I have said from day one that I need my first death in nursing to be during clinical, so that I had a safe place to process it. I wanted the support of my classmates and instructor to help me go through it.
I’ve been in my 2nd clinical rotation for the past 4 weeks. It was in a long term care facility. The clients there are residents for the rest of their lives. They are admitted… knowing they’ll never go home. Most of them have MOST directives of M1.
This means do nothing. If they are dying, they get comfort care only, no extraordinary measures to save their lives.
Over the weekend, before my last 3 days of clinical, one of the residents had a huge decline. She was put on palliative care. Her daughter flew in to be at her side. They didn’t expect her to last long.
I advised my instructor, and followed the LPN/care aides in her care. She wasn’t my assigned client, she wasn’t in my assigned “family” of residents, but in the 3 weeks prior, she had been someone I had seen frequently because she sat at the same table as my assigned clients.
One of the first things I remember about her is that she was singing along to the music playing during lunch. She was so sweet.
Her daughter was incredible. She had taught nursing for many years, and was ok with nursing students watching and learning from the experience.
Yesterday, it was clear that she wasn’t going to be long in this world. I knew that this was my opportunity – that I needed to *be* a nurse in this instance. I started with a “safe” family member – the son-in-law – and asked him if there was anything I could do for him, and let him know that I was available if he needed anything. He seemed surprised and grateful that I had asked.
At lunch, a quick conversation with my instructor and having to take baby steps in learning to deal with it, letting her know that I wasn’t hiding from what was happening, that I was taking as much time with the resident as I had before.
After lunch, after feeding one of my clients, I felt brave enough to go in and talk to the daughter.
It was an incredible conversation. We talked about her dying mother. We talked about my goals in nursing. We talked about her cousin who’s an ICU nurse. We talked about her cousin’s daughter who was in ICU for the same thing that Mark was. We talked about books. We talked about the waiting game. We talked about my experiences with Mark and what killed him.
And I stood there, talking to a woman who was about to lose her mother, and I didn’t lose my composure.
My biggest fear: I was scared to approach any of the family and burst out in tears. I was scared I wouldn’t be able to maintain any sort of professional demeanor. I was afraid that all the emotions and feelings and memories would overwhelm me and I’d breakdown, again, at clinical. I was afraid I would be unable to maintain the professional buffer of emotions I needed to be an effective nurse.
I am that person that confronts my fears, steps into the chaos to find the pattern and doesn’t hide from potentially painful situations. When I am ready to face them, I step into them full force. My counselor has called me the most self-aware person she’s ever worked with.
I confronted them yesterday.
And today she died. I had said to a friend of mine that while death sucks, we knew she was dying and could she please do it in the morning when there was time for me to learn from it?
Then, she died.
I had checked on the daughter almost as soon as I came in. Let her know that I was there, and was there anything she needed? There wasn’t.
15 minutes into my shift, one of the other care aides came out asking for a nurse to come pronounce. I immediately walked back to the room to comfort the daughter. I needed to put myself in that space. I needed to confront that fear of what would I do if a client died?
I was there for her. I spoke to her and offered comfort, and stepped out when I felt appropriate.
I went with the nurse to help prepare the body.
I went with the nurse when the funeral home showed up to pick her up.
I watched as they pulled her over from the bed to a stretcher and zipped the shroud around her.
I watched as they covered her in their blanket.
I watched as they covered her in the dignity blanket.
I watched as they wheeled her past… and I hugged the daughter briefly and told the story about how the first time I met her she was singing along to the music.
I was able to face the one thing that terrified me as a nurse, and I was able to do it in a way that helped me to care for the client, the client’s family and myself.
She died today. And I was able to learn from that experience. I was able to face fears. I was able to watch, remember and move forward.
I will always remember the sweet woman who sung wordlessly to the music that was playing on the radio, while eating her lunch. She may have died, but I will always remember her. In her last moments, she made SUCH a huge difference in my life. For that, I thank her. And while I will maintain her privacy and dignity by not naming names, I will keep her in my heart forever.