I believe almost every nurse can remember their “first”.  By that I mean the first patient that they watched die.  

My “first” was literally a bloody mess, a 54-year-old man with end stage liver disease; I was working the night shift. The patient had no family to speak of and a no resuscitation order (DNR) in the chart.  As I walked through his doorway I could smell the coppery metallic smell of blood and hear his congested breathing.  He had dried blood caked on his tongue and lips, on his nose, on his hands from where he would touch his face and he had soiled the bed.  Blood can’t clot normally in end stage liver failure and patients tend to bleed very easily.  As I got closer, I could see fear in his eyes.  He was mumbling and inconsolable and I recognized the look of fear on his face.

After I checked my other patients I came back to begin his evening bath.  I washed the caked blood out of his hair and the folds of his ears, then his forehead and eyes, his cheeks and his dry lips, taking care not to disturb any small clots or they could start to bleed all over again.  I used the green spongy swabs soaked in cool water to brush the dried blood off his tongue and between his gums and his cheeks.  He started to calm down and stopped wiggling in the bed.  I washed his bony body and gently washed his swollen tight belly and lastly, cleaned the stool from under his bottom.  To get through these experiences, I think if this were my family member, I would want someone to care for them with respect; that is how I learned to cope with patients like this man, I treat them as if they were one of my loved ones.  

Somewhere around 3 o’clock in the morning, I could see him take a turn for the worse.  His breathing was shallow instead of labored.  I had never watched a patient die; just waiting for death to come.  I have to admit I was afraid and asked one of my coworkers for moral support.  Laura came in and confirmed he was actively dying.  She stayed there with me.  His mouth looked like he was gasping for breath but he really wasn’t moving any air and all of a sudden it just stopped.  He stopped breathing.  And you know what?  He finally looked like he was at peace.  The last breath had left his body and I was there holding his hand so he wouldn’t be alone, and I dropped my head down and shed a few tears.  My mind went to “Eternal rest grant unto you and let perpetual light shine upon you”, a jumbled bit of a prayer I vaguely remembered from family funerals.  When I looked up at Laura, still holding his other hand on the other side of the bed, she had tears coming out of her eyes too.  She said it had been a long time since she saw a nurse cry at the death of a patient.  She told me I would have to learn my own way to cope with death, because if I didn’t, I wouldn’t be able to do this job for long.  

I ran a heart rhythm strip from the monitor to show no heartbeat and document the time of death; turned off the heart monitor and IV fluids; removed the feeding tube and IV; and checked to make sure the ID band and belongings were with the body before we placed it in the plastic shroud and then zipped it closed.  The attending physician had been notified, the funeral home was called and the nursing supervisor was updated.  That was it.

I still remember him from time to time and the scary first impression I had, the support from Laura, the way I washed this man and the way I felt my heart working through my hands.  That was it; my heart working through my hands, realizing my healing touch, compassion, and my calling; my “first”.

“I will never forget the moment your heart stopped and mine kept beating.”
– Angela Miller

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