Wednesday, February 01, 2006

Guest Speaker: Alicia

I have entertained the idea of "guest speakers" on this blog for awhile now. I've received some truly beautiful stories via email and finally someone agreed to let me post their story. The following post was written by Alicia:


One of those things, working on my floor, every now and then we have a death of a patient that really affects us.

I was surprised when I came on yesterday morning that my patient, Ms. Russell hadn't died already during the night. She had had a couple of anxiety episodes during the night where she had flailed her arms. My co-worker Margie apparently had been in her room almost every half hour during the night, although for the most part it sounded like the patient had had a good night. I think Ms. Russell affected me so much because she was so young, with such a preventable cancer, such a devoted family, such a young son (he was a freshman in college) and she was obviously very well loved, affected everyone. Shoot, half the time the patients we have are geriatric patients with pneumonia who are surrounded with their families, but that is easier for me because I somehow feel that that is more the course of life. They have lived to see their family members grow up and die surrounded by them.

Ms. Russell's family was so anxious, and I worked so hard with them to assure them that we were making her comfortable, explaining everything that was going on, making sure all the Palliative Care docs went in to see them. Yesterday her whole family was still there, and I took on the "to turn or not to turn" debate with one of her doctors as Ms. Russell had a stage 2 on her sacrum, but turning made her so agitated. I didn't turn her right before shift change the night before because the patient's son felt that she might actually be responding to him, and asked me not to turn her because in order to do so we had to premedicate her with ativan. She looked very comfortable and he felt like he might even see her nodding when he talked to her and he asked that I not "drug her up." Since she looked so comfortable, I didn't turn her, and didn't give her any medication. Her husband then followed me out, and said, "he is so desparate to get something from her, he is trying so hard to get some kind of response or validation from her, so thank you."

So yesterday when I came on, she looked very comfortable. She had one episode of arm flailing during the morning. Her husband asked me if I thought she would die if he went out for a couple hours. He wanted to be there when she died, so if I thought she might die, he wouldn't go. I told him we really couldn't know, her respirations were steady at 16-18, and she looked comfortable. Her doctor was there, and we both informed him it was very possible that she might die once he left (since patients somehow seem to wait until their family members leave to die.)

So finally at 12:20 yesterday afternoon, the husband said to the patient, "It's OK, we love you and you can go anytime you want to." The patient then began to shed some tears out of her closed eyes, and died.

He gave her the OK to move on, and she gave her husband and son the validation they were looking for.

Have you ever heard of an actively dying patient, unresponsive, to shed tears before they die?


What a beautiful story! Thanks so much, Alicia, for sharing this with us. No, I have never witnessed a patient crying moments before death nor heard a similar story. But this was very moving.

Has anyone else had similar experiences? Or would like to share a story of their own?

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