Witness to Goodbye

Busy days are so common on a medical surgical floor that you barely notice when you miss a break. There was too many of those days. I had my assigned patients that I shared with my co-assigned RN. We had our usual scramble in the morning to pass our meds, do the physical assessments, treatments, and pass our meal trays. Much the same for the evening shift, although it was slightly less hectic, you never knew what might happen next.

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  • Specializes in Public Health, Teaching, Geriatric, M/S. Has 19 years experience.

Over a few months, we had a rash of cancer patients on our ward. The time period was somewhere in the early 1990s. We had many end-stage patients, most were elderly. But there was one young woman I will never forget.

She was in her early 30's. She was married with three small children. She had colorectal cancer. From my recollection, we had admitted her a few times over the previous year as she was receiving chemo and needed IV fluids to rehydrate her from the side effects.

Our medical surgical floor had a variety of acute cases, but back then, we served many end-stage patients that probably would have been sent home on hospice or a nursing home today. So it was always interesting and sad at times too. A lot of time was spent on talking with families, explaining end stages choices, and comfort care practices.

The young woman, who I will call Brenda, was told that her cancer was not responding to chemo, and to make her final arrangements and decisions. We tried our best to give her family the privacy and time they needed to do this without a bunch of us nurses lurking about while trying to remain supportive.

How awful I felt every time I came into her room, trying to make small talk to a woman not much older than I was, knowing she was dying. She was, of course, sad and very quiet. She offered little conversation and limited what she said to simple requests for pain meds or another blanket.

Her husband must have been about the same age. He looked pretty tired and washed out. He too was not open to many conversations. Our social worker tried to talk him into incorporating hospice services but he refused, I am sure it was mostly shock and disbelief of the whole situation.

The children were confused why Mommy couldn't come home. The oldest was maybe 8 or 9; he knew something was terribly wrong. I would guess the other two children about 5 and 3, with the youngest being a little boy. The younger two children would be trying to play while visiting, only to have everyone else in the room very unresponsive to any happiness or laughter. Many times we would offer them an ice cream treat to try to lighten the mood in the room, soon they got to know which nurse to approach for a treat when they came. Then, the husband started coming up alone.

I couldn't help but hear them discussing talking to the children about how serious the situation was, and how they needed to do this soon. Brenda was receiving heavy doses of Morphine to control the pain, and her abdomen was filling with fluid. She was also told the cancer had spread to her liver.

As any nurse with some experience caring for end-stage cancer patients can tell you, there is a distinct odor a patient will omit when they are terminal. Even if they are clean and continent, the odor is present. We began to sense this odor in Brenda's room. We knew she was drawing nearer to death.

A couple of days later, in the evening, the three children came in with their father to see Brenda. Of course, ice cream was given out to 2 smiling faces, and one not so happy. Seeing their mother so weak and frail was wearing on the oldest, it was very apparent. He tried to hide his tears when we would enter the room.

I knew the primary bag was running low, and soon I heard the IV beeping as it was almost empty. When I came in to hang a new one, I really wish it could have waited a few minutes more. I did knock, but unfortunately, I came in during the midst of the big speech Brenda was making to her children.

She said, "I am really sick and I am not coming home again guys, I am sorry." The news was too much for the oldest, he knew that she was very ill, but no one had voiced it to him yet. Hearing those words sent him out of the room to the waiting room crying and again trying to shield it from anyone in the hospital ward. The two younger children began to ask innocently "why?" Brenda continued to talk very softly about how she was not going to get better, and God wanted her to come to heaven to be with him. She had such grace to her voice, she knew it could be the last conversation with them and repeated how much she loved them several times. It was a conversation no mother would ever choose to have to make, but she did it very well.

I was starting to cry myself as I spiked the bag and tried to punch in the numbers through blurry, tear-filled eyes. Trying to stay focused and professional was very hard; I wanted to be invisible at that moment so I wouldn't take any attention from the situation or my reaction to overhearing that intimate conversation.

It was only a few minutes in the room, but it felt like hours. After I left the room, I went down the hallway, ignoring my co-assigned who was trying to tell me she was going on break. I brushed past her and went into the bathroom and cried. I couldn't tell you how long I was in there, but soon my co-assigned came and knocked on the door to ask if I was alright. She had no idea what I had just witnessed. I said, "just give me a few minutes and I will be out."

I have gotten used to caring for patients during their last days, cleaning them up and preparing them for the funeral home; it can become too routine. For the case with Brenda, I took it in pretty deeply. Seeing the faces of the ones she was leaving behind, wondering how they were going to handle being without her really haunted me, it still does to some degree today.

As nurses, we are expected to care for our clients, regardless of anything. It makes us professional when we can handle anything with a straight face from bones sticking out of the skin to an abused child. But we are not robots; certain things sink into our thick skin, and remain there forever, like a scar. Brenda really sunk into my skin. I guess it was because I too was a young mother at the time. My kids are my whole world, and the thought of leaving them behind at such a tender age would have been too much for me to even imagine, or want to imagine.

Brenda went downhill fast after that evening. She lingered for a few more days but was unresponsive. It was so hard to face her family in the room, waiting for her to pass. We kept her clean and comfortable. They knew when we came in every couple of hours to step out without even having to ask them.

She was 32 years old when she finally passed. Her husband was alone with her when she took her last breath. He did eventually allow the hospital social worker to help with finding resources to help him and the children adjust to life without her. I wonder about him and the children from time to time.

BSN/PHN for a county public health department

7 Articles   35 Posts

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AccelCNL, MSN, RN

1 Article; 501 Posts

Specializes in PCU, LTAC, Corrections. Has 7 years experience.

Wow....I am thinking of going into Peds Oncology (if my NICU dream does not work out) after nursing school. I find the whole area vastly interesting but when I think about the inevitible death that will come and then when I think about the age of the patients who are passing it really make me think.

You have given me something to think about.

Ginger45

157 Posts

Specializes in Geriatrics, med/surg, LTC surveyor. Has 26 years experience.

This was one of the reasons I went into geriatrics. I applaud you for writting that story. I can remember being a new nurse in the early 1980's. I took care of several young people with terminal cancer and it just broke my heart. She was very fortunate to have you for her nurse.

ernursechic

9 Posts

Specializes in ER, Home Health.

I dont think there is anything at all wrong with crying with or for a patient. In fact I think it helps the patients realize we really do care. I certainly have cried and have done so just recently when a young mom (just around 50) or less was a CPR in progress. Her kids were my age. The pain that family felt had spilled over onto me. I did cry with them and with them that day.

Mahage, LPN

376 Posts

Specializes in IMCU. Has 1 years experience.

What an honor each time we are a small part of a families last days together. We are not robots and thank God for that. I have been a nurse a very short period of time and end of life care has been one of the most meaningful services I have been able to provide. It sounds as if you and your coworkers did a great job with this family.

Mahage

NurseCard, ADN

2 Articles; 2,847 Posts

Specializes in Med/Surge, Psych, LTC, Home Health. Has 13 years experience.
:crying2: What a sad and scary story. I pray that I never have to leave my children behind at such a young age. They are only 6 and 2.

missy--kay

172 Posts

Thank you for writing this story. I lost my sister to cancer at only 30. She left behind a wonderful lil' girl, who still talks about her mommy. She was 3 when she passed, and is 8 now. I am currently a nursing student who only has 10 months left. I often think of Hospice and what I could contribute. The nurses fell in love with my sis, and her with them. They openly cried when she died...

It was amazing to see their human side. We loved them all so much. From time to time, I occasionally see them around town, or doing my clinicals. So many of them have said " oh my gosh, are you *** sister?" Just love that.

Thank you again for the story.

Leonurus

16 Posts

Thank you for sharing this story, and for all you offered to this family.

I just had my first patient death on Wednesday-lung cancer. It broke my heart-I had worked with her for several days and really loved getting to know her and her family. They were so sweet- adult kids and her wonderful husband-they were so in love. It was such a difficult thing to be present for, and such an honor at the same time to be allowed into this family's experience. I often think about moving to hospice nursing after spending some time in the hospital to learn. My preceptor had a background in hospice and was just incredible to watch-she had all these little tricks up her sleeve that eased the patient's and her family's suffering, and her manner with them was so good-compassionate, strong, present, and competent. It was clear that they felt relieved whenever she walked into the room. It really showed me how much we can do for people, even when we can't stop a tragedy.

amateur

24 Posts

:crying2: This is nursing. Hard but humanistic.

God Bless you... wow. All these stories melt me in such a way.. life is sooo short for some. Such a mystery it is... a sad one...

twinmommy+2, ADN, BSN, MSN

1 Article; 1,289 Posts

Specializes in ED. Has 18 years experience.

Your story made me cry at work today. I am 33 and have 4 children those ages so it really touches me. We as nurses are called to witness the best and hardest parts of human life, its a huge gift and burden at the same time. :crying2:

SmilesHeal101

116 Posts

Specializes in Medical-Surgical/Oncology.

OMG... how does one begin. Well, I am a new nurse, and trying to hard to be the best that I can be. I myself was a witness of having a young patient (male, 43) who was battling metastatic thyroid cancer. He had a trach, and was not able to communicate with us. We could only communicate by lip reading. I saw his wife and two young boys come in to visit. It was hard to see them come in knowing the circumstances. After they left I told him he had a beautiful family. I don't know if that was the right thing to say at the time, But, it was on my heart to say that. I haven't seen him since that night. Last I knew he was going home with hospice. I think about them and just wish that somehow and in someway there is a peace with them all before he leaves him. I am at a loss of words. I have always had an interest to oncology. I guess I will see if that will be in my plans in the future. I held back the tears, but oh boy did I feel them coming on. It is only human to feel.