Tuesday, June 24, 2014

Dying with dignity.

A Nurses Story.

A funny thing happens to most healthcare professionals the more they work in a hospital: they become so concerned with saving lives that they have no idea how to deal with death. Doctors can be the worst culprits of all, experts at ordering blood tests, monitoring vital signs, analyzing x-rays and ct-scans, they forget that dealing with death is just as important as nurturing life. With all the controversy surrounding the legalization of euthanasia in Quebec, with a great many dying patients not even having access to palliative care, it is about time we as healthcare professionals come up with a solution on how to provide a patient with a dignified death, with or without euthanasia, which oddly enough, seems to come down to simply being humane.
Two years ago, a day before she died, she danced and had a party in her room without the prying eyes of physicians or monitors, but instead, with her family and friends. Her 17 year old body, beaten down by a devastating cancer, still worked well enough for her to laugh and raise her arms in the air as the record player her dad brought in played music from the 80's. I dared not enter the room but my heart melted when I heard her laugh just a few hours before she would fall asleep and not wake up. A few days prior to that, I was reluctantly inserting an intravenous catheter into her hand as she needed a constant drip of narcotics to control the stubborn pain in her body. I can remember being afraid I would not be able to find a vein in her already swollen hand, but did not show it. Instead I cracked a joke with her mom which made the both of them laugh as luckily, I was able to thread the catheter on the first attempt. 

I had been their primary nurse for some time, maybe weeks, and it was as though they trusted me because as they said "you always tell us the truth". They wanted to know how she would die, just as she did, so I told them. They wanted to know how I would handle her body and where she would go when it was over, so I told them. They wanted to know how I would know when or when not to give extra doses of narcotics if she began to get uncomfortable, meaning they did not want me to give too much. I said it would be a choice based not solely on my opinion but on theirs as well and they agreed. Together, we watched as she passed away while her body, even as she slept, fought instinctively for every breath it could. We all agreed on every dose of morphine and we all agreed that she wasn't in pain when she died. It was very, very hard to watch but during each breath, her family shared stories about her with me that I will never forget. They said her wish was to never be forgotten and my colleagues and I still think about her to this day.
A few weeks after she died, I received a heartfelt thank-you note from her family saying my colleagues and I had done a remarkable job and that they felt she died with dignity. At that time, I had no training in palliative care and had never experienced death that closely. Looking back on it now, all I tried to do was to treat my patient with humanity and respect with an understanding of who she was and what she stood for, so did my colleagues. We tried to be honest with her family and spoke to them as people not as patients and in turn, they showed us that by simply being humane to one another, we as a people, can get through anything and that is a message we hold dear.

My patient did not die in a palliative care facility, but on a surgical ward. There were no doctors there when she died, just her nurse. This leads to some very serious questions: Is euthanasia really necessary or should nurses be liberated to do what comes from their hearts? Usually, nurses who have dying patients as part of their assignments, have other patients to look after as well. I did not, why? Why don't more nursing supervisors think like mine does and realize that dying is as important as living?

Nathan Friedland, (nurse)
Quebec Canada


Winston said...

Alex, how can I possibly trust a doctor or a nurse who refuses to give me enough morphine, even if it kills me?

Alex Schadenberg said...


Re-read the article.

They wanted enough analgesic to keep her comfortable, but the patient didn't want to die from it.

Further to it, notice how the nurse cared for his patient.

Your tunnel vision on dying let you miss the real message.

Winston said...

Do you see a difference between sedating someone into a coma until they die "naturally," and a quick death, Alex?

Because if you do, then you need to rethink your moral paradigm.