Lessons from a patient's death
Sometimes the only thing a healthcare provider can do is pause and be present.
Lessons from a patient's death
When thinking about being a healthcare professional, most people think about what the care giver has to offer the patient. But sometimes a patient experience shapes the way you practice, as was the case with my first experience of a patient's death.
In my last year of nursing school the clinical assignments were getting more intense in my last medical-surgical course. One of my assignments included caring for an elderly patient at the end of her life. This patient had slipped into a coma and was on a ventilator. I have since forgotten the details of her pathophysiology, but I do remember I was concerned about competently providing wound care, administering medications through her gastrointestinal tube and performing her tracheotomy care and suctioning -- the most nerve wracking for me.
I happened to remember the date, May 19, because it happened to be my birthday. My patient was not expected to survive much longer, and had a "Do Not Resuscitate" order.
Though I was not able to develop any rapport with this woman, I did my best to provide all the comfort measures that I could throughout the day, including speaking to her and explaining what I was doing, smoothing her brow and gently holding her hand when I had the chance. Intimidated as I was, I made sure I diligently suctioned her tracheostomy tube whenever she appeared to be in distress. This task was getting easier for me as the day went on, and I started to relax.
This changed rapidly, as alarms started to go off and the patient's breathing began to deteriorate. I urgently called the nurse in charge, as I felt a sense of panic set in. I started questioning each of my actions. Did I do something wrong? Did I miss something? The nurse arrived at the bedside and quickly assessed the patient. She calmly told me that the patient's breathing pattern was called agonal respiration, and this meant that my patient was probably at the end of her life.
I asked the nurse what else I could do. "Should I suction her again?"
The nurse looked into my eyes and gently told me something I will never forget. “Of course you can, if it will make you feel better," she said.
If it would make me feel better? I realized I had heard her correctly, and I understood at that moment that nothing I could do or say would change the outcome for this patient. Nothing I had learned – no training, skill or experience – would enable me to impart anything more to this patient.
I relaxed and sat with the patient, monitoring her and stroking her hand and brow. I don't remember if I said anything more to her, but I do remember that after she breathed her last breath, I listened to her heart with my stethoscope as it beat slower and ceased.
The next skills I learned that day, of course, were how to prepare a patient after death. I remember there were no family members to be called, and so I functioned in the most respectful way I could to honor her as I went about my duties. For some reason that I still don't fully understand, I felt privileged that on the anniversary of my birth, I was there to care for this patient and be present as she left this life.
This was my most memorable patient. I learned that we can do our best to hone our skills and lend our expertise to those we care for, but sometimes the only thing we can do is pause and be present. I repeated the words spoken to me by that nurse years later, during another young nurse's orientation when a similar situation occurred. I hope that young nurse gained as much from the experience as I did.
Barbara McAllistar is a register nurse from Maple Shade, NJ.
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