Megen Duffy, RN, BSN, CEN, currently works in hospice case management. She writes AJN’s iNurse column, which focuses on technology and nursing.
I started my day the way I often do: watching sunlight begin to filter in and softly illuminate the sunken face of a person who would die, not later, but sooner. I sat curled in the chair I’d been in since 3:00 AM, wrapped in my sweater against the institutional chill, and waited.
This is, perhaps unbelievably, my favorite part of being a nurse. In hospice, there is no deadline. No one needs the room right now. The patient does not have to go to the floor in the next 30 minutes to avoid throughput delays. I do not have five other patients claiming my time. No, I have the gift of being able to sit quietly with only one objective: to do everything I can to make sure this person leaves this life without pain or fear.
I am not bored. It may appear as if I am doing nothing, but that is far from true. I am watching and listening for every breath, every movement, every toe that turns a deep bruised purple, every expression that may say “I am hurting.”
I am merely cooperating with death, and death’s agenda is never known to me. My job is to wait for death to make a move and see how my patient responds. I am fascinated to see how this particular dance will go between death and my patient. I find deep peace in knowing that this is an immutably personal process that will occur the way it occurs and when it occurs. I appreciate the reminder, every time, that I have no power over it. It helps me to remember that I can find similar peace by relinquishing my illusion of control over the rest of my life.
As the sun rises, the emaciated, elderly face sinks a bit further into the pillow. The mouth that has sung songs, kissed children, and said a thousand prayers gapes a bit wider, and then the features relax into a craggy panorama of black shadows and white sunlight.
I straighten her sheet and wait a few minutes. As the psalm says, it is the hour of our death, not the second of our death. And after those few minutes, I must arise from my nest and bring the noisy activity of life back into the room. I will finish this early morning by helping to load her body into a van, and then I will go to work.