I’m exhausted and shaky, and the “pssssht!” sound of the pneumatic doors of the ER closing behind me on the way out sounds final, and just fine. I didn’t used to feel this way when I worked in the ER. Of course, that was at the other end, the beginning, of my nursing career, when I was young(er) and callous and every code was a challenge and a rush—as if the people were characters in a play, and I got to join in each evening. I hadn’t a clue what they were going through. Now, 30 years and two dead parents, a dead best friend, and a score of minor players later, I’m beginning to understand. I suspect that this glimmer of connection and compassion is what makes hospice nursing sometimes so draining.
Like tonight, when my patient’s family called to say he couldn’t breathe and the paramedics were taking him to the ER. The grown sons, daughters, and significant others stayed in the waiting room while his wife and I went inside—I to support and provide background information to the staff, and she (as it turned out) to watch her husband for his last 45 minutes. He coded on arrival, probably a massive pulmonary embolism.
He’d been diagnosed six weeks ago. “We hardly had time to take it in,” she explained, her wide eyes never leaving her husband in the midst of the marginally controlled chaos going on around her.
I tried to remember how the nurses from Dallas explained how to prepare a patient’s loved one to decide whether to watch a code or not, but it was lost to me in the moment. Do you want to stay, will you be alright? Yes, yes. Sit here, tell me if you feel like leaving, or have a question, do you understand? Yes, yes.
Even if they only have six weeks, or six days (and they normally don’t come to hospice with much more time, unfortunately), hospice patients have time to say goodbye: to hold hands; to lay together in a lumpy, swayback bed a few more nights; to lose themselves in a grandson’s birthday or a bar mitzvah. But when someone has an MI (myocardial infarction, heart attack) in the living-room or is kissed by a bus, it’s over, time out, end of play. No time to hold hands just once more. And try as they might in the ER, as wonderful as its employees may be, an ER is a crappy place to die.
–Thom Schwarz, RN, is a hospice nurse