She was probably in her late sixties, with the kind of subtle authority you might expect from an elementary school principal. But she wasn’t in a classroom that day, nor was she surrounded by children. She was in a nursing home room, watching her mother slowly die in front of her. It’s tragic…no matter how much time you’ve had to say goodbye. The 0.45% normal saline slowly infusing into her mom’s veins gave her some comfort. Watching it drip into the chamber was soothing. Slow and steady. It was one of the few things that eased her mind. She has spent every waking moment in that room for the past four days, dividing her time between nervously pacing the floor, reading her Bible, and watching her mother’s chest rise up and down in a struggle for every breath.
This wasn’t my first time meeting my patient’s daughter. The LPN taking care of her sent me a text saying that the patient’s IV was beeping. I entered the room, not expecting to see anyone else. She was sitting in the plush recliner, one of the many personal touches added to the room in the past year the patient had been calling the facility home. I paused before introducing myself again, knowing she had probably met many nurses over the course of the past days and may not remember me. She did. I thought about how much she looked like her mother. The same brown eyes and sweet disposition.
Her mom had taken a major decline in the past few days. She stopped eating, stopped responding to gentle touch. The only thing that roused her was when I attempted to restart the IV after the previous one had infiltrated. Her veins were so fragile, so tiny. Even after 4 liters of fluid, she didn’t show any sign of coming out of this…whatever *this* was. Probably the end. At 90 years old, she was tired. She had even told me so three weeks ago. In a small, breathless voice, she said she wanted to go home. I asked her where home was. She smiled weakly and closed her eyes. “Not here,” she said, barely above a whisper. I asked her if she needed anything. “Sleep,” she answered in the same whispery voice. I gave her hand a gentle squeeze before turning off the light and quietly exiting the room.
Now here I was again. She had gotten so much worse in such a short amount of time. Her labs had taken a turn for the worst. Her BUN [blood urea nitrogen level] was 85. The normal is 5 to 25. Her kidneys were shutting down. Her breath was labored and shallow with periods of rapid, short breaths followed by no breathing at all for as long as 45 seconds, then the rapid respirations would start again [Cheyne-Stokes]. Even to someone who had no medical or nursing experience, they would know that she was near the end.
I did my work quickly, trying to find what was occluding the IV line. The tubing was kinked underneath her arm. But that wasn’t the only problem. The patient already had some swelling and edema to her arms…but it looked worse. I put my hand on the woman’s skin. It was cold. I swore under my breath, forgetting I wasn’t alone in the room. I looked up and apologized, explaining to her I’d have to restart the IV.
I worked quickly…stopping the infusion, pulling the old IV, adjusting the light, and tying the tourniquet. I studied the patient’s fragile skin, looking for something [anything] that looked promising. All the while, the daughter’s eye never left me. Finally, not one but two veins popped up. I rubbed her skin with the alcohol pad and steadied the needle. She flinched as I pierced her skin. And just like that…the beautiful flashback I saw as the catheter entered her vein didn’t mean anything…the vein blew. The other spot wasn’t as good. It was in her AC..the bend of her arm. Not a good spot at all but it was my only other option. Again, I tried. This time, she didn’t move. I’m not sure if I am grateful for that or not. It was in. I taped it down and put an armboard under her elbow so she couldn’t bend it. I looked up at the daughter just as she exhaled. I wondered to myself if she had held her breath the entire time I was trying to start the IV.
I reconnected the infusion and watched as the fluid dripped steadily. It is so easy to get wrapped up in that kind of thing. The clinical part of it. Starting the IVs or monitoring the physical dysfunctions of a patient.
I turned around and looked at the daughter again. “Are you alright?” I asked softly, as if I was afraid to wake the patient from her fitful sleep.
“Yes,” she said, her eyes not meeting mine.
I sat down in the chair across from her. “Tell me about her. What was she like? Before this.”
The tears the daughter had been holding back for the past few days finally came forth as she began to tell me all about her mother. For the next half an hour, I was told all about how what a wonderful cook she was. How her crawfish bisque was some of the best you would ever imagine. How much she loved her children and how she was always putting them before herself. By the time the daughter stopped talking, the tears had slowed down too.
I reached for her hand and asked if there was anything I could do for her. She looked up at me, her eyes swollen and puffy. “They don’t tell me anything. The hospice nurses. They come in and they check on her and the LPN tries to give her medications but she won’t take them. I know she’s close. I know that it’s almost over.”
I glanced over at her mother again, watching as her chest rise and fall. “When a person…is nearing the end of life, hearing is always the last sense to go. Talk to her. Whatever you need to say. She knows you’re here.”
“Thank you,” she whispered. I quietly stood and told her I would be back to check on them soon. Turning to walk out the room, I didn’t want her to see the tears start to stream down my cheeks. I know how bad it hurts to lose a parent and I’d never wish that kind of pain on anyone. It is a gnawing kind of hurt that doesn’t go away. You think it does. You think you are fine. Then something sets you off and if feels as if you are back to square one again.
Dearest readers, if you are lucky enough to still have them, call your parents today. Tell them you love them. Please.
Always,
Estelle
