I wrote the poem below after my daughter had been very sick and spent several scary days in the PICU. I was only 6 weeks into my first semester of the nursing program, and ultimately had to withdraw that semester and restart again at the beginning of the next one.

The poem illustrates how I felt as I waited alone outside the CT scan room door. Every once in awhile I pull it out and revisit how it felt to be on the other side of the exam table, and to help me remember the feelings that my patients are experiencing:

TRANSPARENT BOX
I sat in the hallway in my transparent box,
Hard plastic chair digging into my thighs.
I watched them walk by from my seat in the corner,
Saw their eyes gaze just past me as I started to cry.

Important people surely with lives to be saved,
lab test and requisitions and orders for meds.
Yet I sat there invisible in my transparent box,
Did they realize my baby was in one of their beds?

Oh sure, one kind-of smiled and one sort-of nodded,
hurrying past the hallway where I waited in fear.
Stethoscopes swinging and lab coats like badges;
They can deal with diagnoses but were blind to my tears.

So I sat clutching my shoulders, trying in vain
To reassure myself they were wrong, and it’s only a test.
Shivering, shaking, my world falling to pieces
While they bustled on past me doing their best
      To look beyond me in my transparent box
      Where I found no doors, no windows, no locks
      No sympathetic ear to commiserate or heal
      No simple words to confirm what I feel
Just me all alone… in my transparent box.

It just never gets easier. Every situation is different, but every outcome the same.

I hate those stupid surveys that float around email that always ask “Have you ever seen a dead person”

Actually, I have, and I have seen more than I wish. It’s not some thrilling bit of info for an asinine survey. It’s a real event, with real people and real emotions.
You want to know what it’s  REALLY like? Think of this:

The family is sobbing in the hallway while the person to whom you spoke a day ago is now a discarded shell, the actual person having escaped to places Other.

The feeling of shutting off an IV and taking out the IV catheter from a vein that does not have any blood pressure.

The sound of the “death rattle” when the dying person loses their gag reflex.

The feeling of utter helplessness when you know you can’t do anything to make anyone feel better.

The fleeting feeling of fear when you give the dying person just a little more morphine because even though they are non-verbal, they are grimacing, and the hope that you didn’t give enough to kill them but just enough to comfort them. While at the same time the rational thought that even if you DID give them enough to suppress their respirations, your INTENT is to provide pain relief, and therefore you did nothing wrong so you give the morphine.

The sound of the shroud when you unfold it from the bag.

The fear in the families faces when they come to say “I think you’d better come….” and can’t finish the sentence.

The sadness in your own voice when you tell them that you cannot hear their loved one’s heart beat, and that you cannot hear their loved one breathing.

The difficulty in watching other grownups cry.

Having to call a doc and say “I need you to come pronounce my patient”
The heavy feeling of walking into the supply room and getting out the morgue kit.

After all their pain…all their tears….they thank you.  The family who loses a cherished loved one thanks you.

You go home, and hug your children and cuddle up to your spouse, trying not to remember the sounds of grief that echoed down the hallway as you punched out and left work.

One of the first patients I cared for during my first semester of nursing school was Mr B, a nursing home patient with multiple medical issues including ORSA in the secretions from his capped tracheostomy. Because of this, Mr. B was on special precautions, requiring any staff who entered to wear gown, gloves, and faceshield.

I was paired up with another nursing student to care for him, since the staff had noted he was very needy. My classmate and I sat down early in the morning to devise a plan of care. We decided we would ‘cluster’ our activities, not only so as not to tire Mr. B out but also to try to cut down on our visits in and out of the room, and thus decrease our exposure to the ORSA, and consequent risk of spreading it to other residents at the facility..

The first time we went into the room, we brought in towels and washcloths, ready to bathe Mr B and get his dressed. He had an appointment at physical therapy at 11, and given it was 0830, we thought we had plenty of time.

Yeah, right.

First we forgot the soap. Degown, deglove, damask, get the soap, regown, reglove, remask. Next we had to get some extra towels (we were still pretty green at bed baths.) Again, degown, deglove, demask, get the towels, regown, reglove, remask.

We were working on our physical assessment paper, so poor Mr. B patiently sat through a double assessment, as my classmate and I both painstakingly looked him over head to toe, wondering to each other if his capillary return was really <3 and if his skin should be considered pale or pink. Finally, we had him dressed and in a wheelchair, a mask on his face and over his trach, and ready to go to his appointment.

While he was gone, we tidied his room, changed his linens, and worked on our assignment together.

When Mr. B. came back, he didn’t want to eat his lunch. He seemed restless and irritable. And he was on the call light often. I tried answering from the door, but there was often something he needed that I just couldn’t get from the doorway. There were increasing rounds of gowning, gloving and masking for all sorts of things. He dropped his remote, he needed a tissue, needed the urinal, needed the pillow adjusted. Finally, I got my instructor and explained to her what was going on, and how I was beginning to think maybe there was something wrong with Mr. B.
My instructor and I went into Mr. B’s room together, and the image of her sitting on the side of the bed with him, her face near his so he could see, and holding his hand is an image that I want to carry forever, as her body language and words conveyed the compassion that all of us as nurses strive for. My instructor held his hand and asked him what was wrong.

“I’m scared.” Mr B said shakily. “I feel like its almost time to die.”
:”You are scared that you are dying, Mr. B?” My instructor reflected back.
He nodded. “Is there anything I can do to help you?” She asked.
“Just don’t leave me alone,” he said.

My instructor pulled me aside and said that for the rest of the day, I was excused from any duties but staying to care for Mr. B one on one. Together we checked his vital signs, which had been and continued to be stable, and we got him up out of bed and into his chair. I sat next to him and we watched television.I don’t think I’ll ever forget the show; it was a documentary on the History channel of the history of salt mines.
Mt. B seemed a little calmer. He began to tell me about his ‘lady friend’ who was expected later in the afternoon. He told me that they used to dance together “before I got too weak.” I remember how he lit up and smiled when he talked of her and how the two of them could cut a rug in the old days. Unfortunately, after only a half hour, Mr. B began to become agitated again. “I want to go back to bed now,” he finally told me. I went to the door and tried to get someone’s attention, but it seemed that all the nurses and aides managed to look away just as I tried to catch their eyes. I began to see how frustrating it must have been for Mr. B, alone in the room, having to rely on other people to come in all the time, and all the layers of protective clothing between him and simple human touch.

Finally, my classmate came by and helped me get Mr B back into bed. He seemed calmer, and after telling my classmate about the upcoming visit from his ‘lady friend’, he drifted off to sleep.

Soon my clinical day was over, and my classmate and I stayed a little late to work on our assessment paper together. Our instructor stayed with us, and we discussed Mr. B’s care, and the fears he verbalized. He had stayed clinically stable the entire day, with no obvious physical distress. His mental distress, we theorized, was from being alone so much of the time, and that our therapeutic presence had seemed to calm him. We stayed almost an hour late, leaving finally around 2pm.

Two days later, before school, I saw Mr. B’s obituary in the morning paper. His date of death was the same day that we had cared for him at the nursing home. 
Upset, I went to my instructor, who told me that Mr. B had died peacefully in his sleep within 15 minutes of us leaving that day. I remember feeling sad that he had passed, and then glad that perhaps I had made some bit of small difference during his last day on earth. I can only hope that that he and his lady friend are still up in the stars somewhere, dancing on moonbeams and cutting a fine rug.

I have a patient who went on hospice care a few days ago. She appears fine. She is not fine. And she knows it. She is just waiting in a small hospital room watching reruns of CSI and whatever junk they have on TV these days, making herself happy in small ways with the food she can tolerate, complaining about things that she can control when she feels overwhelmed by the things she can’t.

Oh my God, how humbling. What would I do in that position?
What would you do?

Imagine this. You are sick but trying so very hard to beat it. You go to the hospital for a stomach ache. You are told that you have an intestinal blockage and it’s a tumor recurrence. Furthermore, there is nothing more they can do.”I’m sorry, there is nothing more I can do. I can make you comfortable, and keep your pain to a minimum…but there is nothing medically I can do to stop the progression of your disease. You most likely have about 2 weeks left.”

Oh my god. What if that were you? What if you only had two freaking weeks left and you are too sick to go home, too sick to do much, but well enough to be aware and to understand. Well enough to realize “Damn. The writer’s strike doesn’t matter to me because I am not going to be around to see the new episodes of The Office. Christmas ads mean nothing to me because I won’t be home for Christmas this year. I won’t see my cat or dog again. Ever.” It just goes on. No more summer corn on the cob. No more Valentine’s day candy. No more fireworks. You don’t need to worry about taking next year’s summer clothes out of storage and trying them on to see if they still fit.You can cancel your dental checkup and your next haircut. Any appointments you have…you aren’t keeping them.All of life’s special things, and all of life’s mundane things will continue on, but they will continue on without you. You won’t be there.

How would you feel? How would you handle it? You can talk, eat, drink, and have minimal pain. You are tired but not exhausted. You are alert, you are in your right mind, but within 2 weeks - FOURTEEN DAYS - You will become progressively more and more ill. Then you will die.Nothing we can do about it…. Would you cry? Complain? Retreat inward? Would you change anything? Would you mend relationships? Would you rebuild bridges knowing that your particular bridge is going into the great beyond? Would you confess your love for someone whom you’ve never told? Would you confess your hate for someone whom you’ve never told?

Put yourself there. It’s a scary place.

You really can tell infection by smell.
You can also tell impending death by smell.
Little old ladies can poop more than your average quarterback.
Little old men can have ‘innies’
The average man is NOT 7″ long
If someone says that they think they are dying—BELIEVE THEM
If you don’t clamp off your IV catheter before you attach the clave, you will see an amazing arc of blood.
Urine comes in many fascinating colors.
So does poop.