The Last Journey

I started my nursing career working with elderly female women in various stages of deteriorating illnesses. The majority of these women had been living with some form of dementia, while others were living with the effects of Stroke, Multiple Sclerosis, Huntington’s, Parkinson’s and various other debilitating conditions. Many of these women had been unsuccessfully managed in nursing homes and transferred to our hospital unit for more specialized care.

It was not the dream job I had envisioned. I had a far more glamorous idea about what my nursing career was going to look like. I worked with seasoned nurses who were quite content, but I wasn’t sure how I was going to manage to make it to the end of the first week.

In addition to meeting the needs of the living, I was responsible for the needs of the expired. I had to prepare the body before the arrival of the funeral director. Under the tutelage of these skilled nurses, I developed and honed the necessary skills required.

As far as the nursing tasks were concerned, it was pretty straight forward. What wasn’t so clear was the human drama that played out before my eyes. 

Life can be cruel. By the time an individual had been admitted to our unit, it had been determined the prognosis was grim. Sadly, the last leg of their journey often took years to complete.

Not only was the individual’s life impacted, the lives of their families would never be the same. The families often struggled with the stages of grief. Some families were fortunate enough to move through the feelings of denial, anger and depression to a place where acceptance may be considered and healing could begin. Not all families were this fortunate.  No matter where the family was in terms of the grief cycle, it was gut wrenching to watch a family witness the demise of their loved ones.

Often family members reacted inconsistently from one another. Some family members felt the need to be with their loved ones every opportunity they had. Whether they felt guilt, because they couldn’t provide the full time care required or were worried their loved one wasn’t being cared for properly or were desperate to share every last moment they had.  Others felt they couldn’t routinely witness the deterioration of their loved one, as they were not able to cope with the constant reminder of loss and wished to “remember them the way they were” as I had often heard them say.

Conflict would inevitably rear its ugly head. The family members that were hyper-attentive would become tired and resentful and less understanding of the family members that were unavailable perhaps mentally as well as physically to visit regularly. The family member visiting routinely hoped to have some down time to refuel with the assurance another family member was going in their place, which would allow them their much needed time to rest or do other tasks somewhat worry free. Some unavailable family members became defensive and felt the need to justify their lack of visiting by lashing out and at times they became even less available avoiding the possibility of verbal altercations or awkward silences.  By the time the patient passed away, there was often irreparable damage done.

Typically female patients had less visits from their male partners than male clients had from their female partners. Grown children typically were the bulk of the visits.  I would watch how a patient who was not verbally responding to staff, light up when their family member came in. The recognition in their eyes was palpable. However, more often than not this recognition would fade leaving the family with no sense of comfort or reward at all. 

Animals and small children made all the difference. Generally they were pleasantly received with patients very much aware of their presence if their decline had not robbed them of their cognition.

Not everyone wants someone with them when they die. I watched how some individuals hung on throughout a visit to pass moments after the family left the room. Perhaps wishing to protect them from the inevitable or wishing to maintain their dignity and pass alone.  I also watched how some persons hang on till family arrived to share their last breaths with them and if possible to say goodbye.

My time spent on that unit lasted nine years, much longer than I anticipated. I witnessed some of the deepest and most intimate times in a person’s life.

For this I am most humbled.