It is hard to remember the details of the call now but I responded to the trauma bay to help with a ROSC patient brought in by ambulance. Trauma was getting slammed and this particular patient, though now intubated and relatively stable, had actually been a DNR. Someone had missed that detail until he was already in our ER and resuscitated. The family member who had been notified was not overly pleased with us, but not overtly angry either, they simply requested enough time to let the rest of the family know what had happened so they could come say goodbye and all life sustaining measures would be stopped at that time. Of course, we were more than happy to comply with the request.
The gentleman we had “saved” was elderly, withered, had multiple co-morbidities, but was very well-kept, it was obvious he was not neglected. Maybe two hours went by when family started to trickle in. They were a magnificent gathering. All dressed in their Sunday best; the men had on suites and ties, the women had dresses, heels and hats. The walked in together slowly and solemnly, numbering around 15, greeting each other with hugs and kisses. Though they seemed oblivious to the chaos of the trauma bay, I was relieved they were able to have a private room.
Eventually, a spokesman for the family told the attending physician – who was equally as spellbound as the nursing staff – that they were ready to let him go. The ventilator was stopped and the patient was extubated, quickly and quietly per family request. The defibrillator disconnected, though the patient stayed on the wall mounted cardiac monitoring, the beeping was silenced immediately. All IV drugs clamped closed, pumps, suction and oxygen turned off.
At the same time the attending, respiratory therapist, and resident started removing the tube one elderly man in the group started singing. He sang a church hymn confidently, with his eyes closed swaying slightly. Slowly the others in the room started singing with him. They grew in volume and conviction but never seemed to overwhelm the room or detract from the event, the passing of this loved family member.
A nurse stood at the monitor to silence it but from across the room I watched his rhythm falter, increasing briefly, then progressively bradying down. All the while the family sang. Some lifted up their arms, some had their heads bowed, some hummed quietly and hugged the person next to them. It felt like they were lifting him up, saying goodbye, mourning his death, and celebrating it all at once. I don’t remember seeing the last chest rise and fall but I was brought back to reality when the attending with his stethoscope pressed to the patient’s chest look up at the flat line and then to the family in the room and declared time of death.
At that moment is became quiet. I think all the medical staff in the room were unsure if the gathering energy was going to explode into hysterics of mourning, but we were surprised once again. Someone started chuckling and said something along the lines of, “I bet he’s hugging his sister right now.” And then someone else added, “I bet they’re laughing that laugh the way they used to, you remember?” The whole room seemed to shift and come down, as they cried and told favorite moments. We realized we weren’t needed anymore and carefully left the room as the “Remember when he…” stories started.
Outside in the hallway I looked at the other nurse who had been in the room, a guy with more experience than I had at the time and that I respected immensely. He had tears in his eyes and with no shame looked at me and stole my words, “That was beautiful.” In a profession that can be so brutal, so jaded, and so detached, it was the most empowered and connected I have felt to the worst part of our job. We are nurses, we fight against death and dying. Our job is to fend it off and advocate for interventions against it. But every once in awhile our job is to embrace it and support it gracefully when it is the wish of the patient. It was an honor to be taught this lesson, it’s one I will never forget.
About author: April is a nurse who has spent the last 3 years at level I and level II trauma centers in Southern California. You can find her on Instagram as cloverqn17. She is currently enjoying maternity leave- congratulations April!