Kind of Incredible

So under my care this week is an elderly gentleman, recently placed under the code status of: DNR. For my non-medical readers, this means one thing: If he were to die, if his heart were to stop beating, if he were to stop breathing, we would not do anything except say a goodbye prayer...we would not call a code, we would not start CPR.

In addition, we also placed this patient on something called "hospice care". This differs from a DNR based on the fact that a DNR says we won't do anything if he were to die, the term "hospice" means that we are going to stop all treatment to stop disease progression, and purely focus on helping him have no pain, until the moment he does die. Which, being that we stop fighting his disease (cancer), will be soon.


Now this case is common and yet all too unique (but isnt every patient?). This gentleman was diagnosed with cancer long ago and has spent years fighting this battle, as many have. He's had years to come to terms with his diagnosis, what he is doing...his life, his death. But just recently did they decide to change him to hospice...does this mean he gave up on life? No. It means he's done, he's done fighting. He's ready to face whats next.

Now, whats incredible, is the following: As an RN, all of the patients I've had under my care that have died- it was always unexpected. Sometimes I knew they may have been dying but didn't realize it was so close, other times it took me by complete surprise. Shock. They were supposed to have pulled through. I always thought, Oh my god- I was just holding their hand only two days ago. I was just taking care of them. Did I do everything I could have? If Only I had known they were going to die in days....would I have changed my care? WOuld I have stayed to sit with them longer? Would I have that "I'm sorry" look in my eye? Would that make it worse?

So, this is the first time (as an RN) that I have had someone under my direct care that knew, he accepted, the fact that death was upon his doorstep. Tomorrow, next week, next month, maybe.

It may seem strange, morbid even- to imagine this if you have never had the opportunity. Anyone who ever has had the opportunity and it was a loved one, I'm so sorry. To talk with someone, to take care of someone that could not be on this earth the next day and everyone knows it. Its not unexpected. To take care of someone, knowing you may see their obituary in the paper that week. To hold someones hand.


And, to answer my own questions- Yes. It did change my way of practice. Whether that be a good thing or a bad, I don't know exactly. Yes, we did have a small euphemistic conversation about his illness, about passing on. Yes, he was a little depressed and I sat with him a little longer. Yes, I didn't know what to say and it was obvious. Yes, I did have the empathetic look in my eye.


Yes, I did turn around after I said goodbye this morning, Yes- I did go back and give him another hand squeeze, to tell him it really was a pleasure taking care of him. He is probably going to be transferred today, so I told him it was a pleasure taking care of him, in case I wouldn't see him again. On the surface I was talking about if he got transferred before I got back. But we both knew what I was really talking about.

And he smiled.


Its not something you can ever take lightly, death. When someone is that close to whats next- that close to an eternity of darkness or perhaps an eternity of bliss, they are close. They know its coming. They can mentally prepare. It will never not be weird.




I hope its an eternity of bliss.



~ WNB



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