#1000 Speak: Compassion – Gone But Not Forgotten

There are a lot of memorable moments in my nursing career over the past 8 years, but one sticks out the most.

I had been a nurse for a little over a year. I worked on a medical/surgical floor which means that there was a plethora of different cases and illness’ going on at once among thirty plus patients. Six of those were mine.

It was a normal day for me at work. I was busy running around that morning, passing out medications before 9 O’clock. There were doctors writing orders and blood to be drawn and insulin to be given before breakfast.

Each morning during report with our charge nurse, all of the floor nurses were notified about which patients were a DNR (Do Not Resuscitate) and who were full codes. Somehow we remembered these. Especially when we were told which patients were expected to possibly code on us that shift. The ones that were severely ill, and should have probably just been in ICU at that point. Still they were ours to care for and that’s what we did.

Morning went by and then lunchtime came. I remember that day clearly because I had two “feeder” patients which meant that they required assistance in eating every meal due to varying issues. I was running between two rooms feeding my two patients who required assistance, and I heard Nurse P in the room next door coaxing her patient to, “Take a bite now, Mrs. S.” During the next ten minutes I could hear the concern in Nurse P’s voice growing as she lovingly encouraged her ward to eat. Mrs. S had been with us for a little over a week and had been doing OK. Not great, but she definitely was not a patient we expected any emergency surprises from.

Five more minutes passed and for some reason I knew something was wrong.

I excused myself from one patients room and proceeded speedily but calmly to Mrs. S’s room. There I saw my fellow nurse standing on tiptoes assessing her patient and one look between us and we both knew that she wasn’t breathing. As our training dictates we both checked for a pulse but there was none.

I have to tell you that Nurse P is very short. Only about 5 feet tall. I am 5 feet 8 inches. It was only natural that I would be able to do the chest compressions to begin with. I’ll never forget the immediate words out of my colleagues mouth.

“Don’t press too hard…she’s frag-.”

Too late. Ribs cracked. That’s just how it works. You have to get to the heart. It was not my first time to crack ribs to pump a heart manually and it’s not really a feeling or sound that you ever forget.

I was pumping what oxygenated blood she had in her body the best I could, everything else out of my mind. In the meantime a code blue was called. It only took maybe three minutes for the rapid response team to arrive to her room but that is an eternity to be compressing even a frail 90 year old’s chest. The emotional impact is even harder than the physical.

Once hooked up to monitors, the charge nurse came bounding in.

“She’s a DNR! Stop all work!”

“What?”, I heard Nurse P call out, “No she’s not! She’s a full code! We’re still waiting on the family to OK the DNR!”

This whole time I’m still compressing and by now the hospital chaplain is there and praying and I’m oblivious to everything around me. I’m looking down at this white-haired lady. Her face with wrinkles. Not the kind of wrinkles though that mark a hard life of treating herself badly. Wrinkles that mark a life full of experiences. Her eyes were closed and in that moment I could see every tiny little blue vein that wound its way across each one.

Suddenly there was a heartbeat. Faint, but it was there. Very irregular to say the least but she was back. I continued chest compressions at the wishes of the doctor who had shown up by then but then the charge nurse came back and said to stop. The family was on their way and had given permission to let her go. I was stunned. I had just helped bring a human being back to life and now I was just supposed to let her go?

Slowly the room emptied and it was just me and the chaplain. My hands were shaking and it wasn’t only for the fact that I had just compressed a heart for over 7 minutes non-stop. They were shaking because I couldn’t help but feel the need to continue. To bring her back yet again. That wasn’t my choice or my job now.

I sat on the side of the bed. Looked down at her and took her hand. I asked the chaplain if we could pray and stay with her until she had passed. The monitor continued to beep erratically, bradycardic beats for a few seconds and then bounding beats up to one-hundred and fifty the next. Her heart was stopping. Internally I was screaming for her to just go. It doesn’t always work that way. A heart will go into ventricular tachycardia right before it stops and that’s just what her’s did. I looked at the monitor and the beats per minute were two-hundred and fifty or more and the noise was deafening. At least to me. Then they slowed and slowed and while there was no actual point in time when she “let go”, I swear I felt her body sigh under my hand.

The chaplain reached over and turned off the monitor and sat there with me. Neither of us spoke. As I looked up at her face I stroked her hair and said a silent prayer for her daughter and son-in-law who were on their way. I had been able to be with my dad when he passed. I had been able to hold his hand and see his last breath. I couldn’t imagine what it felt like to not be there.

Nurse P came in and told me that I should go check on my other patients and she was right. Mrs. S technically wasn’t under my care. I went back to my patients and I put a smile on for everyone because life goes on for some.

A couple of hours later Mrs. S’s daughter caught up with me in the hallway. She grabbed my hands and thanked me profusely. I took her gratitude. I tucked it away. It’s the same thing I had said and done to my own father’s nurses when they left my home after he had been taken to the funeral home. (I was not a nurse at that time so I had no idea what emotions they had been feeling at the time.)

“The chaplain told me that you stayed with my mother while she passed. That you held her hand and she wasn’t alone. That means so much to me because I couldn’t be here,” she explained through tears.

“It’s the least I could do. Nobody should have to be alone when they leave this Earth. She went peacefully and I’m honored to have been able to be there with her,” I said.

It was true. It sounds strange to a lot of people, especially other nurses. I find great comfort and happiness in a sense to be there when a person leaves their worldly body. I liken it to the feeling that labor and delivery nurses feel when they watch a new life being brought into the world. You are witnessing life happening. Whether it’s coming or going.

Something I need to interject here is that when people pass away in the hospital they don’t always instantly get taken to the morgue or the funeral home doesn’t always come pick them up right away. They can stay in the room for up to five or six hours depending on how busy security is. The good thing about this is that the nurse(s) have time to do post-mortem care which can include anything from just pulling tubes and lines and IV’s from the patient to full on baths and grooming. Sadly, most nurses don’t have time to do the full on care and most nurse aides don’t either. Me? I always make time. As a nurse it’s the last act as that patients nurse I can do in their healthcare. It’s dignity. It’s a right, deceased or not.

Ok so I was always the go-to for post-mortem care. Understandably a lot of nurses don’t enjoy that part of their job and I don’t necessarily enjoy it either but there is a closure there and since I had been the one to be with Mrs. S when she passed it only seemed natural for me to complete her care with us on our nursing floor.

Nurse P came and asked and I gave my all. She took my patients over and I began. I washed Mrs. S head to toe. Combed her hair, put on a fresh gown, changed her sheets, folded her hands and so on. By the time I was finished it looked like she was merely sleeping. If only.

Her nurse aid was gathering her belongings and started to throw her hairbrush into a bag. I stopped her and took a few strands.

“What are you doing,” she asked me.

“I overheard her daughter say she would like to keep a lock of hair for a scrapbook so I’m saving some.”

Security came and we started to move her into the body bag. I made sure to put a pillow under her head and a sheet over her. (I have to say that the morgue had called many times in the past to enquire who kept sending patients down with pillows and blankets. Me.)

I said goodbye. I cried. Not at work but once I got home. I think a lot of nurses do that. We cry for the losses we experience. We cry because part of us thinks we could’ve done something else to save our patients. We cry because we appreciate the fact that life is fragile. A lot of cry because we know it could be our loved one any day or it reminds us of those we’ve lost in our lives as well. Make no mistake though, we cry.

Compassion. That’s what Mrs. S deserved. Compassion even though she wasn’t alive anymore to appreciate it. She didn’t know the care I gave her existed after her death. She probably wasn’t aware of it as I was pushing relentlessly on her chest. I knew though. So did her daughter when she looked into my eyes. I saw the gratitude and felt it. Her daughter saw and felt the compassion in me. I know this.

I will never forget her. She still holds a place in my heart to this day like so many other patients. It’s amazing how so many people can fit in my heart but Mrs. S? She reminds me everyday what compassion is really about. The only thing I can do is to remember her and what she represented and that was caring and love and compassion.

Thank you friend. Rest in peace.