My first job as a nurse was on a Neurology/Epilepsy/Stroke floor in a local teaching hospital. It was interesting to see the ways strokes affected the brain (or didn’t) and to deal with pretty much anything else that could happen to your mind. (Think ALS, severe migraines, MS, inoperable or returning brain tumors, dementia.) My first degree is in Pyschology so this was right up my alley.
While I was still in orientation we were told that the hospital was combining our unit with Palliative Care. We were upset. Staffing concerns aside, we were life saving nurses. We underwent drills for “Code Stroke” and “Code Blue”, we were an acute floor where patients suffered through the worst of their afflictions before moving on to rehabilitation or home. Sure, sometimes they were moved to the ICU if their condition worsened or to Palliative if there was no hope for recovery… but this was different.
For those who aren’t nurses let me put it like this: An acute floor nurse is like a firefighter. We would put out the flames and deal with the immediate damage while searching for the cause. We would help you to understand what had happened so you could live a better quality of life or at least help you see the light at the end of this terrible tunnel. A palliative care or hospice nurse is like a stewardess. She greets the patient and family with warmth and understanding. She gets you pillows, administers medications, teaches the family that dying is a process but that it will end soon. Then she ushers the family to the lobby while she pushes the gurney to the morgue for the funeral home to pick up.
As a nurse, those are two totally different worlds! How could we be both neuro nurses AND palliative? What would our patient families think?
“Hello Mr. Smith. I’ll be your nurse until 7p,” hears wailing from down the hall, “and could you hold on just a moment, I think someone just died.”
Not to mention a dead patient is the norm for a palliative care nurse. I did not become a nurse to watch people die. (And how creepy!)
The merger went through with some “voluntary loss of staff” and room assignment glitches. We all had a wonderful cross-training educational experience where I learned that morphine is man’s best friend. (All those dilaudid folks will beg to differ but when I’m dying, shoot me full of morphine and give me an easy ride home.)
My first three-in-a-row was easy. Nobody died or stroked out (a rarity on our floor). The next week I had delightful families and one conscious pally patient who was in for some comfort care. I made a loop to the break room and heard someone cry out as I passed. It wasn’t my assignment so I kept going.
The housekeeper ran out, “I think they need somebody in there.”
I turned around, adrenaline pumping (most nurses love the thrill of emergency situations), and entered the room. Three family members looked at me with confusion and tears in their eyes.
“I think she’s gone,” said the woman nearest the patient.
I checked above the bed and sure enough, this lady had a DNR (Do Not Resuscitate) Order. I pulled out my stethoscope and listened.
Her heart was still beating but she wasn’t breathing. (This is normal for a person near to death, their respiration rate will be decreased as the body slowly shuts down.)
Then it stopped.
I listened harder, aware of the family staring at my back. The patient’s eyes were open but she definitely was not looking at anything.
What was I going to say? Nobody is glad that their loved one has passed. I didn’t want to break their hearts, but I couldn’t lie either! I was looking into the elderly woman’s eyes, still listening, when I watched her pupils dilate.
And then I was calm. My nursing brain kicked in, “She’s passed.” I said it with as much respect as I could and noted the time. “I’ll give you some time.” The two women burst into tears and thanked me with hugs and the man shook my hand. I was so confused. Why were they thanking me?
The patient had been suffering from bone cancer for almost a year. She had been in pain, could no longer eat, and had no desire to live. She just wanted it to be over so she could be with her husband again. Her passing was the fulfillment of her wishes and her family’s. She would never feel pain again, never vomit from chemo or feel as though her bones were breaking as she lay in bed.
Death can be sudden and unexpected and hurt so bad you can’t breathe. And it can be a peaceful step into the next world, whatever that may be.
Sometimes we are firefighters.
But let’s not forget how to be a steward.