On the third anniversary of my 16-year-old daughter Laura’s death, I reported to my 12-hour nightshift in the ICU where I had worked for 21 years. Laura tragically died at home on April 17, 2010, from a seizure caused by Rett syndrome. Although I miss her everyday, the anniversary is especially hard.
That night, we received report and picked our assignments, as usual. I chose a new admission, Susan*, a 60-year-old woman on a ventilator, who had been resuscitated at home after cardiac arrest and was unresponsive to stimuli. Her husband was traveling back home and was expected by 2 a.m. nine hours later. Susan had metastatic breast cancer and was finishing her lunch when she arrested and was rushed to Hunterdon Medical Center, a 178-bed Magnet designated hospital in New Jersey.
Even though my colleagues questioned my choice, I chose this patient because I felt a calling to care for her and her family that night. We had some things in common. We both were diagnosed with breast cancer in 2001. I also empathized with her husband, as I was out of state at a Relay for Life event, when Laura arrested and died.
When I went to her room, I found Susan’s sister-in-law keeping vigil at her bedside; she didn’t want Susan waiting alone for her husband. She had not eaten, and our kitchen was closed. I informed our nursing supervisor, who promptly provided sandwiches and drinks. I moved our bereavement cart, with CD player, soothing CDs, a Keurig coffee maker, comforters, afghans and aromatherapy into Susan’s room. We placed a sign on Susan’s door — a beautiful blue butterfly sign that I made — alerting everyone that there is a grieving family and dying patient in the room. When they see the blue butterfly, the staff members are extra quiet and respectful inside and outside the room.
I made Susan as comfortable as possible as the evening progressed. I played soft music and provided a recliner for her sister-in-law. My plan of care included emotional support for her family, as well as maintaining comfort, respect and dignity for Susan.
Her blood pressure looked good as the shift progressed. Her husband called several times on various planes for updates. Our intensivist made evening rounds and spoke with Susan’s husband by phone.
Her prognosis was extremely poor. The plan to extubate Susan when her husband arrived, remained in place. At 1:30 a.m., I met her husband, who was visibly shaken, at the ED and escorted him to her bedside, explaining what was going on. Incredibly, Susan’s blood pressure dropped as he entered the room. While he stood stroking her head, crying softly, I told him that she certainly waited for him to arrive. Although unresponsive, I believe she knew he was beside her. Just half an hour later Susans blood pressure dropped again, an incredible example of what I view as patients ability to control their last living moments.
Her husband wanted assurance that she was in no pain. Our family practice resident started a morphine drip. Her husband then surprised us, asking where he could get flowers for his wife in the middle of the night. Fighting back tears, one of my quick-thinking peers offered him a beautiful vase of fresh flowers we received earlier from a grateful patient. He placed the flowers on the table next to her head.
After half an hour and many tears, he told his wife it was OK to go and expressed his desire to continue with the plan to extubate Susan. Our team explained what would happen next. The morphine rate was increased for comfort and Susan was extubated.
After 20 minutes, Susan quietly took her last breath. Standing at the bedside, I wept with her husband as he said his final goodbye. They had no children, were very close and were married for 28 years. He never knew I, too, had breast cancer. I wanted to tell him that I knew firsthand the pain he was experiencing.
He hugged me, asking how I can do this emotionally draining job. I wanted to say that I sometimes don’t know myself, but explained that I believe I am not here for only my patients but to help their families. He thanked me again, removed his wife’s wedding band and left.
Few people outside of other nurses and their families realize the daily emotional distress of our job. It is not the physical work but the emotional component that is the hardest most days.
After Susan passed away, we spent the rest of our shift in a solemn reflection on how precious life is.
*Name has been changed.