The following story has been altered in order to protect the confidentiality of the patient, and family members. This topic may not be suitable for young people.
This Sunday many have been my worst Easter ever. I worked in the nursing home that morning. I was assigned a 1 on 1 case. Before I walked in I received report from the Nurse on duty... "Joe is a dying patient. He had stopped eating, and drinking. Joe is in his late 80's, unresponsive, and had the death rattle, (chain stokes breathing), with slight modeling to one small area on one of his legs. He is DNR (do not resuscitate), and on hospice care." The Nurse added that she didn't believe that Joe would die on our shift.
The family was obviously grieving, but were as nice as could be. His daughter Julie came up to me immediately, and introduced herself, and her brother Sam. Throughout the shift they included me in the conversation, and even offered me some food that they had brought in. You could tell that they were both caring, down to earth people.
Throughout the shift I made sure that Joe received the best of care. I bathed him, put lotion on him, changed his gown, oral care, frequent repositioning. You know the works. When that family left to have lunch I read to Joe from his favorite book, and talked to him.
In my 20 years as a C.N.A. I have seen scores of dying patients. I have witnessed the death of about a half dozen or so. This was not foreigner to me. I noticed that Joe had some strength. He wasn't limp when I turned him. Also his breathing was very regular. I didn't need to count his reparations, but did often. They were always around 14 which was average. I concluded that Joe was to strong to die during my shift. I silently agreed with Nurse Julie's assessment. Of course I didn't tell the family that. Being an Aide, I was in no position to do so, besides it is all subjective.
Later in the shift the Nurse came in, and gave Joe his Morphine. I wish that I had looked at the clock, because that is when the change occurred. Minutes later there were several changes. Over a period of about 20 minutes Joe seem to weaken, his jaw dropped, his breathing changed. Breathing wise, he went on automatic. That's what I call it. It's the very slight difference between an unresponsive patient having some input into his breathing, to no input. It was like he was no longer in control, and part of him seemed gone. I can't describe it other then that.
The family had gathered around the bed, talking to him, and holding his hands. They were both crying. Joe soon stopped breathing, about 30 seconds later he was white as a sheet. Joe was gone. It happened so fast. I remember looking up just above Joe's head, half expecting to see his spirit, or feel his spiritual presents. It happened so fast, that I wondered if he was hovering over his body for a few seconds. But I saw/felt no ghost.
My eyes filled up. It caught me off guard. I didn't expect him to die. I muttered a few words to the family in a fruitless attempt to comfort. I have never been good at that. I never know what to say. My voice cracked as I spoke. I was on the verge of crying, but needed to get a hold of myself. I had learned professional distancing. Usually I could hold back the tears until I got home. That's something that you learn in this business, but still it is very difficult sometimes. Losing a patient is always hard.
Julie the Nurse came in. I couldn't help but wonder if she had killed Joe by administering the Morphine. I knew that the doctor ordered it, but she did administer it. There are some days that I am glad I didn't finish Nursing school.
Morphine is often given to dying patients in order to control pain. It can change breathing patterns, and decrease the respiration rate. It is somewhat controversial. I have heard discussions though out the years. Some Nurses refused to give the P.R.N. med, because they feel that it could kill the patient. Other Nurses give the Morphine to make sure the patient is comfortable.
When I was in my early 20's taking care of my mother who was dying of cancer, one of my mothers meds was Morphine. None of the hospice Nurses told me that it possibly could hasten my mothers death. They should have! The family should always know. Fortunately, I know from the circumstances that it was not the Morphine that killed mom. Otherwise I would feel guilt stricken even to this day. You would think that after all these years, they would have found a drug that could be effective for relieving pain without affecting the breathing. Yes, there are days that I am glad I am not a Nurse. They have to make some very difficult choices.
When I got home I received an e-mail from a friend. She had contracted a Superbug, and had to go into the hospital for surgery. Yes, this Easter was my worst Easter ever.
Additional reading:
Dying and Death in a Nursing Home
