Death.

On our last day of clinical, my instructor called me out in the hallway. She said, “Cee, come over here and stand with me outside this patient’s room.” As I walked apprehensively toward her, she spoke once again, “The door is open and I want you to look inside. Tell me what you see with the patient. Think out loud for me.”

I saw an old lady, grey haired, small in stature, sitting up on the bed, using her left elbow for support. “She’s breathing through her mouth,” I told her.

My instructor nodded, a gleam in her eyes. Knowing I said what she had hoped I noticed, I continued, “You can see clearly her chest is rising up and down.”

“And she’s sitting up on the bed,” my instructor replied.

I looked at the patient again, “Leaning forward.” Right then, a realization struck me and with an alarm look I turned to my instructor, “She’s having trouble breathing. She can’t breathe.”

Instructor smiled and nodded, calmly she pulled me away from the room. “Let’s go see what we can find about her,” she said. Off we went to the nurse’s station to find the patient’s chart and the nurses taking care of her. In the meanwhile, my mind raced with thoughts of why we aren’t helping her and where was the charge nurse.

I didn’t realize I was fidgeting until my instructor spoke again, this time to the charge nurse, “Cee here noticed that your patient in room 10 can’t breathe.” There was that glint again in her eyes when she informed the charge nurse, “We were standing in front of the room, and she saw that the patient has trouble breathing.”

The charge nurse smiled, and my brows furrowed, there wasn’t anything to be smiled about in this situation, so I thought.

“She has a long history of COPD and a primary lung cancer that has metastasized. Her heart is not pumping properly. She’s having fibrillation and flutter,” the charged nurse informed me.

“Oh…,” I uttered, taken aback by the sheer reality of the patient’s condition.

The charge nurse pointed to a group of physicians gathering a few feet away from us, “See that, they’re deciding what to do for her. If we intubate her, she may never wake up. If we don’t, she’s not going to make it past 24-48 hours from now. If her family agrees, we will take comfort measures and let her pass.”

“Wow…,” I whispered sadly.

“But you noticed,” my instructor told me, “You noticed that she’s having problem breathing. Not a lot of nurses will.”

“But it was obvious…,” I disagreed.

My instructor shook her head, “You’d be surprised at how many don’t see it. But you did, and there is a lot you can do even though her condition is terminal. You know she won’t tolerate any activity, you know not to have her do any activity because anything can break her.”

“I guess,” I said, accepting her input.

“You see here?” The charge nurse brought the chart over, “Someone wrote for a PT consult for her, do you think it would be a good idea?”

“No,” I replied. “She can’t tolerate any activity and it may…kill her.”

Both my instructor and charge nurse smiled again, “You got it. You’re right.”

With that, the charge nurse left, my instructor did too, “You did good, I’m proud of you.”

I stood there, trying to figure out what was that for, and to be honest, I was quite resentful to my instructor for doing that to me because I felt like I didn’t need to know of a patient that wasn’t mine was dying and I had the image of that patient’s trying to breathe in my head. I had a lot on my plate from school already, and I’m drained, and I just felt I don’t need to have this reminder that I just saw an old lady who wouldn’t be alive in the next 2 days. I still can’t get the image of that day out of my head, I still think of what happened to her, and how her family is dealing with her death.

I know that one day I will witness my own patient’s death. It is inevitable with the career I’ve chosen, but I’m not ready for that yet, even when it wasn’t directly my patient. I still want to see life in everyone I come across, not impending death. I’ve seen death, I saw a dead 24 weeks fetus, and though I still can’t forget that image, I didn’t know anything about it. I saw it in the hall, heard the story from the nurses who were taking care of it, and that was it. I didn’t see the mother, I didn’t see it delivered, and I had no previous contact.

I guess it’s just still weird for me to see that lady that day and to see her struggling for one more breath, knowing that it was more or less futile and wondering two days later if she was still alive or not. Hopefully, as I go further in this career I’ll find a better way to deal with death and to not let it affect me.