New nurse, in the hood.: Letting Go

This is a a post I've been thinking about for a long time, but real emotions take me a lot longer to process and express than I usually have time for. Also, I'm about to get all religious on you. Consider yourself warned.

Where I work, we see a lot of death and dying. Or rather, near death and dying. A large portion of our population are nursing home patients. Most of them are dealing with some degree of dementia. Virtually all of them have no hope for recovery. Virtually all of them are full codes.

They come in, thin and frail, covered in bedsores, mouths crusted in weeks worth of oral secretions, breathing their last breaths. Their families come in droves. They insist on intubation. They want everything done. They pray for healing over the brittle shells of the people they loved. The process is sad and cruel, difficult to watch.

I have no doubt in the power of prayer, but what they pray for puzzles me. I think back to my first job in high school- watching the young kids in my church's nursery. One of my charges was a sweet, tiny little boy with severe cerebral palsy. He didn't speak words, and his doctors speculated he was blind, but he could hear and responded to every little sound. He would smile at the voices of his kind, gentle parents and giggle at the tickling and teasing of his doting older brother. He loved music and would often grin and make sounds along to what he was hearing. He'd stay behind in his chair while the other kids went over for communion, and I'd stay with him- on the days he fussed, I would sing to him. I took care of him at home every now and then when his parents went out- they always joked that he had a crush on me.

He started getting sicker a little after I went away to college. I visited him in the hospital during Christmas break-he was discharged on hospice care a few days afterward, and a little while after I'd returned to school my mom called to tell me that he had died. I came back into town that weekend for his funeral, still confused and sad. I remember looking at his parents and wondering how they were keeping it together.

My rector gave the sermon that day, and he talked about how much our little man loved being pushed in his wheelchair with someone running behind him, and how much he would giggle at the feeling of the wind on his face. He talked about how heaven as we believed in it was a place beyond the limitations of our broken physical selves. How we become whole and perfect. And he talked about this sweet little boy, and how he was there, running around at last. I cried as I watched it in my head. I still cry thinking about it today, thinking about my grandfather, unable to recognize any of us through the fog that was Alzheimer's at his death, back to building his complex models, back to wiring little devices, back to fixing my and my brother's toys as fast as we could break them.

We say we believe in these things, and we love these people so much. How could we deny them their eternal reward for the selfish purpose of clinging to their broken bodies a little while longer?

On the other hand, last week, I took care of an older lady in the early stages of dementia. She was dealing with a score of other medical problems, none of which were immediately fatal, but enough that she was living in a nursing home. This particular night, she had taken an unexpected turn for the worst and came to us with agonal respirations and a thready pulse. Her family and neighbors flocked to her bedside. Except this time, not to futily try to hold on, but to wish her goodbye. Her son sobbed as he talked to her, telling her that it was okay to go now. About what a great mom she had been, and about all their loved ones who were waiting for her. He even talked about her rotten little dog that she had loved so dearly, and how he was ready for her to come home. They covered her with kisses, and she died within a few hours. This has seriously been one of this most memorable and oddly, most beautiful experiences of my nursing career. I was able to walk the family through what was happening, to comfort them and assure them that they were doing the right thing. I will always remember them and I think her son will remember me too.

I don't want to sound all angel of death here, but I guess my point is, if we say we really believe in a higher power and a better place, why do we struggle so when the time comes for someone we love dearly to go there? Also, that I'm seriously considering quitting ER to become a hospice nurse.

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