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By Marcy Phipps, RN, whose essay “The Soul on the Head of a Pin” appeared in the May 2010 issue of AJN. She’s written several previous posts for this blog (here’s the most recent).

Last week two of my patients died. This alone is not unusual in the ICU. What makes it feel different  is that I’d cared for each of them enough times to develop a solid sense of them and had come to know their families well. They died on consecutive shifts and their contrasting situations, coupled with their proximity in time, have left me unsettled. Poems of Emily Dickinson skitter through my head . . .

I reason, Earth is short-
And Anguish-absolute-
And many hurt,
But, what of that?

The first was a girl who’d fallen and hit her head. She’d been healthy, young, and strong, but it was a devastating blow. Her parents were dazed with shock. As a nurse I was up to the medical tasks, but the “mother” side of me was overwhelmed by their tragedy. When she died I slipped out and left them with the chaplain, lest I crumple into a puddle on the floor.

I reason, we could die-
The best Vitality
Cannot excel Decay,
But, what of that?

My other patient had fallen, as well, but he’d lived a full life and reached an advanced age. As pale and fragile as a baby bird, he lay in quiet dignity and peace. His family gathered around him and held his hands, each of his breaths drawing longer apart and shallower until he slipped away as gently as a morning star fades with the breaking day.

When the elderly man passed there was a prevailing sense that all was as it should be. That “rightness” did nothing to assuage the feeling that the young girl’s death had been unjust. If anything, the contrast made her death seem crueler. Ironic (and unfair), that the one who should have been the strongest was the most delicate, in the end.

I’ve been home from work for days—and plagued with this. At home I have more time to dwell on life and death, and on what seems fair. But instead of searching for resolutions that clearly aren’t mine to find, I’ll write to clear my head, then leave the ruminations to the poets.

I reason, that in Heaven-
Somehow, it will be even-
Some new Equation, given-
But, what of that?

(Indented excerpts are from Emily Dickinson, poem #301)

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