Witness to Goodbye

BSN_after_40

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.

Witness to Goodbye

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