Death walks the halls tonight.
It is not our first encounter. I recognize his presence. I picture him pacing up and down, for he is patient, and can wait as long as he needs for us. We can try to stop him, but we never will. At best, we can trick him, maybe he can leave, maybe he just waits. But one day he will return to continue his hunt.
On any other patient, who lacks a signed DNR, she would be in the ICU no questions asked. Her blood pressure is dropping; 79-45-77. Her breaths are shallow and irregular, but her non-rebreather mask keeps her saturation in the mid 90’s. I give her morphine to ease her gasping, but she continues to do the same. Eventually, she can close her eyes to sleep and I wonder if she will ever speak again? What were the last things she said, and to whom? At least she can nod. She hasn’t shaken her head yet though; what if that’s all she can do right now?
She looks like every other patient I have seen that has died on this unit. Her limbs are cold. Her whole body has severe swelling. The edema on her extremities forms to any pressure. On could sign their name on her legs with their finger and the impression would last for hours. Her stomach is distended far beyond what it should handle. It is hard with a spring, like a red dodgeball. Her labs show how hopeless this case is. Her organs are failing, she is deadly acidotic. I pray she is not suffering too much. One never knows the true pain of passing until it is too late.
She is younger than my own mother. Her family came up by her side and paced the room as I lay my stethoscope to listen to her raspy breaths. Her daughters are stricken with grief. This day was to come, but they never thought so soon. You think you can prepare for when this moment occurs. But, when that day finally presents its darkened face you realize: you are weak, and you are forced to witness the harsh reality of mortality; a trait we are all burdened with.
Throughout the night her pressure continues to drop. 66-58-56. The heart monitor shows her pacemaker working flawlessly to keep what at her age should be a very healthy organ, alive. It beats without fail in perfect sinus. 90-90-90. Does the pacemaker make the dying process longer? I can’t help but wonder. 90-90-90. Funny how resilient the heart is; how it will pump hard until your last moment. They don’t get the credit they deserve.
Her family has gone home now. It’s just I, and what little presence she continues to have. I rest my palm on her chilly hand. The human touch is such a sacred thing in this world, but I can’t stay like this for long and a force draws my hand away. If I get attached, this job will become impossible.
I have other patients to tend to. People who are having the most miserable days of their lives. And I must provide the same amount of compassion to them all. Can a single person run out of compassion? I suppose so. We always hear about compassion fatigue plaguing the healthcare worker. Perhaps true genuine compassion in a certain amount of time will inevitably run dry. But, I can put on a smile in every room. Even if it's fake, I don’t think they know. If only they knew what was happening right now just a few yards down the hall.
When I return to that grim room down the hall I gently lift the sheets to take her vitals; she opens her eyes and stares into mine. She raises her arm as the cuff begins to squeeze; the most reaction I have gotten from her this whole night. I ask if she hurts but she only stares. I pray she nods to let me give her some morphine but her heavy lids close again as she returns to her slumber.
There is an eerie stench in the room. It smells rotten and familiar. Every patient that has died on this floor with hospice care has it. It is death; waiting in the doorway behind me. But I am all too familiar with his presence lurking these halls. I know his tactics, his ins, and outs, its what I have spent years mastering. I watch my patient struggle to breath; he patiently waits for his chance. There is only one thing on my mind: Not today, not my shift.
Photo credit: Robert Reid (1918)