Contemplations on Death

I am new ICU nurse, straight from nursing school to one of the toughest areas of nursing. ICU has some of the sickest patients, many in an acute crisis. Sometimes we help save a life. Sometimes, we witness the end of a life. Today, I witnessed first hand my first end of life.

I have had patients that were fatally ill that died after I had them on other shifts, but never has one I cared for died on my watch. It made me contemplative.

At first, there was the made flurry of medications, interventions and calls to doctors as we tried to save a life that was slipping. It was so chaotic. Everything must be documented. Label IV lines flowing into the patient. Double-check medication doses. Check vital signs and titrate the medications even more. Before you know it, there are 6 medications flowing into the patient. Many of the medications are starting to sound the same so I was triple checking myself. Xrays and ultrasounds had been done. I was using a doppler to find pulses as the patient slipped deeper into shock. Calls were made to the family. Meanwhile, my other patient needs me. Oh, and have I documented everything yet?

It became obvious within 2 hours hours that nothing was going to save her today. We still kept doing all the tasks, but eventually the family also came to the same understanding and decided to stop it all. The patient was removed from the ventillator. The medications were stopped, except the one for pain. That one, we increased the dosage. Within in minutes, the patient had no readble EKG, aka she was in asystole. She continued to breathe, in a strange gasping, slow motion manner. We couldn't feel a pulse, but there must have been a small, thready, weak beat from her heart. Eventually, even all that faded away. Quietly. So, quiet.

That is when it hit me. Up until those last 15 minutes, everything had been so ugly, so fast, so tense, painful and then suddenly it was peaceful. Quiet. The patient looked so relaxed. Almost relieved. Later, as we worked with the funeral home to transport her body, I looked at her hands and her face and thought about the long life she held. The children she raised. The things she did with those hands. I thought about what a privilege it was for me to be with her now and take care of her at the end of her life. Such an awesome privilege. I treated her with respect, talked to the family, and still managed to take care of my other patient.

I wondered if I was numb. Why wasn't I affected like this woman's family that was sobbing....losing their mother the day before Thanksgiving, only days before her 86th birthday? I was thinking about how the next couple of holidays would be tough on them as they remembered her passing. Then, I came back to my work and realized this wasn't personally happening to me. It was happening to them. I had the privilege of helping them through today and helping their mother have some dignity on her last day.

On a slightly odd note, just before we took the patient off the ventillator, I was asked to open the window near her room. I did it without thinking, because I didn't have time to wonder why. I found out why later. Our staff is superstitious. They feel the open window lets the soul escape. I was told "It lets them out of the unit." Who knew all these experienced, intelligent nurses could be so superstitious? :)