At 1830, I walked into her room, as I had done hourly since starting my shift at 1500. She was dying of respiratory failure, a result of her debilitated state and pneumonia.
She was lying in her bed, tilted slightly to one side to keep the pressure off the bruised, paper-thin, oozing skin on her coccyx. Her hands were lying, useless and flaccid, on her lap. The oxygen mask, a non-rebreather, was pushing 15L of humidified oxygen into her mouth every minute. Her head was tilted back, her eyes staring up, as though intently studying the ceiling. Her eyes never closed, she never seemed to sleep. This was the position she was always in.
“Mildred, look at me.” She blinked once, and then her eyes flashed down to my face. “Hi Mildred,” I said, grinning. She stared at me. “Mildred, blink for me.” A pause, and then she blinked. I smiled again. “I knew you were there.”
I turned to her husband of 60 years, who was sitting patiently at her bedside, as he did every day for four hours in the afternoon. “We’re going to turn her onto her other side, put some medicated cream on her bottom.” And he smiled at me, and moved out of the way. And another nurse and I turned her, repositioned her, talked to her, put some pillows under her knees.
“OK, Miss Mildred. I’ll be back in an hour. Blink at me.” And she blinked again, and I grinned, and left the room.
Her husband left at 1900.
I walked back into the room at 1930, and my first thought was, she’s the wrong color. And I realized she had died.
Later, a respiratory therapist came up, and saw the sign on her door (“See nurse before entering this room”), which is hospital code for, ‘there’s a dead body in here.’ He came up and we chatted, and he said, “You know, when I went in there a few hours ago, I noticed that she was breathing about once every ten seconds.” He knew she was dying then. “When was this?” I asked. “About 1915.”
I wish he had told me then. I could have been with her when she died. But I don’t know that it mattered. People wait to die. They wait until their loved ones have stepped out of the room, maybe to get get a cup of coffee, or a snack from the cafeteria, or maybe to go home for the evening after a long day of a bedside vigil. And once they’re left alone in the room, they let go. As though they don’t want their family to see the final breath.
I can’t prove this, just as I can’t prove a lot of things I see in my job. But I see it over and over and over again. And so do the other nurses. We talked about it later in the nursing station — the floor nurses, the aides, an IV team nurse, the admin rep. Just hanging out talking. Everyone had a story of a dying patient who waited, patiently, to be left alone, and then left themselves.
There were a few humorous moments. We had a nursing student on the floor doing some clinical hours. She volunteered to help with the post-mortem care, to get the experience. I had her remove the central line (an internal jugular IV) from Mildred’s neck. She said, “Should I pull it fast?”
I said, “No, it doesn’t matter. Remember, dead people don’t bleed.”
The student blinked a few times, and said, “REALLY?”
I had her think about this for a few moments. She figured it out eventually. I was highly amused.
But there were the sad moments, as always. It’s always the grief of the family that gets to me. I don’t think I can be a hospice nurse. The husband and one of the sons came back after I called them to give them the news. The son wept. The husband reached across the bed and held his wife to his chest. He talked to her for an hour. He opened her eyelids to see her eyes again, to tell her how beautiful her eyes were. Held her head to his chest. Grieved. Blamed himself, because when he was there visiting with her he would frequently hold her hand, and remind her to breathe.
I didn’t tell him that she didn’t need the reminder. That she breathed for him when he was present. And consciously decided to spare him the agony of watching her stop.
Sigh. I start in the ER in less to two weeks. But it’s a drop in hours, so I’ll likely pick up extra hours on my med/surg floor. For all that we see, for all that I want a change, I can’t leave them. It’s a solid team. And even though I can’t stand some of my patients, the bond I form with the others, and their families, is something I don’t think I can bear to leave behind.