See the value of a beautiful death
EDITOR'S NOTE: Valerie Hyde, BSN, RN, CEN, works for the Inova Health System in Northern Virginia.
Late one afternoon, I received a transfer from another local ED. The patient was a 58-year-old woman, mother of two. According to the history, she had dinner with some of her family members the evening before and had spoken with her sister the next morning, just before she became ill.
At about 8 a.m., she collapsed at home and went into cardiac arrest. Her husband called 911 and began CPR. She was taken by ambulance to a hospital where they continued CPR and intubated her. A CT scan of her head revealed she had a ruptured aneurysm that was described by the medical team as “not survivable.” Based on the patient’s neurologic assessment and diagnostic testing, the medical team determined the patient to be brain dead. Although difficult to hear, I knew from my knowledge and training it was true. The physician explained this to the family and all agreed they did not want to prolong her treatment any further. Knowing the patient’s wishes, the family decided they wanted life support to be removed once some more of their family members had arrived. She looked so young. She wasn’t like the older patients we often get, who have led long lives and have seen their children and grandchildren grow up. She was my parents’ age.
When I returned home, overwhelmed with thoughts and feelings, I began thinking about what it means to have a beautiful death. Is there such a thing? Was there anything else I could have done for her or her family?
I believe a beautiful death means something different for every individual. For some, it may mean being at home and in their own beds when they pass away. For others, it may mean being in a hospital with full support from a medical team. Some may want last rites from a priest, while others may not want their loved ones as witnesses to their passing.
I kept thinking about my own mother as I reflected on the whole concept and how I would want our family present at the bedside and praying during her passing. Many times as healthcare professionals, we struggle to keep the patient alive, hoping at least one family member will come in time to say goodbye. All too often, our patients die without a loved one by their side.
As nurses, we are witness to many different ways people leave this earth. I encourage everyone to take a moment before the next patient dies and think about what you would want if that person were your family member, whether it would be to say a prayer together or prepare the body and the room in a special way before the family arrives. Whatever it is, be sure to give the time and respect due to honor the person and his life, the life that is passing before you and his or her loved ones.
It is a privilege to be present at the end of a person’s life, certainly one to be cherished. Being sensitive to not only your own feelings, but also most especially being sensitive to the patient’s and family’s feelings and needs is paramount in making each passing a beautiful death.
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I encourage everyone to take a moment before the next patient dies and think about what you would want if that person were your family member …” — Valerie Hyde, RN
Shortly after her arrival in the ED, her family began trickling in and by the end of the night there were about 20 of them at her bedside. I was impressed that so many immediate family members came to be with their loved one during her last hours. We struggled to keep her physical body alive so they could gather together and say their goodbyes.
Then came an oddly difficult and, yet, easy task for me to do. The physician ordered a heavy dose of narcotics, in hopes that she would not experience pain during her last minutes. Per the physician’s orders, I administered the medication and removed the endotracheal tube. The family had consented to its removal, and intellectually I knew this was the right thing to do. I knew she was being kept alive because of the ventilator, but at the same time, I knew I was assisting with the passing of her life.
However, the family did something that silenced my concerns and fears. They immediately swarmed around the bed, touching her and praying aloud. It was a peaceful moment, where there was no more pain, no more plastic tubes. The family continued to stand by the bedside; crying, praying, holding each other, holding the patient. Forty minutes later her heart stopped beating.
Meanwhile, I knew I needed to make sure I had the necessary paperwork for the release of the physical body to a funeral home. Since it was around the change of shift, I wanted to make sure I didn’t leave any difficult paperwork for the next nurse. I also had to get the physician to come in and officially pronounce her dead. At the same time, I wanted to make sure the family had all the privacy and support they needed.
Nurse learns valuable lessons about end-of-life care from patient and her family
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