i knew that he was dying from the moment i met him. i was surprised because he didn't look bad on paper when i was getting report, but in person it was clear. he was an elderly man who had fallen and broken multiple bones in his face, neck, and back. i could see hear crackly lung sounds the second i stepped into the doorway. he fought the oxygen mask that was cranked up all the way, and the respiratory treatment he was getting did not appear to be helping. his color was terrible, his foley had no urine despite diuretics, and it was pretty obvious where this was going. my suspicions were confirmed when i got vitals and saw an oxygen level in the 70s maxed out on O2.
even in a world where it's somehow ok to try to keep brain-dead people alive, this man was not going to make it. the question at this point was how he was going to die. would it be in a few days intubated in the ICU, sedated and maxed out on pressers? or would it be under my care in a few hours?
the day shift RN and i went to the back room to talk to trauma. everyone knew that the patient had a terrible prognosis, but i don't think anyone realized how little time we had. "he is dying now" i told them. "we need to make sure the family knows what's going on".
the family had been at his bedside the entire time, watching him struggle. that's a terrible thing to see, but despite their own feelings they were doing the best they could to hold it together. a granddaughter was holding his hand so he wouldn't pull the oxygen mask off his face. i stood on his other side doing the same.
i held his hand for over an hour. my wonderful coworkers took control of the rest of my patients so i could see things through until the end. trauma came to see the patient, and in quiet panic went to call the palliative care team. i wasn't sure they would make it in time.
both teams made it to the bedside shortly thereafter. they were compassionate and clear about what was going on. the family talked amongst themselves and decided that he wouldn't want to live like this, and they would follow his wishes not to be intubated. the palliative care team ordered a small dose of IV pain meds and i gave them.
a half hour later, the restlessness stopped. he took a final breath surrounded by his family, and he died.
i had been about to give him some more meds because he was agitated, waving his arms up towards the ceiling when he hadn't been doing that before. now it seems to me that he saw something, and was reaching for it.
but of course we can't be sure of that.
his death was hard to watch, especially for the family. but overall i would say that it was a good way to go. suddenly and quickly, after almost 90 years of a good life. a few short months behind his sweet wife who, according to his family, was his reason for living. there are worse ways than this.
it's a sacred and sobering thing, to be involved in the dying process. how to guide a family through it is not something that they teach you in nursing school. it's another one of those things that you pick up as you go along. more so than anything else, you put aside professional boundaries and just be a human being...a person who has experienced loss personally, and who can empathize. you do everything you can to make the experience easier, and if you can't, you acknowledge the fact that you know it's really hard.
from the moment i met the patient to the moment he died was a short two hours. but i've learned that you don't forget important things, no matter how briefly they lasted.
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