THE SCENT OF DEATH

spotangel, DNP, RN, NP

I froze by room 650 as I wheeled the med cart.

The scent hit me.

The overpowering scent of flowers candles and incense. The smell, I associated with death. This was a very familiar smell to me. I had lost both parents as a teenager and this was the smell in the viewing room that was filled with flowers, wreaths, candles and incense. I hated it with all my heart.

Two decades later, the smell was hitting me right outside Ms. Watson and Ms. Grey's hospital room. I parked my locked cart and went in to investigate. The smell was not around Ms. Grey's bed but around Ms. Watson's bed. Ms. Watson lay sleeping peacefully, the early morning sun gently glowing on her face like a mother's caress. The scent was overpowering and I slowly backed out of the room. I went to the nurse's station and sat down, my mind whirling. What should I do?

This was not the first time; I had smelt death on this telemetry unit. The first time was a few months ago when I was taking care of a very sick septic patient John Perkins. I smelt it around his bed and was puzzled. I did not connect the dots and thought I was being overly sensitive. I thought I imagined the smell and ignored it. He was a full code and coded two hours later. He did not make it.

I began getting the smell more and more frequently before patients coded. Some made it, some didn't. I cursed this "gift" of sensing the angel of death. I tried very hard to ignore it. I dared not speak up about it as I did not want to have a Salem witch hunt or my coworkers look strangely at me. I wanted to be part of the crowd and blend in and not create waves.

My conscience started pricking me. Maybe, if I had told someone else, we could have been better prepared. Maybe, I could have setup the suction machine on the wall, ready to go; maybe I could have asked the telemetry monitor room to observe that pt's rhythm more closely. I beat myself up every which way without relief. One night I sat pondering about this wondering aloud about why I, who was so uncomfortable with death and dead bodies, was given this gift. I argued loudly with God as my kids were sleeping soundly and my husband was at work. I got tired eventually and went to sleep. The next day, I resolved to do things differently. I decided to be proactive. I went in to work with a plan but of course did not smell anything for almost a week! God had his own plan--!

On a Friday, I smelt death outside a single room. The smell was overpowering in the room. There was not a single flower in sight, so I was sure of what I smelled. I quietly checked the suction (which was not set up in readiness---my pet peeve) and set it up ready for any emergency. I then went to the nurses' station and rolled the emergency cart to outside that room. The patient crashed within the hour. We successfully resuscitated her and transferred her to the CICU. She was forty five years old and the mother of three. Later, when the patient's primary nurse asked me how I knew to get the equipment in readiness, I told her that I had a" feeling". She believed me as us nurses are famous for our feelings and intuition.

The team noticed me doing this before unexpected codes and started joking during report at shift change. They would finish report and then ask "Annie, any feelings?" and snicker! I took it in stride .There was an older wise nurse from the "Islands" who suspected that there was more stuff going on that I was letting on and once gently asked me. I told her not to label me a witch and told her.

She told me simply, "Annie, don't fight it. It's a gift not a curse. Use it to help others".

I still was not sure as patients still died, so what was the point of the gift. I did not realize why I got this gift until Ms. Watson room took on the now familiar smell of death.

Ms. Watson was a walkie talkie with three daughters that she always talked about. I had met one of them Beth, who came every day after work. I enjoyed watching the mother daughter interaction as they teased each other and joked about the hospital food and planned for the upcoming summer. Ms. Watson was a renal patient waiting on her shunt to mature and had come in with hyperkalemia with tented T waves on her EKG and chest pain. Her pain had subsided and she was waiting for a cardiac catheterization as her Echo had shown some possible issues in her heart. She was chest pain free but there was a possibility that her Potassium would go up again, hence the wait and monitoring. Her other daughters lived out of state but called every day in the evening without fail.

Beth was walking out of the room and saw me park the emergency cart outside her mother's room. Ms.Grey had been discharged and was waiting for her son to pick her up. Puzzled Beth asked me, "Who is that for Nurse Annie?" I attempted to give her a vague answer but I could never lie convincingly! She saw something in my face and persisted with her questions. I told her that I was being extra cautious. She bought it for the time being. Later she asked me seriously, "Annie there is something you are not telling me. Please, tell me."

I did not want to freak her out so I kept it simple.

"You know Beth how nurses are very intuitive. I just feel we should be extra careful with your mother and monitor her more closely."

She read between the lines, looked me straight in the eye and asked me, "What should I do?"

"Get your sisters to come and stay with mum for the next few days."

She nodded her eyes filling. The next day she called me from work.

"Annie, I took a couple of days off to stay with mum. My sisters are flying in. The three musketeers will be there in the evening! Don't tell mum".

That evening I spoke to the nursing supervisor and got permission for the family to stay in the visitors lounge at night past visiting time for the next few days. Thankfully telemetry was slow and her roommate bed remained empty which was surprising as those beds filled like hotcakes. I told Beth about getting them permission to stay. She was very grateful and introduced me to her sisters. I left for my weekend off with their laughter ringing in my ears as they surrounded their mom who was ecstatic that they girls had surprised her!

I came back on Tuesday to find an empty bed. I was surprised as she was supposed to have her cardiac catheterization that day. I asked around but no one knew as the weekend crew was off. I took the admission discharge log and checked it. My heart leaped to my throat when I saw the Monday 3 am entry. Ms. Watson had died. I was in shock.

I pulled Beth's number from the paper chart that was still there. Drawing a deep breath as she picked up, I carefully said, "Beth, this is Nurse Annie from the hospital. Can you talk?"

I heard her crying and then she told me what had happened. Ms. Watson was fine all weekend and insisted that the girls go home but they all refused. So they kept watch at the bedside, talking softly in between with mom when she woke up. At around 2.00 am, Ms. Watson had a massive heart attack and arrested. She was coded for almost an hour and declared dead at 3 am.

Beth told me, "Nurse Annie! I do not know how to thank you. Mom's last three days on earth were her best and she never looked happier. The memories in this last three days with our mother will comfort us. We have these memories thanks to you. Bless you for giving us that chance to be with mum. I think she is at peace and so are we."

I was too choked up to speak. A month later, I received a bouquet of flowers with a thank you card that said, "Mum thanks you from heaven! We thank you too!-Beth, Pam and Sara". I treasure that card more than a paycheck! Once I moved from acute care, I did not get that scent again. I hope I don't either!

Since Ms. Watson's death, I realized that my gift was to be used to help the patient, family or staff to get prepared. I never knew what the outcome would be but I knew now that every patient got a fighting chance to live or die in peace. As a nursing supervisor covering that same unit, I still see some of the nurses I worked with, who remind me that before we had a rapid response team or a cardiac arrest team we had Annie's ESP!

THE SCENT OF DEATH

About spotangel, DNP, RN, NP

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