The privilege of saying goodbye

I work Saturdays in RL, in Acute Care at a local hospital. I do therapy, social work, psych evaluations, referrals, you name it. Social service stuff. It's the weekend so I am the only one there, handling Emergency, ICU, Labor and Delivery, Medical/Surgical, and Telemetry floors. It's a juggling act, lots of triage as to who needs to be seen first and what they need. I love it.

Yesterday I saw a familiar name on the census, a patient about my age with multiple diagnoses. I made a note to pop in to say hello to her.

Around lunchtime, my pager went off. Four times, all different numbers on the same floor. I called the charge nurse to cut to the chase. "We need to you come up to room ___, the patient is dying and her family needs emotional support." They often say a room number, not a name, so I asked. It was the patient whose name I had noticed earlier. I dumped my lunch and ran upstairs.

I heard the patient before I saw her, all the way down the hall from the stairwell. Moaning. Entering the room, if I hadn't known the patient, I would not have recognized her. She had lost so much weight. Her hair had grown back in since I saw her last, in February. She was not conscious, but taking in ragged breaths followed by loud exhaled moans.

She had a large family and they were all present. She had only one child, an adult daughter who never left her mom's side. Lots of little ones, nieces and nephews, but they remained in the waiting room. The family felt it was best. I talked to each family member, checking to see how they were holding up, answering questions about the process we were witnessing as best I could, going between them and the medical staff when needed. Gently asking about...plans. They had it all covered. The patient had valiantly battled lung cancer for a long time. She was tired, they said. They each took a few moments to lean down toward the patient, and in their own way each person told her they loved her and that it was okay to let go.

As the hours passed, the inhalations became fewer and farther between. The exhalations became quieter - more sighs than moans. Her blood pressure slowly dropped. The family kept watch and I kept it with them. Holding a hand, giving a hug, calling hospice at their request, getting tissues, and much of the time just sitting quietly along with them. Waiting.

There was soft laughter at times. Family members talked about how stubborn the patient could be. Remembering good times. She was the baby of the family, and her siblings, all in their 50's, were there. There were no orders to resuscitate. Just to keep her comfortable and to allow as many friends and family members who wanted to be there, come and wait, talk, pray, laugh, remember.

The oldest sister took me aside at one point and held my hand. She looked into my eyes and asked "I work in a hospital, too. Is this hard for you?" I said no. This part of my job is a privilege. She looked at me for a long time and nodded, with tears in her eyes. And we went back to our vigil.

I stayed three hours overtime with them, and was honored to do so. Hospice arrived, not to intervene in any way with the patient, but to support the family. I went home to mine, and hugged each one of them extra tight.

Last night I was hit by a wave of concern for how the family was doing, even tempted to drop into the unit to see if all was well. Normally I leave work at work, but some patients and families stay with you. This was like a lightning bolt, though. I finally called the doctor on call and he told me that the patient had just passed away, peacefully, surrounded by her family.

I love my RL job, even though when they call me it means something is pretty wrong. The person is a drug addict, homeless, just got a terminal diagnosis, threatened a nurse, is in ICU, has domestic abuse, or any of a hundred other reasons a patient would need psychological support or intervention. Sometimes the vigils I keep are with 16-year-old moms, laboring to give birth all alone and scared. Sometimes, like yesterday, it is for someone leaving this world. If you look hard enough, there is beauty in both sides of the human experience, birth and death. Today I am thankful for my patient's life, for her family, and for the peaceful and loving way she moved on.