Another Day, Another Death.

“Someone is going to die today.”

I don’t know why I said it, maybe I was feeling dark, the journey from my warm bed to the cold hospital hallway had been long and full of cuss words. My coffee that morning was doused with almond milk because I was out of cream which made my morning pick me up taste like a luke warm cup of shit.  My hair was in a demented mood, and I had a blister on my lip that was NOT a herpe, but still looked like a herpe. It was 645 am, I was under caffeinated and in the mood to bite. Maybe I just felt like saying something irreverent….or maybe it was a premonition, who knows?

But someone died.

I had no way of knowing I would be caring for a man that was in the process of leaving his body until I received my assignment and was told, “I’m sorry Kate, this man is dying, and his wife is crazy…” to which I replied, “I’m in no mood for putting up with any bullshit!” and I meant it. In that moment I was prepared to bite a soon to be widow in the face, I would tear off  her nose with my teeth if she crossed me.

I took report from the night nurse who informed me that the wife had called her 3 times throughout the night making all sorts of ridiculous demands. She sounded like a lunatic.

I went to assess my patient, he was in the active stages of dying, and we still had a sitter by his bed. Our nurses aid was being used to watch over the patient to make sure he didn’t hurt himself by climbing out of bed or pulling out his lines. I told the aid that she didn’t have to sit with him, he wasn’t going anywhere. I stopped the fluids that the wife had insisted we start, and asked the doctor to order a foley catheter. The man was doing what we in the biz call the “death rattle”, this is a sign that the end is near, a gurgling in the throat and chest that indicates the persons lungs are filling up with fluid. The heart is giving up the work of beating and moving the fluids around the body…. I put the foley in so he wouldn’t be disturbed with our turning him to clean up his urine, gave the man a drug to help dry up the secretions, and one to help with air hunger——and then she was on me.

Just as I’m walking out of his room, I spy a little lady storming down the hall, walking in the wrong direction, but I know it’s her. She spies me watching her and demands, “where is room 15!” I show her to the room, she  walks over, busts in and spits,”where is his sitter?”  I try to explain to her that he no longer needs a sitter, she spins on her feet to face me—I am at least a foot taller—and she says, “back off!”  But I’ve already backed off. I decided before I even saw her that I wouldn’t tear her nose off, instead I would get good and present.

I walk out of the room and she follows me , firing off questions to which I reply in the most placid way. I assure her I have already notified the physician that he should come speak with her, and that he is on his way. Her questions don’t stop, her head is spinning on her neck, her eyes are full of mistrust, fear, and….she has the eyes of a madwoman, darting around, unable to focus, her eyes see everything as oppositional. This is a woman who is used to being in control, she’s lost it, and is clawing to regain her footing.

The doctor comes and he and I meet her in her husband’s room and listen to her complain and accuse for a solid twenty minutes to the backround sound of the death rattle. She doesn’t seem to notice, she complains about doctors and nurses and orders that she gave that weren’t followed….. and when she finally notices the gurgling she says, “how can you just let him drown!!” —Even though she called to insist that he be put on fluids because she heard that it was painful to “die dry”. The doctor tries to explain in between her spinning that this is what happens at the end of life. She has been told that her husband is dying. She was told weeks before that his heart was giving out. She had refused hospice, accusing them of being “murderers!” because they allow patients to eat whatever they want at the end, “they just want to hasten things by letting them eat all that salty food, they want him to drown!” She decided that they would make her sleep on the floor, because she had taken a tour of a hospice unit and saw people camped out in sleeping bags, and she insisted that one of our most beloved palliative care doctors was a monster, because he spent an hour explaining her husbands condition, and then suggested hospice.

I had to leave the room to go tend to another patient, and when I came back to look in on them, she had her head in her husbands bed, holding his hands, sobbing—-Finally. I left her there for a few minutes and then went back to offer support and see if she needed anything. I put my hand on her back and offered her tissue, I asked her if I could bring her anything, and she popped up out of her heart and back into her head and started telling me stories about the nurses on the other floor, and the one that she actually wanted to kill, and on and on she went making me sorry that I came in. I listened for a long time, just being present. I asked Jesus and Buddha and Zorba to come in to that room, to lift us all up….

The man died 3 hours after I got to work. His wife had stepped away from his bed and his godchildren came out to tell me they thought he had stopped breathing. I brought my stethoscope in, but I knew he was gone when I noticed the quiet, the stillness, the way it feels when someone dies. The sacred way it all felt. It’s always sacred, but it’s easy to forget, especially when there is a hysterical woman spewing her disowned pain all over the place. When the wife comes back into the room, she cries, but I don’t feel like she gets it yet.

The chaplain comes and the wife wants to know her name, and she tells me that she wants this specific chaplain, and this specific social worker. and I apologize and tell her that it’s Sunday and I give her the names of the people that are available. She’s still trying to run the show and I’m astounded….

When the family leaves and we finally get around to caring for the body, it occurs to me that I haven’t given this man’s spirit the attention I normally do at the end. I said some prayers, but I didn’t connect with him, and I wonder if it’s because his wife has stolen his thunder. She took all the attention—and while it is appropriate to support the grieving family, I felt like I had done a diservice to this man. I felt no connection to him. I mentioned this to one of the other nurses, one that had helped me place the foley and comfort the family. I love and respect her a great deal, she is one of the best people to have around during a death. She agreed that she too felt a lack of connection with the patient, and that it felt like he was gone long before he took his final breath. Yes, he was dying, but  typically there is still something there, some strand of spirit that we recognize and connect to.

But with him it was different and I can’t exactly say why.

As the wife was leaving, she hugged me and said, “I’ll probably call you later…”I looked at her confused, and said, “ok……”Was she going to call me to direct his care? She still didn’t get it.

Neither do I.

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