Death is the final and inevitable stage of life. Taking care of patients in the last stages of life is not easy. These patients literally hand their lives to your hands. People believe life is controlled by a supernatural being. The nurse is like a mid level power between the supernatural and the patient. This gives the nurse responsibility to care for the dying patient. The belief that seeing many deaths makes you stronger is false. Each death feels different depending on condition of the patient, the family and duration with the patient.
My first death experience as a student nurse is clear in my memory. It was during my first rotation in a medical ward. I was talking blood pressure readings and noticed how difficult it was to get readings of one patient. We tried with my colleague and ended up getting a very low measurement. We informed the nurse-in-charge who came around the bed, did her assessment and started resuscitation. The patient was dying if not dead already, I cannot recollect the details well. It was one of my unforgettable experiences ever. Since then, I have witnessed countless number of deaths, you don’t get used to it. I believe people just handle it better with experience.
There are three important people in the death process; patient, family and healthcare team. The patients can be on palliative care, severely ill or some just appear well and die the next minute. How do you prepare patients for death? Some are in comatose state before they die while some are alert and oriented. Hearing is the last sense to be lost, communicate to the one’s in coma. Greet them by name, introduce yourself and tell them what you want to do to them. Remember to tell them what you have done for them, they hear you. The patients who are alert need more care. Allow them to talk about their beliefs on death. Do not judge the patient, if they hold a different belief from yours. They always have fears on how their families will cope after they are gone. Some believe they have unfinished business. Whatever is possible within the hospital policy should be done to allow them to have a dignified death. Some want to meet all the family members, some want spiritual nourishment by their spiritual leader. One patient who had cancer, had a wedding done by the bedside before dying. Some will give you a chance to prepare all the above while some will die before you do any of the above. Do everything possible to help in these times.
The family of the dying person is another important player. They are the ones who feel the loss more, their loved one is departed. They need the most attention and support. In any setting, there are members who are ready and most are not. The ones who are do it for the ones who are not ready. The oldest and the youngest are the mostly affected. Many are in denial, as the first step in the Kubler-Ross stages of grief. A counselor is important, let them express their grief and anger. Share information about the patient truthfully without withholding any important information. Answer all their questions and don’t be in a hurry. Most of them remember the support during these times. Always put yourself in their shoes. My father died in an ICU setting, same place I worked and I know how those briefings mean a lot.
The healthcare team is important in the death process. They care for both the patient and family in the last days. They guide and become part of the family in the process. I once had to clear a dead patient and immediately admit another one on the same bed. How do you transition within a matter of minutes? Some say its part of the job, some say work has to go on and some even say patients will always die. They are all true, however the nurses are human beings. You have read of many healthcare workers, nurses included who have committed suicide following the mass deaths by the COVID-19 pandemic. Some hospitals have debriefing sessions for the healthcare workers. The most growing solution is the psychological support and mental health care services for the healthcare workers.
Death and dying is not easy for anyone. Care is important for the patient, family and the healthcare team. As much as you appear to be super heroes to your patients, be mindful of your own mental health. There is no magical card to this, I will say, put yourself in the patient and family’s shoes. Do to them what you would want to be done to you.
Happy Father’s Day!