This last week I had three patients pass away. One each day that I worked. (For anyone who is just reading this, please note that I work on a Medical/Oncology floor and that these patients, unless otherwise specified, were on End of Life care, they did not have a cardiac arrest or "Code Blue.") Since I started working at Madigan last June, I have had 23 patients pass away. Each one is different. Each patient passes away in their own way. Each family reacts differently from the next. I'm not sure there is any way to "get good" at being a nurse taking care of End of Life patients.
This month I was reminiscing on the past year and thinking about the different family members, friends and coworkers of these patients. There are some patients you just cannot forget. (Some you wish you could forget...) There is a handful of people whose stories will continue to live on. Memories of children weeping over their dead mother's body haunt me in my dreams. Their faces are so real, so tangible, I feel that I can still reach out a hand and touch them, put an arm around their bodies riveting from sobs. I see mothers crying over the bodies of their young sons. I see fathers, once tough and calloused, brought to their knees. I wonder if there is something I could have done differently, something I could have said to ease the pain, but in my heart I know there was nothing to be done.
The Family members become your extended patients and suddenly you go from having one patient to 6 patients. There is nothing more humbling, nothing more draining, nothing more saddening than standing by a husband or wife and showing them how to let their spouse go.
I always thought the kids were the hardest ones to watch when a patient is passing away. Their small world is crashing around them as they know it. This week I realized something - More than watching a small child cry, more than watching a mother or father weep at a bedside, more than watching a husband of 50 years hold his wife's hand as her heart of gold stops, above all of these heart wrenching scenarios is the moment when there is no one there. He came in as a train wreck and I overheard the physicians say they would be surprised if he even made it out of the ICU before he passed. He made it. Barely, but he made it. He came to our floor in the same train wreck condition, was listed as a "DNR/DNI" (Do not resuscitate/Do not intubate) and added to our growing list of "End of Life" patients. What I was expecting to meet, and what I did meet, were completely opposite. I was anticipating a patient that was unresponsive, I got a patient that was alert and oriented. Due to his condition and Diagnosis, making out the words he was saying became my mission. It was obvious that there were things he needed to say, and things he needed to be heard. One morning it took me almost six hours to figure out what he was saying. After many frustrating attempts to communicate, I decoded that he had some parts that were at Tyson Motors getting fixed and he would like me to call and tell them that he was sorry he didn't pick them up on Monday like he had told them he would do. I actually found it quite admirable. I learned that he hates country music with a passion and lives to hear classical. I learned he had an estranged daughter. I kept waiting for a family member to come to his side. A son, a daughter, a wife... but there was no one. He told me no one would be coming unless his neighbor stopped by. He was right. Spare from a neighbor stopping by, he was alone. Alone and dying. Dying yet still too aware of his surroundings to turn off his mind.
The last time I visited this patient in the hospice house that he had been taken to, the nurses told me he had been unresponsive since he'd been there. I went in to his room and I heard some ungodly country music playing from his radio at his bedside. I started laughing and I said, "Well no wonder they say you're unresponsive, Mr. Blank, they're playing the devil's music for you. Let's find you some classical." A small smile spread across his face and he simply said, "You're back."
It seems the more I see the end of life, the more I treasure the beginning of life. Each time I watch a patient pass away, I get to see the people that are surrounding them and the legacies they leave behind. It gives me hope and passion to live a life worthy of being mentioned. It makes me want to cherish the good times and forget about the bad. It makes me forget about tomorrow and relish in today. To capture the sun and dance in the rain. It makes me appreciate the little things, look forward to the larger things, and believe for the supernatural things.
