Goodbyes

I walked into her room and almost cried at the sight of her. She had been my patient a number of times in the past two years. Over that time she changed, I changed, we got to know each other a little more with each visit. She had become emaciated since the last time she was here. Her cheeks were sucked in, the petechia present on her cheeks was spiderwebbing down into her neck. Her body, once full and plump, was now just a sack. Her bones were sticking out in odd angles. I turned her to the other side when I assessed her, not knowing how long she had been laying on her left. The redness to her ribs was plain to see, non-blanching. The pressure ulcers were present on every prominance, the one on her coccyx looked especially angry - there were discussions that it was a possible Kennedy ulcer...

I looked through the MDs notes and saw that she was on comfort care - minimal position changes. Crap. I can see why though, she was in so much pain with movement, despite the continuous infusion of morphine. I gave her some more morphine prior to turnings to help ease some of the pain, with only minimal success.

I entered her room every hour, would touch her head, let her know I was there. She was never verbal, she opened her eyes a little when I talked her, but not for long. Once she was settled in, she would quickly relax back into sleep.

I left for lunch, came back then had someone help me change her position. That was at 1:30. She opened her eyes and looked into mine. I touched her forehead and told her it was okay, I was there with her. When I looked in her room 15 minutes later, she was gone. Making that phone call is difficult, I always feel inadequate when I deliver the news.

There is something very touching about post-mortem care. I like to wash my patients with warm water and place fresh gowns on them, even if I am the only one that will see them. It's my time to grieve for them, to say my goodbyes, to tell them I have been honored to care for them.

Death doesn't get easier.