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On Euphemisms and Learning to Be Present

November 28, 2011

By Alicia Marie Hinton, who is a BSN student at the College of New Rochelle School of Nursing in New Rochelle, NY. This is her first post for this blog.

by grepsy, via flickr

My senior year preceptorship was an assignment on a palliative and acute care unit at a busy medical center. When I received the assignment, I prayed that no patient of mine would die during my time on the unit. Every nursing student is afraid of their first patient death. Simulation and course work prepare students in various ways for this experience, but nothing can really prepare you for the emotions you’ll feel. Some students experience a patient death during an undergraduate nursing program, but for others it may not happen until their first year or two working as an RN. I hoped to never endure it, but knew it was inevitable.

During report, working alongside my preceptor, I listened anxiously to the status of the various patients. Since my first day on the unit, I’d practiced my therapeutic techniques and researched different cultural needs pertaining to the death of a patient. I felt culturally competent and well informed about what a nurse should do when a patient dies, but I couldn’t shake my fear. What would I say to the family? Would they value my presence?

Finally, during morning rounds on my third day on the unit, I was told that a certain Mr. P wasn’t doing too well and might “expire” that day. Our focus would be to provide comfort for him and his family.

How did they know he was to “expire”? Was that the politically correct term for dying? I was familiar with “passed away,” “deceased,” or “gone to a better place.” But the word “expire” didn’t feel right. I’d cared for Mr. P since his admission and interacted daily with his family, and news of his impending death hit me hard, increasing my anxiety about how I’d respond when it happened. While I was anxious about my own feelings about the patient’s death, I was preoccupied with my ability to comfort that family.

It wasn’t until later during the shift that the call bell went off in Mr. P’s room and the unit clerk responded. I heard the unit clerk say, “I am so sorry.” As my preceptor approached me, there wasn’t anyone there to cue the slow motion or play the soft music that many medical TV shows would have us imagine. She calmly told me that Mr. P had expired. The word echoed in my head. It made death seem mechanical and artificial. When she asked me to go speak with the family, I assumed a stoic expression to hide my ambivalence and told her that I was ready. I searched for the right words to use, but nothing I’d rehearsed came back to me.

As I entered the patient’s room, I was overwhelmed with emotions and I had to force myself to keep walking. When I looked up and met a relative’s eyes, she clasped my hand, hugged me close, and said, “Thank you so much for caring for him. You all provided such excellent care and comfort, and we’re truly thankful.” Then she turned to my preceptor and said, “Don’t worry, she’s going to be a wonderful nurse.”

At that moment all my fears dissipated. I knew I was a nurse. As family members expressed grief and shared memories of Mr. P, I comforted them and, most importantly, simply offered my presence. The death of a patient will never be an “expiration” to me, and I can imagine that it might never get easier for me to deal with. But I now know that the desire to be present and console the family will be enough to silence my fears about what I will say or do.

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8 comments

  1. Great reminder about how significant our presence truly is!’

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  2. I am so glad that your first experience with death went well. Every death is different and your feeling about each will be different. They never tell us how to cope with the deaths that we face in our work. Always feel something when a person dies just don’t let it overtake you.
    I have been a hospice nurse for 15 years now and have never liked the term “Expired”. We did have a patient’s daughter become very angery when someone said her mother “expired”. The daughter said “My mother is not a library card”. I always teach the new nurses and students when I speak to them the story of that daughter. My message is that we need to usee the terms dead, dying and death. We as a culture have made those terms so frightening, if we learn to use them we will also become more comfortable in caring for the dying. I would say practice saying death, dying and dead with friends and collegues so you will become more comfortable with them. The term expired as it relates to people should not be used, but we need to work on it and each person that can use the right term moves us closer to the elimination of “expired” when we talk about death.

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  3. [...] published a post on their Off the Charts blog entitled “On Euphemisms and Learning to Be Present.” The [...]

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  4. Its so hard. I usually let the family lead, and give them what they need. If I find its about what I need and what I feel is right, i have lost my perspective and I trade places with a coworker. I have found most families like honesty and openess. If they speak about a higher being, I agree. If they want to make final arrangements and leave, I can do that to. Once my pt has taken his last breath, the family becomes my pt. Every death is handled differently, but so is every life.

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  5. Alica, thank you for sharing this touching story. The first time I experienced a patient death was as a CNA. I remember talking to the patient, holding her hand, and telling her I would see her in hour because I was going on break. After my break, there was a doctor and nurse in the room and I was confused because they mention ” Ms. M expired”. Hearing that term made me think of expired food or milk not a person. I took that heart–how can you refer to someone as expired. That was the hardest moment I had to face–Death up close and personal.

    I still remember her, cleaning and making her presentable to her love ones. I held her hand and teared up. I felt cheated because I made a promise to come back after lunch and keep her company. However, I did keep her company, I gave her my undivded attention and said a silent prayer. Yes, death is apart of life and something health care professionals will see often. As nurses we have be strong–emotional, spritiual, and mentally. It takes time to build those skills. In addition, It takes great courage to be present during and after a patient death and comfort the family.

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  6. Ms.Hinton as health care professionals facing death is inevitable. I remember my first patient death experience as a new nurse. This was a young women with end stage liver cancer. Her son was at her bedside through out her last days and most of the time he was alone. I was very anxious while caring for her because of the fear of her dying and having to see her son grieve for his mother alone. I made sure that I put my personal emotions aside and provided emotional support to her son. We as nurses have to convey emotional support by showing empathy and being sympathetic to our patients and their family as well.

    As a Palliative care nurse I have learned to be more efficient in providing emotional support for my patients and family. Our presence and comforting words as you mentioned in your article is enough to convey caring.

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  7. My first patient death was during my “charge nurse rotation” during nursing school. (Gives you an idea of my age, right?). The patient was in his late 80’s when he died of heart failure. There was no family around as he took his last breath. The room was empty. When we called his wife we were told that she did not want to come to the hospital, she would see him at the mortuary. It was too hard for her, she said.

    We returned to the room to perform post-mortum care. I sat there for a few minutes just holding his hand. Tears ran down my face. It all felt so wrong. It was as if his life ended like a sentence without punctuation. It just ended without being finished. I have never forgotten that gentleman. I now am a palliative care coordinator, having 11 years in end-of-life care. I draw my strength from memories of patient’s ending journey, always trying to remember how to make the last days, hours, or minutes more comfortable and more meaningful.

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  8. Ms. Hinton thank you for sharing your personal story about facing the death of a patient and being with the family. It brought me back to my experience in the late 1980s as a new nurse. Rob was dying from complications from AIDs. He never came out to his family about being gay or that he had HIV/AIDs. His family arrived from out of state to find him gravely ill. His life partner and friends stayed away that day after being there daily out of respect for his wishes to protect his secret. Late in the afternoon of their arrival, I was instructed to ask the family to leave the room while an attending physician examined him. I escorted them down the hall assuring that it would only take a few minutes. He died moments later in their absence. Going down the hall to the family room where they sat waiting to return to him felt miles away. I felt like I robbed them of their parental rights to be with their son during his last moments of life. It felt awful.

    Somehow, seeping in this sense of failure, I found some courage to fight hospital protocol. That and a sympathetic nurse manager who backed me to keep his body in his room until his life partner could get there to spend some time with him before they brought the body to the morgue. I stayed past my shift until he arrived guarding watch over the sacred which helped to heal my nursing soul.

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