Tuesday, October 12, 2004

Home Hospice

Bridget just wrote a very thoughtful posting on the start of her home hospice clinicals and got me recalling my own clinicals in a home hospice setting.

On my very first day of clinicals, a patient died. This was my first experience with a patient who died while I was in close proximity. She died while we were in her living room with her daughters (she was upstairs in her bedroom).

It was pretty intense. I hadn't met any of the family members nor the patient before, so it was a little awkward for me, as I didn't feel like I really had a role nor had I established any kind of relationship with them before. But it was helpful to see how the nurse who was my clinical instructor, interacted with them and what her role was like.

Although my instructor was able to maintain her cool, I got teary eyed several times, especially around the youngest daughter who was in acute distress, because her mother had died when no one was in the room. My instructor explained that a lot of people wait until they're alone to let go. Having loved ones nearby is often what keeps the person from passing, because it is harder for them to let go of this life with a reminder of what they must leave behind so close by.

The daughter also felt bad because she had withheld pain meds (from her mother) because she'd wanted her mother to be alert. Her sisters had gotten very upset with her because they knew their mom was in pain. They all struggled over keeping her alert verses sedating the pain away. And after she died, the daughter who'd insisted on withholding the meds became incredibly guilt-stricken thinking that she'd let her mother suffer too long. However, the mother's pain had been in control over the last few days, so she was able to die peacefully. So my instructor tried to refocus the daughter on that fact and helped her appreciate what time she'd had with her mom while she'd been more alert, despite the pain. My instructor was very tactful despite her own frustrations with the daughter's withholding the meds. (She had expressed these frustrations to me before we’d entered the house and before we knew that the patient had died).

This was my first time seeing a dead body, other than my grandmother’s body at her wake. I was a little nervous and the whole thing felt very surreal to me. I kept looking at the body and wondering how my instructor could be so certain that the patient had died. I would later develop a keen eye for when a patient was about to die.

These brief interactions with the family members, as insignificant as they seemed at the time, had such a profound affect on the palliative care nurse I have become. And of course, I am still learning.

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