Experiencing a difficult patient death on his last night shift as a student nurse helped James to shape the type of nurse he wants to be
I have just arrived on shift and I’m about to begin my third and final night shift as a student nurse.
As I walk around the ward I look in at bed eight. The patient is a young man and he does not look well. His face is pale and sweaty. I glance at the observations machine and his blood pressure is very low but his heart rate is normal. He has a doctor with him.
It’s now 7pm and I’m ready to start my shift. The day nurse explains that the man in bed eight has been having palliative radiotherapy but has a poor cancer prognosis. He is beyond help and we can’t do anything for him. He’s dying. A “Do Not Resuscitate” form has been completed and is in his notes.
As the day nurse talks to my mentor I look at the patient. His hair is greasy, it’s dark and wavy. I examine his face closely and it’s pale, but he seems pain free. He seems to be sleeping.
I have mentally switched off from the handover, but suddenly ask “where are his family? Do they understand what’s happening?” The doctors have spoken with them. His wife was very upset but she’s gone home to see their children. “Their children” I think. Her details are in his nursing notes, you know, just in case.
I have drifted now to thinking about my own children at home, getting ready for bed. I don’t know if I can cope with this. I cannot imagine how difficult this situation must be for his family.
I have a flash back to when I was 10 years old. I picture my nan dying in her hospital bed from terminal cancer. I remember being at the nurses’ station where a group of nurses were sat talking. “Please don’t let my nan die, I love her, she was a nurse. Can’t you just cut the cancer out, then she can come home?” I pleaded. The nurse smiled at me with a tear in her eye and said “I’m sorry, she’s very poorly, she’s beyond our help.”
Beyond our help? What does that mean? “Am I dying?” she asked. “Yes” I mumbled and climbed on her hospital bed to cuddle her. She died at midday.
I’m back in the room and my mentor calls me. My patient’s wife is on the phone, I pick up and introduce myself. She quickly asks if he’s okay and I repeat the handover that I was given. Then she asks if she should bring in her eldest son to say goodbye? “Of course, if that’s what you think is best, then you do that”.
His wife has arrived. She hesitates but asks “is tonight the night?” I look at her and look down. A boy by her side has dark wavy hair. There is such sadness in his eyes.
I look behind them to a middle-aged couple who are crying, and must be his parents. I look into the room, praying they will follow me. His wife turns to me and asks “can he hear me?”
“He may be able too, it may help to talk to him” I tell her.
His blood pressure is low. “Turn the monitor off” whispers the doctor in my ear. His heart rate has begun to decrease. I turn the monitor off under supervision from my mentor.
His wife kisses her husband’s hand. Sobbing quietly she holds her son tightly. “Mummy, is Daddy coming home tonight?” She doesn’t answer him and turns away. The boy looks at me, “Is my Daddy coming home?” I see myself in him. “Daddy’s poorly”, I say, “But he loves you very much.”
As a nurse, I can be this man’s advocate. I can share his last moments, hold his hand, watch his vital signs but I cannot die with him. I cannot feel what he is feeling now in these last few moments. I am just an observer. But certainly his death teaches me about myself as a nurse.
My patient dies at 23:52. His family have gone home and bed eight is empty again. In the brief time we were together this patient taught me about life and myself as a student and a future nurse.
Death is never routine.
James Merrell is a third year student nurse studying at Bournemouth University. James is also a Speak Out Safely Ambassador for Nursing Times.