Death, for many nurses, is the enemy. We come to work ready to conquer it or, at the very least beat it back, beat it down for another hour or another day. However, I never felt that way; as a patient, as a family member, or as a nurse. Death was never wanted, never welcomed but neither was it the enemy nor the ultimate loss in a battle of good vs. evil.
For, you see, there is no battle with death, not really. It has allowed us to think we have won other battles but it was only a trick of the ego, our ego, as death was never truly in those fights. For, you see, when death has truly come there is no beating it back, there is no winning. In those moments when you know this, when you accept this, I believe nursing and nurses can be at their greatest.
It is nurses at the bedside providing palliative care for the patient, comfort care for the families, and much needed resources for everyone involved over the next coming months, days, or years. . Yes, we give meds that make people better; we do treatments that make people well. But, we also give meds and do treatments that make people comfortable and make the days to follow bearable.
For me, palliative care was the one job in nursing that made me just a little bit better, both as a nurse and as a person. For those that know me, my cardinal rule of nursing is 'treat each patient as if they were your mother, brother, sister, father'. This is as important during end of life care as it is during the fresh cardiac admit coming in from the ER with his two pages of orders. In my opinion, it is one of the true tests of nursing. How do you react when there is no more "enemy", when there is no more "fight"; When it comes down to just you, the patient, the family, and the realization of a new reality to come.
I went into nursing after I became pregnant with my first child. The pregnancy was difficult with lots of complications, office visits, and monitoring. I remember each and every nurse who treated me well and some who treated me poorly, as just "another" 19 year old kid who had no idea what she was doing. I wanted to be one of those "good" nurses who helped people, who saved lives. However, it wasn't until my third child that I came to realize what a great nurse was.
I had just had a stillbirth after hours of induction and labor in which everyone knew what the outcome would be. We still waited for the cry, even knowing it was never going to come. I remember the labor, I remember the silence, and I also remember that the nurse always, always said she was going to take my son back to the "nursery". She also advised my family that the baptism should be done quickly, for practical reasons (I was catholic at the time). It was the nurse who gave me my options as far as burial, hospital policies, etc. All I wanted was the last few days to come to an end. However, had it not been for that nurse, I would have nothing but the remembrance of the awful days that followed. Because of her care and resources I have a grave to visit. I have proof that I did indeed have a son and he lived, albeit inside me, on this earth.
I went into nursing due to the blessings of life. I learned what true nursing is due to the devastation of death.
It is not surprising then that it is the end of life patients that I can remember most vividly after years of leaving the intensive care unit. I remember the father who would not quit seizing and was brain dead on arrival. For a fairly new nurse calling the doctor was, at best, scary and at worst terrifying but that night I didn't care. I called for more ativan, I called for more pain medications, I called for MORE...all through the night. Finally, the doctor at 3:00 in the morning asked me what I really wanted him to do for this man. Wrongly, he thought I had naively hoped that the patient might recover. When I finally admitted that I did not want the son's last memory to be of his father's unending seizing he paused for only a second before I got full orders for a phenytion drip, ativan, and morphine until the desired results were achieved. By then I understood that dying is an individual journey, but death is a family experience.
Then, there was the homeless man left frozen in a gutter. On arrival to the ER he had no signs of life. They had managed to resuscitate him enough to have a heartbeat due to multiple drips and good air flow due to a ventilator. For one night we were his only family. We were the last ones to care for a man who had not cared for himself; To make him safe, make him warm, and hopefully take away some of the pain that he must have been carrying. For one night we cared for a broken body in the hopes that we could comfort a shattered soul.
Finally, life does tend to loop back to your beginnings. Despite travelling all over the world since leaving the ICU, it was me who made that overseas call to the same ICU after my sister was admitted. I talked to the same nurses whom I had called colleague almost a decade earlier, one of them my mentor. I got the same responses that I had said so many times before, the words we say before the doctor sits down and tells family news that will forever change their life. You know the words. Things like "I think you need to talk to the doctor about that", "I am sorry, truly, talk to the doctor". I heard it in their voices that they were sorry that my 37 year old sister had just been diagnosed with stage IV lung cancer. I heard it on the phone in the ICU, I saw it on the floor of oncology, and I felt it in the presence of the hospice nurse as he faced my family after my sister told him she had been "healed" of her cancer because they had allowed her to leave the hospital. He looked to me for help but I didn't have any, couldn't have any-I was a part of this experience and I just couldn't say what needed to be said.
You see, I told that son a decade ago that I, too, believed in miracles. However, for his father to be completely healed it would truly be a miracle. I could tell that to the son when he looked at his seizing father ...but....I just couldn't tell that to my sister, or my mother, or even myself.
I still don't believe death is the enemy. I have journeyed with it on more than one occasion and each experience has left me more convinced that it is how we live those journeys, how we travelled each part of that path from beginning to end that defines a part of who we are; whether it be as a patient, as a family member, and most especially as nurse.
