Tears and being present.

The call came in from EMS as “72 y.o. man with end stage Lung Cancer in respiratory distress~ vitals stable~”.  Family requesting transport to the ER for evaluation. He is on Hospice~ the nurse tells us the family is no longer able to cope with him at home.”  I went to room 7 to prepare for my patients arrival.

My patient arrived 10 min later on the EMS stretcher~ His gaunt frame fought to hold up his head~ his skin was dry but pale, respirations were labored but controlled at approx. 32 bpm~ his eyes were open wide and they never left my face as the paramedics brought him into the room and moved him to the bed.~ The venti mask covered his mouth so I couldn’t quite understand what he was saying to me. The paramedic was delivering his report but I was so distracted by the look in my patient’s eyes that I went to him and removed the mask so he could talk to me. 

“My wife is coming (breath) with my son (breath) please let her (breath) in when she gets (breath) here…she (breath) has Alzheimer’s (breath) disease and she (breath) is easily scared (breath).” 

I placed the oxygen mask back on his face and reassured him “My name is Bobbi~ and I will be your nurse tonight~ I promise you I will let your family in the minute they get here.”  With just that simple promise I watched his shoulders relax, his head rest on the pillow and his eyes close.  As I worked to deliver a Nebulizer treatment to him, get him on the monitor and draw his labs I asked him some questions.  He nodded yes or no to most but did tell me “I do not (breath) want to be saved (breath)if I die here (breath) please just keep (breath) me comfortable (breath)…I have a DNR.”  He assured me that his family was aware of this wish, “all except (breath) my wife who (breath) just doesn’t understand (breath) what is happening.”

10 min later my patient was much more relaxed and breathing easier post DuoNeb, Ativan, Morphine and repositioning.  His wife, son and daughter had arrived and were now in the room. I found a rocking chair for his wife and brought her a cup of tea and a warm blanket.  As I talked with their children about what had transpired in the last few hours I watched his wife tend to her husband.

Her brow was furrowed as she moved to the head of the bed and rested her hand on his forehead.  He smiled at her. She said to him, “see… you’re okay now…” She picked at his blankets and smoothed out his pillow. 

“My mother is in and out with her thoughts…she has Alzheimers but all in all she is in the present moment lately,” her son told me.  “Our sister died of a rare lung disorder when she was 40 and my mother has never been the same. I think my father’s breathing issues are reminding her of that because she is talking about her a lot.”

As the evening progressed my patient grew more agitated and anxious with his increasing respiratory distress… despite our interventions.  The doctor and I talked with the patient and family and the decision was made to increase his morphine for more comfort.  My heart ached as I watched his wife struggle with the information…she understood in one minute but in the next minute she did not…she paced and cried…she tended to him by readjusting his blankets, offering water, kissing his hand. She on several occasions would get up close to her husband’s face and cry to him, “don’t leave me…please don’t leave me…”  His daughter left the room often in tears and his son tended to his mother.  He reassured her often with his hand on her shoulder, “Ma, it’s okay…dad isn’t in any pain and the nurse is helping him…don’t be afraid.” 

Two hours later my patient passed away~ more peacefully than when he arrived…His family struggled to let him go and to be present for one another.  His wife at first didn’t believe what she was seeing…she begged me to help him…how could I make this woman understand that I couldn’t…tears fell from my eyes as I watched her son hold her as she cried for her husband.  She came to me and put her arms around me and I hugged her back…she cried long deep cries of sorrow~ My heart broke. 

As I write this I continue to cry for this woman.  They were married 50 years and now her husband is gone. Her house is empty and her mind is clouded…what will become of her?  My best friend lost her husband to cancer 3 months ago and I know the pain she is in…deep dark pain~ I pray for them both. 

Being a nurse is at times a painful job…Even though I know that giving a patient and their family my heart is needed; it at times is overwhelming.  I saw this patient’s son yesterday in Subway~ he approached me and thanked me repeatedly for the care I gave to his father and his mother.  He told me that my compassion was worth more to them than anything else I did that night… I guess for the families being present is exactly that….a present!