Finishing the Race

My patient died on my watch. I knew it was possible…I just didn’t think he would. He was on comfort care – basically hospice in the hospital. I have 5 patients each night and he was the only one on comfort care. He was breathing like he was running a marathon all night. His breathing was so loud I could hear him down the hall. 

Fortunately it wasn’t a crazy night – no alcohol withdrawals, active seizures or patients jumping out of bed - so I was able to spend a good amount of time with him. I have only had one other patient die and she had family and many visitors around when she died. With this patient, his family left around 10 that night to get some rest with assurances from me that I would call if there were any changes. But there weren’t any changes…until he was gone.

His life story isn’t mine to tell. I didn’t know him. When I took him as a patient he was no longer responsive. I don’t know what his personality was like, what he did for a living or if he had a good sense of humor. I just know his medical history. His heart was in really bad shape – kidney’s weren’t so great either. He then had a pretty significant stroke and his body and his mind just couldn’t recover.

I tried to make him as comfortable as possible – after all, it is called “comfort” care but I just couldn’t seem to change his breathing no matter what I tried. It was almost like he was racing to the end. I asked the more experienced nurses that night for advice. I didn’t feel like I was providing him much relief. When all the medications didn’t seem to be changing anything…I just spent time with him….did my extra charting in his room, put chapstick on his lips and swabbed his very dry mouth. He was working so hard. From my experience with running, there isn’t anything better (other than finishing) than having a cheering section along your route. If I couldn’t give him a more comfortable pair of shoes, at least I could provide encouragement along the way.

My shift was just about done. The day nurse was there and I was giving her a report on the night. I had just finished telling her how hard this patient was working all night when we walked in his room. It was silent. His race was over. We listened for a heartbeat and it was still there…barely. We stood in his room in silence as he died.

Being with someone when they die is mostly beautiful with just a smidge of terrifying thrown in. He seemed peaceful…the most peaceful he had been all night. But, in the back of my mind I am wondering, is he scared? Is he comfortable? Did I do all I could do for him? I will be left to wonder. His heart came to a stop and his soul was gone. 

I knew my patient would die soon. I just didn’t expect it to be on my shift. Maybe he took pity on this poor new nurse who was trying desperately to provide some measure of comfort and wanted to show me how comfortable and peaceful he could be. Maybe his heart just said enough. I hope that as I encounter more death in the hospital I never get used to it. If I never see it as normal or routine, I am hopeful I can hold on to the sense that the experience of a physical life ending and a soul going on to find rest with God is sacred.

Keep the Gown On

I have to believe that nurses see more people naked than most legal professions. I see a lot of naked people. When I was a student I found this embarrassing. Now, I have come to expect it. There really isn’t a chance that if I am your nurse I am not going to see some skin. It is my job to perform an assessment of you when you become my patient. The assessment includes looking at your skin. I will be discreet but I do need to see a good portion of you. Now, if you have wounds, I am going to have to look even more thoroughly. After the initial assessment you might be able to keep your gown intact the rest of the evening unless you spring a new leak or have any complications.

That being said, I can’t get some of my patients to keep their gown on no matter how hard I try. Just because you are in the hospital, you don’t have to be naked. I know those hospital gowns don’t provide good coverage but you shouldn’t take that as a license for indecency. I had a patient recently who was going through alcohol withdrawals and having a bit of a break from reality. Every time I came into his room – which was about every 20 minutes because he kept trying to leap out of bed – he had disrobed. The whole situation was a bit unnerving but the nakedness made it even more so. I would get him back to bed and reattach his gown…each time…even though I knew my efforts were probably pointless considering we would repeat the entire scenario shortly. Don’t misunderstand me, I really think most people in the hospital are half naked without even realizing it. They are out of their environment and their routine. They are put in a strange place and given a nightgown with a big gaping hole in the back. Many are in pain and have much more pressing issues than whether or not they are clothed. We don’t hand out tickets or fine you if we come into your room and you are naked. But, we also don’t charge you extra for the gown. Go ahead and use it.

All this skin has become part of the job. It doesn’t rattle me much anymore and if you find yourself in this situation, you shouldn’t feel too embarrassed about it. Know we have seen A LOT of people before you. For what it’s worth, let me offer you some advice for the next time you are in the hospital. If, on a daily basis you wear clothes at home and work, do the same in the hospital. We have hospital pants. If nobody offers you them, ask for them. Ask for an extra nightgown and tie it on backwards. That way your backside is no longer hanging out for the world to see when you walk in the hallway. Bring your pajamas from home and we may let you wear them as long as we can still access the iv sites and hook up the heart monitor if necessary. If you feel less inhibited and freer half clothed, go for it. You will be in good company.

In spite of my own advice, I imagine if I ever find myself as a patient in the hospital one day I will probably be the delirious one disrobed at the end of the hall. If you see me, please give me a gown...wait, make that two.