philip died and is no longer with us. I have learned that death is as important as life is in the grand scheme of things. When the limitations of medicine show their face and suffering is overwhelming, a peaceful death is one of the most compassionate things you can offer a patient. I would guess most hospice workers would understand this concept. For me, the most painful part of losing my brother was not being able to be with him as he passed away. I am grateful that he no longer suffers from what was tormenting him, but the feeling of loneliness he must have felt is an overwhelming, unbearable concept for me to comprehend. I would do anything for the opportunity to be my brother's nurse. To sit at his bedside and listen to his story, to hold his hand and hug him, to remind him how wonderfully special he is, to alleviate his loneliness. Knowing Philip, he would hit the call light just to annoy me....