Dora's Nursing

Recently in MICU we’ve had a hard time with families refusing to let their elderly parent or loved one die a peaceful and happy death. One 89 year old gentleman had made a will a few years ago and he did not want to be put on a ventilator. His son and power of attorney insisted we go against his wishes. He made threats of suing the hospital. He created havoc every time he visited; we had the nursing supervisor and security at the bedside at one time. He was placed on a ventilator and was not able to wean off. His son insisted he not be sedated. He was awake alert and pitiful at the end of his life. The son was suspicious we were trying to kill his father, the poor man wanted to die and he wouldn’t let him. It was a very bad way to end a life, I hope his father comes back and haunts him!

It shouldn’t be this way. Death is always sad because a loved one is gone but there are far worse things than dyeing, and we will all die someday. So I’ve had to remind myself of the more civilized passing’s I’ve seen over the years. My family is aware of my own personal wishes, I have a living will, I do not want to live beyond my time. You may be thinking that this is a sad and morbid post but it’s nothing of the kind. The following are true stories of happy passings.

A few years ago I was working a night shift in MICU. We had a patient in his sixties who was in the terminal stages of his illness. A family meeting was set up with the family and his attending physician. His code status was changed to DNR (Do Not Resuscitate) he was made comfort care only.  His family had visited during the evening and his wife of 40 years was spending the night at the bedside. She asked me if she could get into bed with him because he always sleeps peacefully when she spoons him. I saw no harm in it so I helped her into the bed. In no time they were both asleep. About 4 am his heart rate started to drop and I went into his room to check on him. His wife was quietly singing and praying while stroking his head. I turned off the monitors so they would stop alarming and I let them be. I checked in on them again every half hour over the next few hours. On one such visit she said he’s gone but can I just lay here a while longer. I called their son and by the time he arrived she was up and ready to go. The paperwork was done quickly and the patient’s wife thanked me for allowing her to spend the time with him. Really I should have thanked her for showing me how to give dignity in death.

We had a lady admitted for respiratory distress and pneumonia. She had just returned home from a cruise with friends and had a wonderful time. When I first saw her sitting up in bed, holding court with family and friends, in full make up and perfect nails I thought ‘what’s she doing in ICU’. When she said jump family and friends (actually everyone) said how high. This was a lady who always got what she wanted; she could be demanding at times and was on the call light regularly. Over the next few days her condition rapidly deteriorated. She was put on a ventilator but she refused sedation. It was a full load taking care of her and the massive entourage of family and friends. When the time came to discuss tracheostomy because she was not successfully weaning off the ventilator she decided her time was up. With family and friends at bedside she insisted on removing the endotracheal tube and stopping the ventilator. She was alert and fully aware she would die. The tears and pleas of all in that room could not change her mind. So her next of kin agreed to let her go as she wished. No sedation she wanted to be in her senses to the end. She was dead in 15 minutes, peacefully quietly with no drama and on her own terms. I was in awe of her strength of character. 

We are mortal and as nurses we see death and accept death, it’s a part of life. I don’t know if it necessarily makes us better at the end of our own or family members life but it certainly did for one patient we had a few months ago. Her husband was a Hugh character and plied the nurses with boxes of oranges and food; he brought us in a ham one weekend. His wife must have told him feed those nurses and they’ll do anything for you; which of course we did. That family was loved by all and they were a pleasure to care for. In her final hours it was beautifully sad and dignified as it should be.

My most memorable Palliative ICU patient was the Golfer and his family who sat around his bedside holding his hand, comforting him and helping in his care. They discussed his various games and wins over his sons on the golf course. The hole in one in a tournament, that cost him dearly in the clubhouse because he had to buy a drink for everyone. At the end it was my pleasure to help them on the 19th green, dignity in death and a celebration of life. 

Dora Meulman