I’m not sure how I learned to walk swiftly and without sound. I supposed it came from an unconscious drive to avoid waking patients, lest rousing them created more work for me in the dead of the night.
Sister Sweeney told me to take Mr Denmeade’s observations for midnight. Mr Denmeade had been badly burned as the result of smoking in his bed in the nursing home. He was an old man who had been allocated to a single room requiring a certain degree of privacy to ensure his dignity when receiving nursing care. He had a chest infection and we were providing nursing care to minimise his symptoms and to enable him to enjoy the greatest degree of physical comfort possible. As a nursing student newly appointed to the second year of training, I did not think about this man’s future, just his present needs.
The evening handover described him as having all the armor of a person battling life in a hospital. It didn’t occur to me that he was dying. I thought of him as needing his airways maintained, being adequately hydrated, receiving pressure care, personal hygiene and kindness. This is what I had been taught and trained to do. This is what I assumed I would have to do for him on my shift throughout the night.
On entering Mr Denmeade’s room, I found he had nasal prongs delivering continuous oxygen to assist his feeble attempts at breathing; he had intravenous fluids running with a chamber containing an antibiotic solution to combat his chest infection and he had been deftly placed on his side by the nurses on evening duty. He had a uridome around his penis to drain his incontinent urine away. He was lying on a lamb’s wool rug and he had lamb’s wool booties on his feet to guard his heels against pressure areas. He smelled strongly of the barrier cream we used to stimulate his circulation by rubbing areas pressured by his dormancy for those periods of time in between being turned. This was all familiar nursing practice to me, but the sound of his breathing made me uncomfortable; he breathed in a funny way that I had never heard before. I wasn’t sure of the correct term, but it was a gurgling sound. It sounded like he was trying to breathe while underwater.
The room felt eerie, it was dark, my legs felt heavy and I was scared. I didn’t want to be in that room by myself with this gurgly sounding man. I had a severe case of the midnight jitters. I tried to distract myself. I turned my back and concentrated on setting up my blood pressure machine.
I remember thinking “s – p – h – y – g – m – o – m – a – n – o – m – e – t – e – r”. That was the first time I could spell sphygmomanometer correctly, but I gained nothing by this correct spelling tonight. The spelling distracted me mentally from this difficult and unfamiliar situation but I still had to take his blood pressure. I was ready to measure it, I had my apparatus ready. My stethoscope was draped around my neck, heralding me as a professional. I gently and respectfully lifted his arm, just a little, and placed the device around his ….. “humerus, I think it’s called, but this is not the funny kind of humorous, this is an old sick man’s humerus”. My mind was in an emotional flurry. I wanted to get his blood pressure and get out of his gloomy cave. As I applied the cuff around his upper arms our eyes met for a moment. I’m not sure who was experiencing the terror and who was doing the reassuring, but I think we both respected each others’ personal difficulties in that moment.
His gurgling slowed and he looked at me. I couldn’t think of any words to say to him, so I just touched him. Then he breathed out, he slowly expired. He lay there, with eyes staring vacantly, no longer looking at me, but through me. There was no more gurgling, no more breath. He was gone. I had witnessed a soul leaving a body just after midnight on that winter’s night on my own and when I was only 19 years of age.
All my peers had seen a dead body at least once; some had seen many. Some even bragged about their experiences but I didn’t envy them. I had managed to avoid seeing a dead body for the first two years of my nursing experience. Why I had not yet seen a dead body perplexed me, but I was not unhappy with the absence of death in my nursing career to date. Death was (and still is) a disgusting and unacceptable mystery to me. Whenever I came across a patient whom I had been told was in the process of dying, or who seemed to be struggling with the basic functions of staying alive, I leapt to my nursing best. I took pride in providing physical comfort for them and I would brighten their spirits with lighthearted chatter if they seemed preoccupied or down. Patients responded readily to my efforts to connect with them. No one seemed to die on my shift. I sometimes wondered if the care I gave to my patients extended their inevitable passing to someone else’s shift!!
As I placed Mr Denmeade’s arm back to the side of his body, it was as though I was watching myself from outside of myself. I did not really want to be in this situation. My mind was numb, and I attributed this to working irregular and odd hours. People had told me this did funny things to the body, so it seemed only natural to me that funny things happened to the mind as well.
I walked stealthily away from the room. My footsteps were automatic; my feet moved with muffled precision towards Sister Sweeney. Deep, deep down, I was screaming, trembling and unprepared to deal with the situation I had just come across. I had to think about how to hand over this task to her. There was only the two of us on duty, and one of us had to take charge of this clinical dilemma.
I approached her as she was moving from patient to patient, measuring volumes of intravenous fluid left at midnight and emptying catheter bags in preparation for the daily fluid balance chart calculation. I whispered to her, “Sister Sweeney, Mr Denmeade is resisting me taking his blood pressure. I think he needs a more experienced person to persuade him. If you do his blood pressure, I’ll empty the catheter bags.”