Before I started studying nursing I had no experience of the caring profession. Other than my nephews and nieces I had never washed anyone, or helped a person to the toilet, or fed someone.
My first placement was working on an acute stroke unit. On my first day I cared for a male patient who had a reduced level of consciousness and was scoring 3 on the Glasgow Coma Scale. Consequently he was fully dependent on the nursing staff for assistance with all of his activities of daily living.
Each day I took care of him I would give him a full wash, dress him and change his bedding. I would shave his face and brush his teeth. I would comb his hair. I would change his incontinence pads and record his bowel movements and his fluid output.
I would turn him in his bed and inspect his pressure areas for any damage. As he couldn’t swallow safely due to his stroke, I inserted a nasogastric tube into his stomach to maintain his nutrition and fluid balance. When he seemed in pain and his eyebrows furrowed I would hold his hand and he would squeeze it and rub my hand.
I felt overwhelmed at how helpless this man was and realised how privileged a position the nurse is in to be able to help their patients remain comfortable and uphold their dignity.
And I realised another thing.
That behind every patient is a family. That this man was someone’s father and someone’s husband. His wife would come every day to see him, and in many ways I found that harder than taking care of him.
“But speaking to his wife, and seeing her distress and the pain and suffering that she and the whole family were going through, was the hardest thing to deal with.”
My patient didn’t speak a word once whilst in my care, and what had happened to him felt so sad, but sad in an abstract way. Because he never spoke to me, everything felt a little more detached, and that made it easier to deal with.
But speaking to his wife, and seeing her distress and the pain and suffering that she and the whole family were going through, was the hardest thing to deal with. I tried as much as I could to make life more comfortable for her whilst she went through this ordeal. I would make her a cup of tea or sit and talk to her, to support her whilst also looking after him.
“Firstly, I was struck by the stillness and quietness of the room.”
Unfortunately he didn’t recover and over the course of several weeks his condition deteriorated, and sadly he passed away. I asked to be there to assist in performing his last offices as a sign of respect, and to learn this clinical skill.
It was a surreal experience, and one that I won’t forget.
Firstly, I was struck by the stillness and quietness of the room. The healthcare assistant had nearly completed the last offices, so by the time I arrived he was already dressed in his shroud and the body was half wrapped in a white linen sheet. The windows had been opened, “to let out the soul” the healthcare assistant said.
I had expected that when someone passed away they would look different but my patient looked the same, except now he looked calm and at peace.
“I found covering the mouth and face particularly difficult to understand. It seemed unnatural to cover his airways. It almost seemed to dehumanise him. And then it finally became real to me that he was dead.”
I put on a pair of gloves and an apron to assist as we closed his mouth, forced down his eyelids and continued to wrap his body until he was completely covered. We left his right arm exposed so we could identify him from his wristband. I found covering the mouth and face particularly difficult to understand. It seemed unnatural to cover his airways. It almost seemed to dehumanise him.
And then it finally became real to me that he was dead. And that death is merely the absence of life, and that his life was gone. But also that death and life are all the same thing and that taking care of a patient who has died deserves all the same dignity that the living receive. And that it is an honour to be able to give someone a ‘right’ death, in the same way that its a privilege to be able to give someone a ‘right’ birth.
“It hurt to see them grieving the way that they were. And inside I grieved a little bit too. I felt a little bit broken, caught up in the moment, struck by the solemnity of the situation.”
Then his wife arrived. She mourned the loss of her husband and we were there to comfort and support her at such a difficult time. But then his body was taken away to the mortuary by the porters and his wife and family left the hospital in tears.
It hurt to see them grieving the way that they were. And inside I grieved a little bit too. I felt a little bit broken, caught up in the moment, struck by the solemnity of the situation. Time stopped still as I saw their pain. But then when they had left the noise of the busy ward came roaring back and suddenly I realised that I was back there with 22 other patients who are all acutely unwell too.
You’ve got to stop grieving with them and focus on your next patient. There’s not much time to process everything that’s just happened and then suddenly it’s time for a bedpan, to take a blood pressure, or to fit a nasogastric tube and you just have to detach yourself and get on with the job. I found that difficult, and I still do now.
The registered nurses tell me that your first patient passing away is the hardest, that you remember it, but over the course of time it gets easier to cope. I can’t see the way just yet; it still makes me sad to think about that man and his family, and I don’t see how it will get easier. I imagine you just grow to accept it.
Tristan Crombie is a current student nurse studying at Plymouth University