Story of Sarah

Submitted by Karla Scholl MSN RN

Tags: death dying emotions end of life nursing students

Story of Sarah

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Nursing is a unique professional where one individual has the ability to make a significant impact on the life of another.  Utilizing their knowledge, skills, compassion and ability to provide support to patients and families during the dying process, nurses make a difference and change lives.  But sometimes, not only will the lives of the patient and families be changed, but so to the life of the nurse. This was such the case with a nursing student named Sarah.

Sarah is a senior in a Midwestern baccalaureate nursing program.  In her medical surgical rotation, she had been assigned to care for a middle aged male who had previously been diagnosed with a progressive incurable disease. His admission several days prior was due to complications from this disease process. The physician’s goal was to stabilize the client and return him home with his wife.

The first day Sarah cared for this gentleman, he alternated between periods of confusion and lucidity. When alert, he and his wife chatted easily about their lives together, including Sarah in their conversations.  Stories were told and laughter was shared.  But these periods of alertness decreased as the day progressed. When the client would slip into a confused incoherent state, Sarah and the wife continued to visit while Sarah provided cares. A strong bond developed between the two women by the time Sarah left for the day. Telling the patient and wife she would return the following day, Sarah, hugged by the wife, was thanked for the wonderful care provided to both of them that day.

In the early hours of day two, the patient’s condition began to deteriorate.  As Sarah arrived on the floor to start her day, she was shocked to see how dramatically her patient’s condition had worsened. The physician, having been called, waited at the bedside for the patient’s wife to arrive. When the wife arrived, Sarah noted she was alone. The physician, concerned about the patient’s condition, inquired about the client’s wishes regarding end of life. Having never considered this hospitalization being her husband’s last, the wife shared that neither one of them had previously discussed his wishes.  Sarah watched as the physician explained that very soon the patient was going to require life saving measures including intubation and ventilation. He went on explain that due to patient’s incoherent and lethargic mental state, the wife would need to determine what avenue of care should be pursued. Did she want tubes and machines or did she want to let “nature take its course?” Overwhelmed by the physical change of her husband and the significance of the decisions placed before her, the wife turned to Sarah and asked: “What should I do?”  Sarah recalled the day previously while visiting with the wife as the patient slept, the wife had stated: “Whatever happens, I just want him to be comfortable.”  Sarah shared this recollection with the wife who slowly shook her head in acknowledgment.  After several minutes, the wife looked the physician and said: “Just keep him comfortable.  I know he would not want to live on machines.” 

Sarah, having never been in a position to witness a loved one making a decision regarding life or death, was profoundly touched as she recognized the anguish and pain radiating from the wife’s face.  She realized the magnitude and the weight of the decision that had been placed on the wife’s shoulders. So moved by this realization, Sarah was brought to tears.  Knowing she had started to cry, she quickly left the room, seeking out her instructor.  “I can’t do this!! I can’t be in there!  It’s so sad and I will cry the whole time!” Sarah exclaimed. 

While being encouraged to express her feelings, Sarah said: “I feel so vulnerable!  It’s going to be so sad today. I am going to be crying all day!”  It was stressed to Sarah that the bond that had developed between her and the wife was very special and that she was in a position to provide comfort and relieve pain for the dying patient as well as provide emotional support to the wife with her compassion and empathy. She was in a position to lessen the wife’s sorrow. Sarah slowly shook her head and said: “Yes, I need to be there for her” and returned to the patient’s room.

As the day progressed, death became imminent. Questions such as: “What will death look like?” and “How will I know it is near?” were asked by the crying wife. Through tears of her own, Sarah answered each question with honesty. Later in the day, with Sarah at her side, the wife watched as her husband took his last breath.  

In the debriefing session with her instructor, Sarah commented how much this experience would change her as a nurse and as a person. “This will forever be a patient and wife I will never forget and someone I think of when I am caring for dying patients and their families.”  She went on to say that feeling emotionally vulnerable was a side of nursing she had never experienced in her young career. But by acknowledging and facing that feeling, she recognized that her feelings weren’t important: it was the patient and families feelings that mattered.  This recognition allowed her to focus on who needed her.  After sitting quietly for several minutes, Sarah looked up and with tears in her eyes quietly said: “Being present for my patient’s death was an honor.”

Nurses can be forever changed when they chose to be available to these clients and their families who are struggling through the dying process. Sarah was an excellent example of this. Putting her own fears and vulnerability aside, Sarah was able to put another person’s feelings before her own. She wanted to care for her client and wife not because it was expected of her, but because “it was an honor.”  This demonstrates the true essence of nursing.  We can all take lessons from Sarah.  For our patients and families, being “present” is the best gift we can give.