I have a large amount of sadness in my heart right now.
This job of mine, it can be so fucking intense. Of course I knew it when I chose to be a hospice nurse, and my skin has been relatively thick for most of patients' passings. But today I feel depleted and tired.
I've been very close to this one patient. She was only 44 and she had ovarian cancer. With her, there were tons of nursing tasks that needed to be done, like continuous infusions pumps and home paracentesis and an absolute ton of medicine management. So my point is, we've spent a LOT of time together. She was really just so loveable, and I know she loved me. She called me Summer Wummer whenever I came over. She bought me my own chest of drawers so I could organize all of my medical equipment. She was so kind. I became really close with her and her entire family.
She had tumors that literally looked like fists protruding out of her abdomen. Literally. It often reminded me of spaceballs when at the end the alien climbed out of that guy's stomach (I never told her that). She had intense pain that just got worse and worse. Yet she was such a fighter. She never wanted to admit that she was dying...never. When I told her last week that she was going into kidney failure I felt like I burst her hope. It was a terrible conversation but when I look back, one that needed to happen and I said it as kindly and gently as I could. She was in kidney failure. Those conversations are one of the more challenging aspects of this job.
When I arrived on Monday morning something had shifted. She was in agonizing pain. She was crying and had a sheet over her eyes because the pain was so bad. As a hospice nurse this is exactly what I NEVER want to see. We have tools for that shit. How had it gotten so bad? So I worked my butt off in there. We had her on medications that would have killed 10 elephants. We got it relatively controlled, but on this day she knew she was dying. At one point she was sitting on the edge of her bed and I was standing next to her. She leaned into me, so sweetly, so tenderly, and said "Summer, I can't fight anymore."
I literally sat at her bedside for 8 hours on Monday and 11 hours yesterday, keeping her medicated, doing everything in my power to manage her symptoms. It was shocking the amount of medicines that she required, and any ICU or ER nurse would be surprised that I was administering them in the home setting. And that her pain was still not fully managed!
This patient had terminal agitation, and I knew she was going to get it all along and really geared up her family for what that would look like. But still, you're never really ready for terminal agitation (when the patient is restless and agitated and appears so uncomfortable). As a nurse it broke my heart. I loved this patient and no amount of medicine that I gave her seemed to do the trick. Last night she was finally sedated enough to be calm, but at 5 this morning the agitation started again. I got there at 9am and tried everything I could think of to keep her comfortable, and I was working with some big guns. Oh how she struggled. Her breathing became gurgle-y (death rattle), her legs were mottled and cold, and she would flail her arms around like she was trying to get out of bed. And then, around 1045am today the room changed. She became calm. Her breathing sounded better. Myself, her mother and her sister were all at her bedside. At 11am she took her last breath. When I said "I'm so sorry, she's gone now" her mother looked at me with the most frightful eyes and starting bawling hysterically. The world lost this really wonderful woman.
As the nurse I had to be as professional as I could. But I couldn't contain the tears that fell from eyes this morning. This patient had become such a part of my weekly routine, of my life. So I let them flow, briefly, and behind bathroom doors. Then I had to get to work: calling the coroner, mortuary, cleaning her body, all that stuff. It was hard, because what I really wanted to do was curl up on the couch and cry. She really got past that clinical boundary of mine, big time. Man I miss her so much.
Cancer is a terrible, horrible, good for nothing fuckhead of a disease.