Death happens

You would think that by working in hospice you would become less surprised by the ache and pain you see others experience when death is near. I saw a patient yesterday, she was in her late 70's and it was very clear to me that she was starting her process and if I was to guess, I would say she was hours away from taking her last breath.

Her husband of 54 years was not ready to give up hope, he was not willing to believe that her time was up and refused to have "that" discussion with me. When I arrived, she was experiencing pain, and while I was not clear where from. I feel confident that her whole body was riddled in pain. I desperately wanted to give her something, my medication of choice was Morphine. He refused initially because he was absolutely certain it was the "death medication" and if she was being given that, it was the admission that death was near. He wanted nothing to do with anything that didn't hold out hope.

I am sure many of you in hospice have had the conversations about Morphine; people are frightened... it has a scary and negative connotation and most people think it will cause addiction or death. I had a patient once that told me he thought of morphine as a velvet blanket that once taken, feels as though it wraps around you, comforting all the places that ache and makes you feel cozy and safe. This is the explanation I give to many and it is the one I gave to him. He finally gave in and Morphine was administered. It took about 20 minutes before I could see she was more relaxed. I assured him that he could call our after-hours line if she was not relieved of her pain and that I would make sure a nurse was scheduled the next day (today) to come back and check on her.

I was scheduled to visit him today. About 15 minutes prior to me heading there, I received a call that he thought she had passed and wanted to call 911 and have someone resuscitate her and make her better. The triage nurse told him I was on my way and asked him to please wait. I drove so fast to get there, I was certain I would get pulled over, in fact I had decided on my route that if that happened, I would just keep going until I got there and deal with it when we arrived. Because I knew, this husband needed me NOW and nothing was going to get in my way.

When I walked in the door, he was standing there in the living room, his eyes so red and puffy they were hard to see. "She died Gabby. She died. She stopped breathing. What happened?" And I went to him and hugged him tight and asked to see her to make sure. I walked over to her bedside and I knew. But I needed to go through the proper steps and listen for a heart beat and feel a pulse. As I placed my stethoscope against her chest I took in a deep breath as I prepared myself to turn around and give him the news he never wanted to hear. I know he was hoping that I would say something else, that he was wrong and she was just deeply sleeping. I took my stethoscope and slowly put it over my head and on my shoulders and I very slowly turned to face him. "I'm so sorry..." and I reached for him to hug him. I could feel his tears soak through my scrubs. I could feel his heart break. And while I knew I was not responsible, I was the one that gave the news and for a brief second I really, really hated my job. I cried as I watched him call his kids.

I convinced him to help me bathe and change her before their kids arrived. I changed her clothes and brushed her hair and I repositioned her in such a way that she looked beautiful and at peace. I asked him to go out to the garden and pick a flower for her to hold. He walked in with a blue hydrangea and asked "is this one okay?". I took the flower and tucked it in her hands that were carefully placed in her lap. He said "she looks so beautiful". We sat at her bedside for about 15 minutes as he told me about their life and their love.

His kids arrived while I was still there, as did friends and family that rushed over the minute they heard. News spread fast and he was supported and loved by many. Before I left I reminded him what a beautiful job he did caring for her. He asked how it happened so fast, he needed answers. I tried to use all the right words to help him to understand that while his hope and faith for her to recover was strong, her diagnosis was stronger and it had a mind of its own. I assured him that his care allowed her more time than was probably expected and he should hold that close to his heart.

I walked out, got into my car and drove about 30 feet to a shady spot under a tree and I cried. As I say often, I see death but I also see love, deep, amazing, beautiful love. I reminded him before I left that some people in their entire lifetime never feel the love he had for her and she was blessed to have that. He told me he was too.

xo

Gabby