A Night In The Dark

how to comfort a dying patient
“Have you ever thought about dying?” she asked so softly I could barely hear her. “I mean what it’ll be like, if it will hurt, is there really anything after?
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 “Who’s there?”

The tiny woman raised her head from the pillow and tried to see who was creeping into her darkened room. I reached out and flipped the switch for the night light so she could see my nurse’s aide uniform.

“It’s just me making first rounds Mrs. Greer.” I checked the daily tally on her intake and output sheet, the level in her I.V. and the drainage in her Foley, all in one practiced glance. Everything was normal for her situation. Good, I thought. Grab a temp and blood pressure and I’m one patient closer to a cigarette and a Coke. “Do you need anything?”

She sat up in the bed, brushing a strand of gray hair from her eyes. “I guess I don’t need anything right now. What time is it?” 

I checked my watch in the dim light. “It’s ten after midnight. Sorry I’m a little late tonight.  Second shift was pretty busy and Connie didn’t give me my patient rundown till 11:30.” Smiling apologetically, I busied myself with pulling the extra blanket around her feet and smoothing the covers. “Would you like a sleeping pill or a pain shot? I think you have orders for both.”

“No, thank you dear.” She waved a thin hand at me gently. “I believe I’ll just lay here and think for awhile. I think better at night.” She smiled. “No distractions.”

I pulled out my pen and note card. “Tell you what. Let me get your vital signs real quick and I’ll go away and let you think.” She obediently began rolling up her sleeve so I could wrap the blood pressure cuff around her arm. “Did you have any visitors today?”

“No visitors, but my daughter called. I got to talk to my grandson for a few minutes. He just turned six and he’s so precious.” 

I smiled again.  “I’ll bet he is. O.K., can you hold still for just a minute for me?” I hooked my stethoscope in my ears and gave her my best reassuring smile. Second shift had reported her pressure was down in spite of her medications, so I took it twice to be sure. It was still low.  I made note of it on my card.

“She has a job, you know. She has a job and a family and she’s a very busy person right now. She comes up when she can, but….”

I nodded and motioned her to be quiet so I could count her pulse. She sat quietly staring over my left shoulder as I felt her heart beating through the thin skin of her wrist. It was steady, but I thought it was a little weaker than it had been last night. I made another note. She began talking again as soon as I dropped her wrist.

“She sends flowers nearly every day, my daughter.” She gestured towards the window ledge, crowed with bouquets and potted plants. “And sometimes, if she gets a chance she calls me on her lunch hour. She’s a busy woman.”

“She sounds like a busy woman alright. Let me get your temp right quick and then I’ll be out of your hair.” As I waited on the thermometer to beep, I tried to remember how much change was in my pocket. Was there enough to get a Coke out of the machine at the end of the hall now, or would I have to go back to my locker and get some more?

The thermometer beeped and I smiled. “Your temp is normal.” I announced, glad to finally have something good to report. I gathered my things and stood with one hand on the night light switch. “Do you want this on or off?’

“It doesn’t matter. Off I guess.” I flipped the switch but before I could say goodnight, she spoke again. “Do you have a minute? I glanced at my watch. My Coke would have to wait. When a patient wanted to talk at night, it was usually to tell a good joke, repeat some hospital gossip, or maybe complain about the food. Whatever it was, it usually didn’t take very long.

I put on my best smile and sat down on the bed. “Sure, I can sit with you for a minute or two.  What’s going on?”

The only light in the room came spilling in from the open door and I could hear muted voices coming from the nurses’ station. The smell of too many flowers in a small room was becoming overpowering. She obviously had something to say, but was having trouble finding the words. I sat on the edge of the bed and patted her bony hand. She pulled a tissue from her sleeve and wiped her mouth, then spoke softly into the dark. “You know my doctor came in today.” She watched her hands shred the tissue into her lap.

I waited for her to say more, but she wanted to me respond first. “I know he was here, but I haven’t looked at your chart yet.” I didn’t have to look, second shift had clued me in and I was getting a bad feeling about where this was going.

 She took a trembling breath. “He said the cancer has progressed faster than they expected. I have about a month left.” Again, she waited for my response.

Nothing in my training had prepared me to talk to people about their own final journey. My job was to wake someone up to get their vitals or get them some water or another blanket. I only knew of death after the fact, or if it was happening to someone I didn’t know or care about anyway. But I knew Mrs. Greer and I was seriously beginning to regret staying with her in that dark room.

She had finished shredding the tissue and was looking at me expectantly in the gloom. Did she want confirmation or denial from me? What could I possibly say to her? I didn’t know if it would do any good but I reached across the bed and gave her a gentle hug, mindful of fragile old bones.

“Have you ever thought about dying?” she asked so softly I could barely hear her. “I mean what it’ll be like, if it will hurt, is there really anything after?”

I sat back and looked down at her hands floating in a cloud of shredded tissue. As I gathered the shreds together, I still could think of nothing to say.

She grabbed my hands and I felt her trembling. “I’m 84 years old and do you know what they’ll say at my funeral? ‘She was old.  She had a full life.’ Well, I haven’t!” Her voice got louder, stronger as she grew angry. “I’ve never played golf. I’ve never been on an airplane. I’ve never seen the sunrise over the Grand Canyon or felt the ocean wash over my feet.  I spent my whole life right here in this town, raising a family and there are lots of things I’ve never done. She took a deep breath. But I’m old now so nobody will think about all the things I never had a chance to do. They’ll just put up a stone for me and it’ll say ‘She had a full life.’ “

I couldn’t look her in the face. I desperately wanted to be somewhere else, doing something else: getting a glass of juice for someone or emptying a bedpan or listening to the gall bladder in 214 telling dirty jokes, anything but sit here and listen to Mrs. Greer talk about her own death.

She spoke again, quieter now. “My husband died years ago, all my friends are already dead. I have one brother in Arizona, but he’s in a nursing home now and doesn’t even know his own name half the time, lucky man. And my daughter is a very busy person.” she said, bitterly.

I was trying to understand all this when something hot and wet fell on the back of my hand. Oh my God she’s crying, I thought. She’s crying and there isn’t a damn thing I can do for her. Call the nurse, get another blanket, pour her a drink of cold water…?

My own throat started to tighten up. I knew that if I didn’t get out of that room right then, I’d start to cry and that certainly was not how trained hospital staff behaved.

I looked at the flowers on the window ledge, trying to think of a way to comfort Mrs. Greer without getting tangled up in tears. As I watched, a wilted bloom fell silently to the floor. Part of me wanted to somehow revive that flower, to breathe life and beauty back into it so I could put it back on the branch and know it would be there always. Another part of me wondered if housekeeping would sweep it up or would it still be there tomorrow, wilted and ignored. 

Mrs. Greer began to cough, choking on her own tears. As I reached for the box of tissues on the nightstand, I suddenly understood. She didn’t want a blanket or cold water. All she needed was to have somebody listen to her, to understand. She wanted someone to see her, not as Mrs. Greer, the terminal in 251, but as Emily Greer, human being, afraid of dying alone and unmourned. She was tired of playing a role, of being and doing what was expected of her as she had her whole life. Dutiful daughter, good mother, jolly grandmother, uncomplaining patient, she had been all these things and now she was dying. The time for pretense was past. All the extra blankets, and smiles and flowers in the world couldn’t make up for a life not fully lived.

She continued to talk and cry and talk some more and soon I was crying with her. Pulling me to her she hugged me with desperate strength. I could feel her tears coursing down my neck, burning as hotly as my own. When we ran out of tissues, we used the corner of the bed sheet and at some point I was dimly aware of a figure in white softly closing the door to the room.

Eventually she ran out of words. The tsunami of tears that had swept her out to sea brought her back again and she was stronger for the ride. After a while, the cloying scent of stale flowers was replaced by the face powder she used, sweet and gentle and as we sat together, watching the sunrise through the window, Emily smiled.

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