After spending so many hours at the home of a patient who is actively dying and working with a family who is struggling with the difficult task of finding the words to say goodbye… I close the door and I walk away. It feels like time stops and seconds take minutes and walking to my car feels like crossing the finish line after doing a marathon. I am completely and totally spent. And the crazy thing about this is that I wake up every morning ready to do it again.
I never know what I have waiting for me on the other side of a door I am about to knock on. I have been called to see a patient who was actively dying and lasted two more weeks, and I have been to a patient for a routine visit that died the minute I sat down at his bedside. As a hospice nurse, one of the things I struggle with most, is seeing a patient who is in distress and whom I believe is actively dying, but somehow rallies, gets up and walks to the kitchen and asks what’s for dinner. How many times can I give the “he only has a few hours left” speech, without completely throwing the entire family totally off whack?
No human dies the same, death in general is so unpredictable that despite the obvious signs, you cannot be certain that he/she truly only has minutes to live. I’ve seen enough last breaths to know they are near, but death does not punch a time clock, it does not wait for a holiday or a special event to come or to pass… it simply has it’s own agenda and happens when it is truly time. And humans, despite how well you may know them, and lovingly want you at their bedside, will wait until that one moment you leave to get a bite to eat to take their last breath. It is not personal, some people just don’t want an audience, and some… feel the need to protect you and don’t want you to have to see them at that exact moment. Do I believe they know? Yes. I believe that sometimes, they are completely in control of the exact moment they take their last breath. I also believe that sometimes, they are waiting for one more person to come say goodbye, or for families to come back together, or for fighting to end, or forgiveness to be given.
My mother was a bit of a drama queen. The day she took her last breaths, she had all of her kids gathered around her bed; calling us by our nicknames, saying her farewells… she even called my dad, who happened to be in a hospital bed three cities away, to say goodbye (they had been divorced well over 20 years). She said very dramatically “I am going now”, she crossed her arms over her chest and she took her last breaths. There was no struggle, no distress, no lingering apnea or slow drawn out breaths. She just died. And I stood there… totally unprepared for what that might feel like. All of a sudden your mother is no longer here. We were not close, I didn’t have that sadness I see so often with others, I wish I did. But I am thankful I did not have to see her struggle.
So I have learned, when I am sitting at the bedside helping a loved one say goodbye, that instead of giving them a time frame, I let them know it’s close, it could be soon, and that for right now, they have an opportunity to make it the best last moment they possibly can… and if there happens to be a few more hours, another day… or even longer… those are bonus moments. I think I would regret it more if I didn’t say it was close, if I didn’t give them that last chance to say a few more words. I am okay with prompting them too early…