This week at work was particularly tough - physically and emotionally.
Death is nothing new to me. In my few years as a student and as a nurse I've seen, prepared, and often shrouded roughly 50 people. It does get easier the more times you do it but it hasn't become so easy that I ever feel completely comfortable doing it.
It's weird knowing that someone who was just there with you isn't there anymore.
The death of a patient (thankfully in my case all my patient deaths have been expected or at least not a complete surprise) becomes even less comfortable when the family are there. It's more emotional and I know nothing I can say or do will make things any easier.
I think I wanted to write this as a way of saying that while it is (usually) always way more emotional for the friends and family of the dying person, there is also a team of health care professionals who are emotionally involved as well.
Unfortunately it isn't always the case, but in a lot of circumstances it is and if people reading this can take away only one message from this post I hope it is this:
Your loved one, in their final moments, even if you're not there, is not alone.
This past week I had a patient who had been admitted for palliative care about 2 months prior. Generally a 'palliative' diagnosis means 3 months or less. I've seen people pass away quicker and I've seen people fight a lot longer. This gentleman seemed like he might be one of the ones who fought for longer than 3 months. He was weak and quite sick but got up to the bathroom independently and would go out for smoke breaks occasionally or out to picnics and other events with friends.
He also had some of the most intense wounds I have ever cared for. I obviously can't reveal too much for fear of somehow breaking confidentiality but this involved a stage 4 sacral ulcer (google it if you're not too queasy), an incredibly deep rectal cavity wound (which required frequent cleaning from bowel movements and then packing with antibiotic-impregnated gauze or packing tape) as well as wounds on the penis, through which the patient's bowel movements eventually began to exude thanks to a fistula. Wound care was not a quick endeavour. And worse, you can probably imagine how painful it was for the patient.
Pain.
We do our best to manage it but sometimes it's hard. Sometimes it's frustratingly hard. This particular patient went through trial after trial on a number of medications, none of which seemed to adequately manage his pain. Especially once he really began to deteriorate. Over the weekend he really began to take a turn for the worse, refusing to eat and barely taking in any fluids. Doing his wound care was absolute agony for him and we all kind of weighed which was the lesser of two evils: making him suffer through an incredibly painful half hour or leaving him to sit in a dirty incontinence brief. When I came back after a day off he had become mostly unresponsive, meaning verbal stimuli and even tactile stimuli wouldn't bring him into a more alert state. But he spent the entire day in undeniable pain despite regularly scheduled medication, breakthrough pain medications, and new orders for other pain meds on top of that. Nothing was working and as the person who was directly responsible for his care that day, I felt awful. Knowing that someone is suffering and you are supposed to be there to ease that suffering is incredibly hard to stomach. Not for the first time and I'm sure not for the last, I silently wished for my patient to just slip away as soon and as peacefully as possible.
The next day he was less responsive and all signs pointed to the end of his suffering coming soon. I gave him as many pain medications as I could even though he didn't look as uncomfortable as he had the day before. I gave him any medication that I thought would help. Something to relax his stiff muscles, something to try to dry up the chest secretions that cause the death rattle.
And I sat with him.
I sat with him for most of the morning, getting up every now and then to check on my other patients. I held his hand and I rubbed his arms and I talked to him. As we tell an unresponsive patient's family and friends, hearing is often the last sense to go.
Eventually his breathing slowed significantly. The health care aide who had come in to sit with me noticed it and we both looked at each other, knowing. We held his hands, told him he had fought bravely and that he could go home for a well deserved rest. Within minutes his chest stopped rising and he had gone. There was no dramatic last breath, no dramatic anything. Just peace.
I think it's been on my mind because of the 50 or so people I've seen die, this was only the second death that I had been physically present for. And it made me think of my own grandfather who passed away in an ICU several years ago. He was lucky to be surrounded by his family, although I wasn't there.
I'm not sharing this to have people say "oh you're so wonderful, how caring of you to be with him in those final moments." That's my job. I'm sharing this because I've seen this many times with other nurses, social workers, doctors, health care aides, and others being there in the final moments.
I'm sharing this to try and make the dying process a little easier for those of you who have or who have had someone they love pass away in the hospital.
I have had a few patients pass away alone, in the early hours of the morning, often when we thought they had more time. I've had patient's go when I was helping another patient. I've had it happen in the time it took me to leave the patient's side to call the family to tell them they should come in. There is no way to say accurately how much time a person has left, and it is similarly impossible to predict exactly when a person who is dying will take their last breath.
But these patients, these mothers/fathers/brothers/sisters/aunts/uncles/children/friends never die alone. They are so many wonderful health care providers who do their best to manage pain but also to manage fear and anxiety and make the unknown a little less scary.
This may sound like a weird thing to say, but death is inevitable and I know in my line of work I'm going to see a lot more of it before I retire. So I'll say it.
I hope I get to hold the hands of many, many more people in their final moments.
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