Monday, March 21, 2005

My First Death Since...

Last night, I was present for my first death since my grandmother died. Complicated by its unpredictable arrival, I sheltered my grieving soul, tucked it deep away, to maintain my professional objectivity in the situation.

[Perhaps part of what I didn’t emphasize enough in my post about professional boundaries is the need for the nurse to make objective assessments and clearly rational decisions when in the best interest of the health of their patients. A lack of boundaries may easily result in a lack of objectivity, which is essential to the role of nursing].

This patient had requested not to be resuscitated (DNR/DNI), but he was not a hospice patient. There is a process of letting go of curative measures with a large gray area in between. This gray area is often very uncomfortable for health care providers, most especially when the patient dies in circumstances such as these.

How much do we do to try to save him? How much would he want us to do? His disease is terminal. He has just died peacefully in his sleep. Would he want us to bring him back so that he can spend a few more days in the ICU and then possibly die less peacefully there? Maybe he does. Maybe he doesn’t.

The intern convinced the family to let her try some non-invasive ways of bringing him back to life, despite his DNR/DNI code status. They didn’t work; I watched as Mr. Indepi gasped his final breath. Frantically, the intern listened and felt for a pulse. When she couldn’t find one, she ran from the room in tears. I can sense, but don’t relate fully to her sense of failure with this particular patient.

This man’s suffering has ended. He died as quietly and as peacefully as any of the hospice or palliative care patients so often do. My regret, instead, comes from the fresh perspective as family. This man died alone and unexpectedly. His girlfriend had been phoned as he approached the last hour of his life. In the middle of the night, she was the only loved one we could get a hold of. Will there be other loved ones who feel bitterness from the lack of warning? “Why didn’t anyone call us and let us know that she was dying?” The words I spoke like a mantra the day of my grandmother’s death sting my ears.

My grief made me more solemn than usual as I repositioned Mr. Indepi flat in his bed and cleaned his room. I instructed the nurse to leave his hands out of the linens so the family could hold them if they came to say their goodbyes. I've always done this. But remembering my grandmother's hands unaccessible under the sheet at the funeral home made my instructions slightly more vigilant, lest she forget next time a patient dies. At the funeral home, I'd wondered - why did they cover her hands? Is something wrong with them? She'd been dead for several days before I'd been able to make the trip to Florida to see her. And her body had not been embalmed, so I honestly didn't know what to expect.

As I awake, hours after my shift has ended, stormy waves brew under the surface of my skin. My sleep was filled with disturbing dreams; my rest was agitated.

May Mr. Indepi and my grandmother rest more peacefully than I have in the past night. And may Mr. Indepi’s family find peace in their grief. Peace knowing the doctor did everything she could to keep him alive; peace in the fact that he died comfortably and without fear.

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