Final Exam

Beka - I just walked 21 blocks today. Not bad. No falls. You see -- I fell twice the other day at work. The first time a co-worker caught me before I pitched forward. The second time I wasn’t so lucky. I landed on my left hip and for the last two days have been nursing an increasing black and blue bruise, along with a bit of stiffness. So, since it hasn’t begun raining yet, I decided to go out and march down a few blocks. I landed in the local Barnes and Noble branch on East 86th Street. It was still relatively early, so sofa chairs remained unoccupied.

A small book titled “Final Exam: A Surgeon’s Reflections on Mortality” by Pauline Chen (2007) caught my attention. It is funny how I always end up gravitating towards the medical section of the bookstore. Reading the front inner cover, I learned that the book was about a liver transplant surgeon’s perspective on mortality because, as a surgeon, she had been trained in medical school to “save lives.”

Isn’t the same approach taught to us as nurses in nursing school?  I remember my first patient who died in the ICU -- her name was Alice and I was a young fresh new grad determined to save every person in the ICU. But, her family wouldn’t allow it -- they had signed DNR papers and asked for “comfort care.” Alice was 96-years-old in the end stages of class 1 heart failure. There was little equipment in the room except for a low maintenance intravenous infusion of normal saline, oxygen, the cardiac monitor that displayed a lowering heart rate each hour.

I was lost -- the crash cart had been set aside. Alice was still awake; but breathing heavily. Within 15 minutes, I knew what I had to do – provide comfort -- a gentle back rub, oral care, allow her to be surrounded by her family in a pain-free state, and focus on the use of touch and voice. I talked to her about the day and the blooming lilies in my garden; she smiled as she was gently lulled to sleep by my voice and touch.

I recall holding hands with her son and daughter. She was certainly surrounded by love and peace. By 1 am Alice had taken her last breath. I cried with the family for the next hour. It is an experience that brought mortality to the forefront of my young career.

"Death is simply a shedding of the physical body, like the butterfly coming out of a cocoon…It is like putting away your winter coat when spring comes…” E.Kubler-Ross

Chen writes in her last chapter that “when we are finally capable of doing that, easing suffering, we have become true healers.” (I have an awful habit of always reading the ending of a book first before buying it.) I headed towards the cash register. This was going to be a good read.

Related link: The Last Hours of Living: Practical Advice for Clinicians