I'll see you in heaven

I just read ER Nurse K's post here, and it reminded me of a similar story about one of my patients. Stuff like this is what you cannot anticipate about being a nurse---the gut-punching horrific emotional situations you find yourself right in the middle of. My patient was an elderly man who had a known diagnosis of some kind of cancer (it's been awhile). He had abdominal pain that couldn't wait until morning and called an ambulance. We did the abdominal pain workup and discovered a giant mass bleeding into his GI tract; there was nothing to be done about it, and he was a DNR anyway. I stood there while the ED physician told him about the mass and said that unfortunately he would most likely die within the next few hours from internal bleeding.

This is news that would make me shriek and bang my head against the wall, but, as most dying patients do, he took the news calmly and asked for a phone. He had two children, one of whom he lived with, but this daughter was on a business trip; the other sibling lived across the country. The first one he reached immediately and she was grounded at the airport because of a blizzard. The other one we never did reach (never leave your cell phone off if you have a sick parent, people). The blizzard daughter was frantic. This is the kind of soul-sucking bad luck that just makes you rail against fate. Had this mass decided to bleed 24 hours in either direction, my patient would have had a family member with him. But it didn't.

He was losing strength quickly so I called the blizzard daughter on speaker phone and retreated to the hallway. It is intriguing to hear people's last words. They range from "don't forget to take care of the dog" to "I've loved you since the day I saw you in 1925." This was one of the more poignant conversations. The daughter said, "You have been a good dad to me since the day I was born, and I love you very much." (What more could a parent want to hear?) My patient said, "You've been a good daughter and I love you too. Please tell [other sibling] the same and I don't blame him for not being awake. God has a plan." [Crying on both ends.] Blizzard patient said, "I don't know what else to say, but I'll see you in heaven." My patient said, "Count on it. You. Me. Heaven," and signaled he was through. I hung up the phone for him and he died.

This kind of thing really takes it out of you.