Three young patients on the same trajectory.

Image by strikers/pixabay

I have recently spent time with a few young patients all on the same sharp trajectory towards their final day of life. All had different diagnoses, and on the days I had the privilege of being their nurse, they were each at different points on that trajectory.

M. was just four days away from dying, though he and all his medical caretakers thought at that point that he had at least a few more weeks.

J. was a couple of months away from dying, and on my shift with her, she knew her situation was bad but remained hopeful for some last-ditch interventions.

R. was well-appearing outside of an unsteady gait and slight sideways drift of her eyes. She maintained levity and a hopeful innocence in the first few hours of my shift with her before I took her to her MRI scan. As I watched her MRI images appear with a clear and tragic diagnosis, I heard the physicians outside of earshot from the MRI table discuss the inoperable, inevitable turn this would take for her in the very near future. R. didn’t know yet that her budding dreams for adulthood would not come to pass, and it felt a terrible secret to know this about her future before she knew it.

When every patient connection may matter more than we know.

It felt important to me to connect well with M. and J., who both already knew they were at a critical point in their respective disease courses. It also felt important to me to establish some meaningful connections and moments for the rest of my shift with R., who would not know her diagnosis for another day or two—even if I couldn’t tell her the sobering reason why those meaningful connections now felt more urgent than ever to me.

It is a curious experience to reflect back on time spent with patients who I knew to be dying but who themselves remained ignorant, in some cases willfully, about the harsh reality of their impending death. When I took care of M., I was so struck by his poise and gentle humility that I considered signing up to be one of his primary nurses so that I could help give him some consistency in his final weeks of life, though I knew it would leave me vulnerable to grief in the most bittersweet way.

I had no idea he would be gone in four days. I find myself asking, “How did I shape that fifth-to-last day of his life? Did I help him feel joy, comfort, significance, and respect? Sure, life has been hard for me lately, but was I overly self-absorbed that day? Did my presumption that he had a few weeks to go cause me to take my shift with him for granted?”

When circumstances make a slow and gentle approach impossible, everyone suffers.

We nurses are human too, and it’s unfair, particularly after such an exponentially stressful year, to expect ourselves to be stellar in every single shift. But if I only had 60% of myself to offer that day, did I give that 60? Or just 40? Such questions don’t feel like they matter as much on a shift that I am on some level taking for granted. It matters more in hindsight now that I know that shift was in fact my one and only chance to shape some of M’s final waking moments.

This also causes me to think of the trauma that so many nurse colleagues are slowly emerging from after the waves of COVID patients overwhelmed their hospitals. There is an art and nuance to a nurse’s care for dying patients that, when given sufficient time and presence, brings deep validity to the weightiness of this moment in the patient’s life. The ability to settle into that gentle, slower approach brings comfort to both the patient and the nurse alike.

While that critical period is not primarily about the nurse, there is no question that the shared experience brings grief to both patient and nurse, not to mention any loved ones who may be present. It is the shared connections in the midst of that pain that bring a balm of healing to all. When I consider my connections with my patients in their recent end-of-life experiences, I ache in a new way for my nurse colleagues in the COVID trenches who felt overwhelmed, rushed, and disconnected in attempting to care for their dying patients because of all the unfavorable dynamics that the pandemic forced upon them in their nursing practice. I know they gave all they could, but also wonder if they are still traumatized because of all they felt they could not give.

To give ‘without reservation what is possible to give.

I know I can’t always show up 100% for my patients. I am, after all, only human. I am somewhat spent on my young children who have been in distance learning at home for a year. I am somewhat spent on my husband, my parents, my dear friends, my own colleagues who are all still recovering in their own ways from the toll this past year has taken. But for whatever I can bring to my patients, I hope to bring it without reservation, and with a renewed perspective on what it is to present my very self as their nurse in whatever time has been entrusted to me with them.