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There are very few experiences as unique, distressing and intimate for a nurse as entering a stranger in the middle of the night and watching him die.
There is no palliative care center where I am based in a rural area of northern Scotland. For people diagnosed with incurable and progressive diseases such as cancer or heart failure, a health professional will offer them a preferred place of death. It is a difficult choice: a bed at the local community hospital (if available) or die at home.
For most of the farm families I visit, it's an easy decision. "They will have to carry me here in a box" is a familiar refrain. Farms have been handed down from generation to generation and with them, a lifestyle that encompbades everything until the end.
I have already been called to visit a terminally ill elderly woman with her illness. Barely conscious in the bed, she no longer had the strength to stand up, though the agitation in her face and limbs indicated that she had not stopped going to bed. try. "Can you believe she was in the yard counting the cows this morning?" Asked his daughter in amazement. "And complain because I brought her back inside."
Earlier in the afternoon, the district nurse had inserted a tube into the bladder to allow the urine to drain. He had fallen and a new one was required. "Did she remove it?" I asked, wincing at the sight of the intact balloon that should have been sitting on the bladder neck, and contemplating the potential journey that was going on. he had gone from there to freedom. "Oh no, he just fell," said the girl over her shoulder as she continued to wash the dishes. "She had so many children that I would be surprised if something stays there- high a long time. "
The farms are often huge stone buildings surrounded by fields and tarmac tracks, impossible to find by satnav, extinct and barely perceptible in the middle of the night. They are placed very high on so steep hills that in case of bad weather, you lose the professional calm which prevailed when you get off the car and you find yourself sliding back on the slope, the feet unable to hold, to beat like a cartoon.
The people who live there are tough, mixed up in work and weather, with rare stoicism.
I work at night. In the wee hours, driving in the countryside can be spectacular. Mine is the only vehicle on the road, round deer surprised by lighthouses or slowing badgers and pheasants in panic. At the height of the summer, the light barely dimmed at night and, once or twice, I was caught unawares under a meteorite shower, the vast clear night sky cleared for a moment.
Pain is a big potential problem during the process of death – for both the patient and his family. Sometimes I feel totally inadequate by opening the so-called "case-by-case" box and looking at the handful of vials that I can administer to relieve pain, agitation, or nausea.
My colleague likes to tell the story of a patient whose unresolved abdominal pain was a huge problem at the approach of death, and the eventual solution that became like the Holy Grail among practitioners. It finally happened that the nurse had a conversation with the elderly patient who told her that as a proud woman, she did not want anyone to see her without her denture.
The thing she feared the most about the death was that someone removed her teeth after the event and was powerless to stop them. At the moment the nurse rebadures her, she makes sure that the teeth remain intact, the woman's pain, incurable by morphine and any amount of auxiliary treatment, will simply be dissolved. She had a peaceful death.
The dead I see are rarely about a person who dies. Family and loved ones are part of the experience, just like our nurses. The path to death can be difficult to navigate. Sometimes it is not peaceful and we can not solve the pain or agitation. "They are going to have to take me out of here in a box" seems easy when you observe a patient or a loved one unable to express his experience and turning and turning around relentlessly for hours, making us all onlookers who can only guess what they might need. But it's also a truly human experience, to which all our lives lead – and for me as a nurse, as humble as this meteor shower.
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