Death and Dying

Below is an experience that I had in the hospital recently.

A few weeks ago I cared for a palliative client. Palliative care is for persons who are nearing  end of life as their condition may be deteriorating quickly and their overall prognosis is poor. Failing body systems caused by cancer, old age, trauma, disease, medications, etc. ultimately end in death. The particular patient I was caring for had extensive bowel cancer metastasizing to the pancreas, failing liver and kidneys, and oxygenation to tissues was becoming poor. When I cared for this patient I saw her deteriorate quickly; she was responsive to stimuli i.e. she would react to my voice or touch on the first day I cared for her, but on the second day she presented as unresponsive to stimuli (she was however still breathing and had a pulse).

I found that the most difficult part of caring for this patient was not that she was dying, it was the impact that her dying had on her family who came to the hospital to see her pass. As the patients primary care provider at the time I am responsible in caring for both the patient and family during the patients stay in the hospital. Your responsibilities as the nurse for a palliative client is to console the family, answer questions, effectively communicate to family members the patient's condition and measures of care, provide comfort measures to the patient (control pain, turn patient Q2hrs to reduce the chance of skin breakdown, clean mouth, etc), advocate for the patient, and collaborate with the patient's physician.

On the day of the patient's death her husband phoned the hospital and asked me if his wife was going to die today. Not literally in those words but that is what he meant. How do you answer that question? I told him that the his wife was doing poor toady, more so than yesterday, and that we do not know when she is going to pass. He asked me if he should take the kids out of school to see her. I responded that he should come and see her himself and make that decision, I cannot make the decision for taking the kids out of school to see her as patients can still survive for many days in the same state that she is in but she could also pass suddenly.

The whole family (or those who could make it) ended up coming to see her. They said their good byes and mourned for her. Many tears were shed... she had a young daughter. She ended up dying a few hours later after the family arrived (this is a phenomenon that happens quite regularly, the patient holds on to the last thread of life until family members say their good byes or at least come and see them in their final hour).

This is a bit of a morbid situation yes, but it is important to think about death and how it affects us personally and others around us. I thought about this situation extensively after it had occurred because I have not had many patients die under my care.

So what did I learn and what do I know?

1) A persons perspective of death is obviously effected by the experience of death in their lives. Many people have never seen someone die or had someone close to them die. The effect of death may have a very different impact on this person than someone who has been through the process of death and mourning of a loved one. The experience of death can be very negative, on the other hand death can be seen as very peaceful, and it is for many people. It can be seen as a beautiful transition from one life to the next. Many people die in their sleep or otherwise painlessly.

I do not know how I would react to the death of one of my family members. At this time because we are all so young I think it would come down fairly hard. But I know there would be light somewhere at the end of that tunnel. My spiritual beliefs would comfort me because I do believe there is life after death, I know that I would see that person again.

2) Why am I thinking about this? Well unfortunately or fortunately in the nursing profession you are thrust into situations where death is imminent and you are a crucial piece in the dying process for helping the family and the patient transition from life to death. It is key to have an understanding of the death and dying process in the nursing profession because you will undoubtedly be exposed at one time or another.

3) Death and dying experience, life experience, and maturity is key to finding the appropriate way to communicate with family members and close friends of the patient who is dying.

4) It is critical that as a nurse you are able to dissociate yourself from the situation. If you get too emotionally attached to the patient or the family you will suffer from increasing distress and negativity in similar situations ending in burn-out. Maintaining a caring presence for the family is key but a balance must be made with your inner-self and the context of the situation.

5) I did alright. I was able to console family members to the best of my ability and experience at the time. I was thanked for my care.

6) Death is a part of life and is a transition into what we do not know, and that is why it can be a source of fear for people. It can also happen at anytime, making the thought of death for yourself or a loved one even more scarier. I have decided to not be afraid but instead to be prepared, I want to have lived as righteously as I could have during my life so that when I do come to the time of death I can reflect and say to myself that I did what I was meant to do.

Gabe