I'm laying in bed, Ruthie is softly snoring at my feet. I'm thinking about my day, my short shift at work and the events that occurred.
I now find myself in the position of the patient (minus the snoring dog): laying in the bed. I suppose it is a perspective I don't always think about.
My perspective is generally at the foot of the bed, looking down at the patient.
I stood at the foot of a patient's bed for a long time today. Had lots of conversations with the family.
They asked what the chances are. We him hawed around the question. I finally told them that they would probably die before the weekend was up. I hate that question. Who really knows? They thanked me for my honesty. It was just the facts.
The family talked. We talked with them. They talked with an additional service that was concurrently managing the patients care. The family talked again. And then the talking was all done.
They decided to withdraw.
I hate this term "withdraw". Generally we say we are going to "withdraw care", but this isn't true. If anything we heighten the level of care so that the patient will not suffer. What we withdraw is aggressive intervention, resuscitation, powerful medications; but not care.
We wrote the orders. Discontinued all the interventions. I called the respiratory therapist. We asked the family to briefly step out. The respiratory therapist pulled out the endotracheal tube. The patient coughed and sputtered and we cleaned them up. We made the patient look pretty. The family came back in. The spouse and child flanked the patient, each holding a hand. They kissed the loved one and said sweet words. We provided suctioning, morphine, ativan, and peace. The monitor was turned off. We do that so the family can concentrate on their loved one and not watch the monitor. We can watch the monitor in the hallway. The nurse kept me updated on the blood pressure and heart rate.
It was a typical death. Deep shallow breaths, a fast heart rate, low blood pressure. Then, the heart rate begins to fall and there are long periods of time between each breath. Then the heart stops and there is no more breathing.
I put my stethoscope on. I listened to the silent chest. I took my stethoscope off, nodded my head, and said the words the family had feared all day, "they're gone". There were tears, but they had peace. The patient had fought a long time and didn't want to suffer anymore. Now, there was no more suffering.
I don't know why I stand there, but I always do. The nurse in the room is more than capable of handling the situation without me. All the orders are written and she won't need anything more from me. And there are other things I could be doing. But I almost always stay and observe.
Maybe it's morbid of me to say, but there is something...... I don't know the word. I'm not sure of what the word is. But there is something in that moment when death occurs that is somewhat awing, so extremely surreal yet unmistakably absolute. There is a deafeningly quite peace that falls.
I suppose it is easier to watch death when I don't know the person, when I'm not the one suffering a loss.
So that was my day, my short shift in the unit. The one thing I accomplished today.
I don't know why I always talk and blog about death. Maybe it's simply the avenue I use to release the events of today so that I can encounter the events of tomorrow.