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).

by doortoriver, via Flickr

Dusk is near, and I’m standing in the woods under a gunmetal sky, watching the snow begin to fall. I can’t get my last patient out of my head.

The struggles the man had faced were obvious. A gauze dressing was wrapped around his head, concealing the bullet wound he’d inflicted, and his skinny arms were scattered with small scars and open wounds, many of them infected. He wasn’t young, but it felt like he was.  Something about a coma
. . . the lines and wrinkles disappear from the face. He almost looked asleep.

But there was no peace here.

Breathing was all that he had; there were no other reflexes. Scant life left and no hope. There would be no organ donation. His family signed the forms to withdraw care and said goodbye.  He was left alone, breathing.

It didn’t take long for the tracings of his ECG to become irregular, the angles wider and more erratic. I rushed into his room (no one should die alone!) just in time to see him exhale with a loud and raspy sigh. I stepped toward him and put my hand on his shoulder, thinking that I’d just seen this man’s last breath, and that he was gone.

So many thoughts went through my head at once; that my hand on his shoulder was wasted . . . too little, too late; that our care had been futile; and that the loss of this man was an epic failure. We came in at the end of the game, and this failure was larger than medicine.

I was shocked when one last rasp of breath escaped him and a drop of something icy cold and wet hit my arm.  I pulled my hand back with a shiver. Such a stupid thing to do, to stand right in front of the open mouth of a dying man.

A dead man.

I’m standing in the cold, and it’s beginning to snow harder. The further I look through the static of falling snow, the less I can see; the horizon blurs softly into shades of gray. It’s so quiet.

I’m struck by the sound the snowflakes make as they tap against the dead leaves that cling to trees. Cold like ice, yet they sizzle.

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Chief flight nurse at Global Jetcare. Regular author on this blog.


  1. Laundry « Off the Charts March 10, 2011 at 9:58 am

    […] appeared in the May 2010 issue of AJN. She’s written several previous posts for this blog (here’s the most […]

  2. Sean Meade March 9, 2011 at 10:38 am

    Part of humanity is feeling multiple, even contradictory things at once. Marcy does a great job of capturing those things here.

    No caring is ever wasted. At the very least it makes us more human.

  3. Patrick P. March 4, 2011 at 8:48 pm

    Journals that center on the blending of humanities and medicine have been around, and new ones, like The Examined Life at Univ. of Iowa, are emerging. AJN’s support of creative non-fiction writing is much appreciated.

  4. […] I wish I could write like this. At AJN’s blog, Off the Charts, a post by Marcy Phipps, RN. Snow. […]

  5. RC March 4, 2011 at 11:18 am

    It’s interesting how fast the author’s emotions transform from compassion to disgust. The difference of feelings toward the living and the dead changes our entire outlook. This closely relates to the view of an individual once it’s been determined that they’re on life support simply to maintain their organs so they can be donated.

  6. Emily March 4, 2011 at 11:03 am

    Beautiful. Reminds us that nursing isn’t perfunctory, and involves endless humanity.

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