The Last Entry

"Therefore, we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day." II Corinthians 4:16

Reaching over to click my seat belt into place, I took a deep breath of the mild night air and let it out slowly, in a long sigh. Weary after a busy day, I wondered what else I could do for Mrs. C, a resident of a nearby nursing home, who was experiencing agitation in the process of dying. We had already given her the medications that were available to us, and as I drove along, I thought over the process of what to do next. My cell phone buzzed beside me, lighting up the interior of the car. I reached over and held the phone to my ear only to hear the nursing home night nurse say, "She just passed." A mixture of sadness and relief washed over me as I pulled into the brightly lit parking lot and headed for the main entrance. I thought to myself, "There is a gift in every visit, but I can't imagine what the gift will be here."

I spoke with the charge nurse and went to the room to begin the process of postmortem care: pronouncing her, making the necessary calls to family, removing extraneous tubes, and making her presentable for her family. The two relatives stopped by for just a few minutes to say quick good-byes to their elderly loved one and longer thank-yous to me and the staff.

After finishing the chores surrounding death, I sat down in the sturdy bedside chair to wait for the funeral home to come. I thought to myself how little I knew of this woman. What had her life been like? I knew from the chart that she was into her ninth decade and came to the nursing home after breaking her neck in a fall. The residual effects of the fall left her unable to sit up or even turn her head, and I remember during interdisciplinary team meetings (IDT) conversations discussing different ways to help Mrs. C. cope with the extreme boredom of being bed bound and limited to one view. While patients are in hospice, we hold weekly IDT meetings, times when the nurses, social workers, chaplains and occasionally families, gather together to exchange ideas and information that helps us take the best care possible of the patient; sometimes we find solutions, at other times we simply open the door for solutions to find us.

As I scanned the room, my eyes lingered over the bulletin board, and I stood up to get a closer look at Mrs. C with her husband, first in a copy of an old wedding picture and then in a more recent color shot of the two of them beside a decorated Christmas tree, smiling through the years at loved ones.

Instinctively, I reached over to straighten out the lotions and combs on the bedside table, and as I did I saw what looked like a journal. Opening it to the first page, I read an entry by her primary nurse relating the fact that Mrs. C. repeatedly asked her to "write down my story." The nurse brought the journal and at each visit recorded some of what Mrs. C told her about her long, eventful life. As the pages went on, there were entries from social workers, chaplains, even visitors. Each one recorded their own thoughts or memories of their relationship with Mrs. C. As I neared the end of the well worn pages, I felt my weariness fall away, replaced with a warm feeling of, "I think I know this lady now!" So I pulled a pen out from where it lodged next to my computer and began my own entry, "This is the final chapter," I wrote and suddenly felt unexpected tears well up in my eyes. In the night quiet of the nursing home hall, I heard the click of the metal funeral home gurney and hurried to finish my entry, adding a few more words of comfort to a family and respect to a woman who lived a good life.

I tried to get out of the way while the burly men completed their task, then gathered up my things, ready to get on home and try to rest. As I stepped out into the hall, I heard a surprisingly loud greeting. "You are here!" a lady yelled excitedly as she began running toward me, arms outstretched. As she got closer, I realized that this was an elderly lady with mental handicaps and big, wide, toothless grin. I smiled back and when she got to me, she threw her arms around me and enveloped me in a big hug. Her body was soft, almost fluffy, and I allowed my chin to rest on her shoulder, feeling the friendship and absorbing the comfort that she transmitted as a gift for the end of my day. My pace quickened as I headed out into the night, spirits lifted by the two gifts I had received: first the gift of knowing another human being just a bit better and the other an unexpected gift of a comforting hug, given freely and unexpectedly but at such a welcome time.

As told to me by Joyce Peak, RN, BSN, CHPN

Joy Eastridge, RN, BSN, CHPN