As a nursing student in my early twenties, I remember an instructor telling us very concretely that it was important for each of us to become comfortable with death.
She said that modern medicine and the American culture generally do not embrace death and there would be doctors, patients and family members that would push to save a patient by any means; no matter if the medication, surgeries and therapies made the quality of life of the patient desperately poor.
She told us stories that curled our toes and told us that if we, the nurse, were comfortable with death that the patient would know this and would count on us to advocate for the “best possible death.”
As a young woman, still not yet a qualified nurse, who had yet seen so little in the world, I listened but was still unsure if the instructor was right. After all, wasn’t I becoming a nurse to save lives—not to let my patients go quietly into death?
After nursing school, I went directly into Pediatric care. Each death of a young child struck my heart in the cruelest of ways. The death of a child always seems an unnatural thing and witnessing the parents’ extraordinary, otherworldly grief was (and is) the most heart wrenching sight that I have ever borne witness to.
As a nurse and as a person, I was not making friends with death in any way.
Several years into my nursing career, I was given an opportunity to work as a hospice nurse. It seemed to be the complete opposite of the work I had been doing, which seemed perfect to me as I was incredibly burned out and disenchanted with pediatric nursing. I decided to take the opportunity and found myself working on the opposite side of the life spectrum—I had gone from working with babies and young children to working with people in the last days of their life. I had no idea yet that this job would change my ideas about death and, even more, about life.
In my first days as a hospice nurse, I realized that I now had a front row seat to the damaging effects of a medical system determined to “save” a patient at any cost.
At intake into the hospice system, patients told us stories of the brutality of the care that doctors had forcefully talked them into undertaking and how they now lived lives of great pain and suffering. Lives lived with no quality of life.
Many of these patients reported having to practically beg the medical staff for a hospice referral when they were ready to die and no longer willing to live a life of intense suffering in a futile fight against a disease that was going to take their life.
For the most part, patients entering the hospice system were ready to die.
As a hospice nurse, my job was not to save lives but to usher my patients into death. I learned quickly that there was such a thing as a good death—a thought that I had never considered before. Many of our patients were older and had been infirm and in pain for quite a long time. They would express a readiness to die and were open with their families about this. They were grateful for the chance to share memories from their lives—both good and bad—and were ready to move on. We made them as comfortable as possible and granted every possible wish that these patients had.
These deaths were often peaceful and the families seemed to move on easily. Mourning deeply and moving on with gratitude for what that person had been in their life.
There was another side of hospice nursing that was not so pretty, of course. The side that was the people who were not yet ready to pass on.
There were many reasons for this—an illness that had been sudden and thus not allowing them to yet come to terms with death, unresolved strife with family, children that were still young and deep concern for how they would be after their passing, an unsure feeling of their own beliefs of a higher power, religion or what may happen after death and a myriad of other reasons.
As a nurse I had been taught to administer meds, perform assessments and procedures and follow doctors’ orders. None of these tasks (save for the passing of pain meds) would assist me in giving these patients what they needed—an acceptance of their forthcoming death. I would learn to spend hours of my time listening and holding space. Making phone calls to estranged family members begging them to call or come visit so that my patient could make peace with them. Calling in chaplains. Writing down precious memories and many other duties that one would never be able to do in a traditional nursing job.
Instead of dramatically preventing death, I was gently steering the client towards an embraced and peaceful death.
I had learned the lesson that my instructor had years before begged a class full of naïve nursing students to learn. I had embraced death as I was helping my patients to do the same. I became an advocate for hospice care and a patient’s right to a peaceful death on their own terms. I witnessed hundreds of deaths, deaths of patients that I had come to know and love and was overcome with gratitude when their deaths were peaceful and attended by those they love.
A year later, I would return to pediatric nursing when I realized that this was my true calling. However, I took with me the many lessons of that treasured year as a hospice nurse with me.
There have been many times since in my personal and professional life that I have been shocked and saddened by death. I know that I will never get used to the death of a child or the sudden death of a young loved one. Yet, I no longer fear death—I have seen far too many deaths that were beautiful and witnessed too many unexplainable after death experiences to not believe in an exquisitely peaceful afterlife. I am now able to comfortably usher my patients and their family into the next world with compassion and grace, even as I mourn the loss of my beloved patients.
Those of us working in healthcare often have chosen our field because we have a strong desire to help people. I know that it is not easy to accept death knowing that this means we no longer have the physical comfort of a loved one in our lives. I now strongly believe that prolonging life is not always the kindest act we can provide our patients with.
By coming to terms with death as a natural event and passing that acceptance on to our beloved patients, we can give them the peace that is often missing in healthcare today.
We will all die, that is inevitable. What we do have control over is the manner in which we approach death.
I hope for a future medical system that unilaterally allows our patients the right to a death on their own terms. I believe that the first step to such a system is our healthcare professionals being willing to find within themselves an acceptance of death—as a natural part of life and as something not to be feared.
Author: Amanda Redhead
Apprentice Editor: Carlene Kurdziel; Editor: Renee Picard
Photo: Flickr/Hartwig HKD