Wednesday, August 31, 2005

The Last Minute of Life

When I came onto shift tonight and walked into my first patient's room, he was breathing at three breaths per minute. Just as a reference for non-medical folk, the normal rate of respiration for an adult is anywhere from 10 to 28 breaths per minute. So this man was breathing very very slowly. He was clearly within the last few minutes of his life. He was a DNR/DNI and was expected to die within the next few hours, so I was not alarmed by this sign of impending death.

It is rare that I get the honor of being with someone at their precise moment of death. Most often, the family will be there and will come and get me when the patient stops breathing. But this man had no family at his bedside. I thought to myself, what would I want in my last moment of death?

The patient's family had come to say their goodbyes and had said that they would not be coming back. When the family had left, they'd left the tv on. The noise was distracting to me. This was my patient's last moment on earth, so I turned the tv off to offer him some peace from the tinny sound of the voices coming from the tv's blue glow. The light over his head was bright, so I dimmed it to provide for more relaxed and muted tones. Even if he had not been dying at this moment, I would likely have done these same things for him. But somehow these acts carried more significance, knowing this would be his last experience of life in his body as he'd known it for only 44 years.

He had drooled a little on his pillow. I moistened a soft cloth and wiped the drool away, then got a fresh cloth and gently wiped the rest of this face. As I held his wrist with loose fingers, searching for a pulse, I wondered what else I could possibly offer him in this final moment. As I gazed at this beautiful man, I noticed the pulse in his neck slow and then stop.

Although I have been present at the final moment of life for a few other patients, somehow tonight, I was expecting something magical to happen. Perhaps as I have been on a spiritual quest lately, I expected those changes in me to create some clear change in my experience with death. But there was no obvious change.

Question for you, dear readers: how would you like your last minute of life to be? TV or music or silence? Family/friends present and/or medical staff present or alone? At home or in a hospice or hospital?


Anonymous said...

I am a new RN and have had several pts die in my presence. I hated the nonchalant attitude at the hospitals-it seems cold, and business like. I was also present when my fil died at home after a long cancer battle and I turned off the TV, gathered his sons and we all held a part of him as he passed. It was quiet, very quiet but peaceful and loving. I'd much rather be w/someone when I go, preferably someone who can give some significance to the event. The small things you did were beautiful.

Anonymous said...

I was alone with my mother when she died in the hospital. She had been having some respiratory distress, even with morphine, so I thought listening to prayers would soothe her. I held her hand and whispered Hail Marys and Our Fathers over and over until she slipped away. Her PCT stopped in, noticed I was praying, then pulled the curtains for us. I felt the nursing staff, and even the hospitalist who treated her in our small community hospital, were very kind to us. Thanks to all who care for us in our weakest moments.

Sherry said...

I think you showed a lot of compassion. By dimming the lights and turning the tv off I'm sure that made him more comfortable. The thought of dying alone is an awful thought to me. I hope I have loved ones at my side. If for some reason my family is not there, I hope to have a compassionate nurse like you. Cleaning the man's face and just being there, is more than his family was able to give him. We can't always chose where we will die, but it sounds nice to have someone hold my hand.

Unknown said...

i am dying , i lost my wife a few years ago , my children have there own lifes , but do come to see me , i am scared to die alone at home , but from my hospital stays i see the nurses are to bizy to give any care like this in our hospital , i have seen people die in there some with out them knowing till later . jon