THE VISITORS

spotangel, DNP, RN, NP

Sammy's eyes were wide, her hands nervously locked together.

"Umm! Annie, I am not comfortable with this".

"This", being her dying patient on her first day off orientation on our telemetry unit.

"You'll be fine", I encouraged her but she grabbed my hands!

I gently removed my hands from her tight grasp.

"C'mon! Let's go see the patient". We walked over to room 680. Mrs. Grant looked thin and frail and lost among the white sheets. Her breaths labored, her face pinched in pain. Her systems were shutting down as the cancer had spread all over and there was no other treatment left to try. She was a Do Not Resuscitate (DNR) on palliative care and was dying. I recalled her conversation with me from last week when we spoke of dying as I gently turned and repositioned her.

"Annie! I am afraid!"

"You are afraid? What are you afraid of? "

"Dying alone" she whispered feebly. I washed my hands, pulled up a chair and sat closer to her and held her hands.

"Talk to me Ms. Grant. Tell me more".

"I just don't want to die alone. I am scared".

"It's ok to be scared of something new but you don't have to be afraid".

"Why?" her eyes clung to me desperately seeking reassurance.

"Ms. Grant. When you die, you never leave this earth alone. Your guardian angel and your family who have died before you come to accompany you."

"Is that true?"

"It is true. I know. My dad came for my mom. He died three years before she did and she saw him and told me just before she died in my arms in the hospital".

"Oh!" Hope flared in her eyes.

"Ms. Grant, would you like me to pray with you? God will give you strength".

"Yes, please!" I prayed The Lord's Prayer (Our father, Hail Mary and Glory be to the father) with her and especially asked Mother Mary (who I adopted as my mum as a 15 year old when my mother died) to especially watch out for her.

"Ms. Grant, Mother Mary's got you. Don't worry."

"I am not anxious any more. Thank you Annie." Now, as I looked her pain filled face even though she was on a morphine drip, I hoped that her anxiety about dying was gone. I silently reminded Mother Mary not to forget her at her hour of death. Seeing that Sammy was clearly overwhelmed, I told her that I would take over care for Ms. Grant and she could continue with her other patients and call me if she needed me. Her relief was palpable as she quickly left the room. I checked Ms. Grant's vitals, checked the telemetry box and wires attached to her and took a morning 12 lead EKG. Her heart rate was 44, normal sinus rhythm. Her skin was intact, diaper clean. She was unresponsive and actively dying. I upped the morphine as per the protocol and left her attached to the 12 lead EKG machine. I gently turned and positioned her as I prayed the Lord's Prayer over her and left the room.

As charge Nurse, I checked the assignments, made the breaks for the staff, checked the unit and rounded on the patients. I also called Nannette the telemetry tech in their room across the hall and told her that Ms. Grant was actively dying and that she was a DNR/DNI.I requested her to call me once the heart rate dipped in the 30's. She promised me that she would. I then called the two sons and informed them that this was a good time to come visit mum. One of them, Clark, lived far away and could not come. The other one, Little Jimmy as his mum fondly called him told me that he was on his way. I told him to drive carefully and that I had a feeling mum would wait for him.

Little Jimmy turned out to be 6'5'', 300 lbs. and was clearly distraught. I took him to her room and he helplessly asked me, "What should I do?" I pulled up a chair for him to sit by mum.

"Just sit by her and hold her hand. Talk to her as the last sense to leave is hearing. Tell her whatever is in your heart. She can definitely hear you." Little Jimmy sat with tears dripping down his shirt, clutching his mum's hand sobbing as he talked to her. I patted his back, told him to ring the bell if he needed me, assured him that I would be back and left the room. In a half hour, I checked on him and now he had his face resting at her waist and his arms gently cradling her as he poured his heart out. Half an hour later, Nannette paged me to call the telemetry room. The heart rate was 36.I walked towards the room and stopped by the door. The scent of roses filled my nostrils as I looked into the empty room devoid of flowers. The scent was sweet, clean and powerful. I also sensed that the room was crowded even though I didn't see a soul other than the son. I felt like I was entering a packed room.

"Blessed Mother, You came with your angels. Thank you!" I silently said, my heart full. I stood by Little Jimmy, one hand on his shoulder, the other on Ms. Grant's knee. The 12 lead EKG rhythm showed a pulse of 28 on the monitor. The room smelt as if there were hundreds of roses in the room.

"It's time Jimmy. She will be leaving soon". He nodded his eyes red from weeping. Ms. Grant's face suddenly changed. Her eyes opened and she looked up in wonderment at the ceiling like a little child. A peace stole across her face and her face took the glow of a happy bride and she stopped breathing. The EKG machine showed a flat line. We stood silently awash in the peace of the moment. In five minutes the room lost the scent of roses and suddenly felt bare.

"She is gone Jimmy but she didn't go alone".

Little Jimmy looked at me and said, "I know, I felt them too". My mother had come to take her home. You can always count on her to keep her promises no matter what!

THE VISITORS

About spotangel, DNP, RN, NP

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