There are Things Worse Than Dying
On a 75-degree sunny summer day, I learned that there are things worse than dying. It was my last day of orientation as a Nursing Assistant at the University of Minnesota Medical Center, and there were two things I still needed to cross off on my skills list – remove a foley catheter and deal with a patient’s death. I knew removing a foley catheter would be incredibly awkward, but I would rather extract a plastic tube from a grown man’s urethra over bagging a dead body any damn day. I made it through the first five hours of my eight-hour shift with those two skills still left unchecked. Thank God. I thought maybe it was a good thing that I had made it nine shifts into my orientation without any of my patients dying. But I knew that I was required to get these two skills crossed off before the end of my tenth shift. I needed someone to die.
I have been around death and dying before, but this was the first time I had the responsibility to “deal” with a patient’s death. It was going to be me who would have to remove the IV from the patient’s arm, clean them up, and place them in a thick white plastic bag to be escorted by security down to the basement of the hospital, where the morgue was. My shift ended at 3:30pm, and around 1pm I knew that I had to get things rolling. I headed up to where I knew death was lurking around every corner, the ICU. My landing options were the Cardiovascular ICU, Neurosurgery ICU, and General ICU, each with its own share of traumatic and tragic stories. I started with the Cardiovascular ICU. I was not completely sure how I was going to go about this. Hey, has anyone died yet? Is anyone close? No? Ok. Here’s my pager number, please call me if someone takes a turn for the worse. 2:00 pm rolled around. No bodies needed to be bagged. No catheters needed to be removed. I had ninety minutes left.
I circled the three ICU floors like a vulture. I saw moms, dads, and kids crying in family lounges. This was likely the worst day of their entire lives, and there was I, hoping someone’s loved one would die in the next 90 minutes so I could graduate orientation. At 2:45pm I got a page that I should head back up to the Cardiovascular ICU–someone wasn’t doing so well. I rushed over to the front desk to get a report from the charge nurse. A 53-year-old female with heart failure, on ECMO, a ventilator, and a massive brain bleed. My heart dropped. I remembered this woman. I remembered hearing her story early that morning from another nursing assistant. This woman had had a heart attack while at a family outing, surrounded by her eight children and a plethora of grandchildren. I remembered seeing her family in the lounge, holding each other. Machines were the only thing keeping this woman alive. This can’t be happening. This can’t be the first patient death I have to manage. I walked off the floor to regroup. Maybe I don’t need to get this skill checked off. I already knew how I would theoretically deal with a death, maybe that was good enough in this case.
I walked back into the ICU, taking the long way around to avoid the family lounge. I just wanted to get this over with. I checked back in with the charge nurse.
“Hey, Hannah,” she said. “The family isn’t doing comfort care yet, so I don’t think anything will be changing for the time being. She’ll stay on the ventilator.”
“Sounds good, thank you. I’ll be around till 3:30pm if you need anything else, just let me know.”
“Will do. Thank you…. Oh, wait. I’m sorry, Hannah. I forgot to tell you, we did have another death. 87-year-old male. Room on the end. I’m going to head in to get him cleaned up in a few minutes. He has a foley you could take out if that’s still on your list. It’s about 3pm now, could you stick around and help me out really quick?”
“Sure. I’ll head over now.”
I turned around and saw the room on the end, the only room on the entire floor with the lights off. The curtains were pulled and the door was closed. I waited outside the room until the charge nurse was ready to head in. No way would I go in there alone. The charge nurse slid the door open, pulled back the curtain, and flicked on the light. The hospital’s fluorescent lighting was blinding and sterile. The room was silent. No beeping, no breathing, no sign of life. The room was freezing cold. I didn’t know if this was to fight off the summer heat, or prevent decomposition. The patient was lying on his back with a blanket pulled up to his waist. I saw five tubes impaling his chest wall attached to large drains at the base of his bed. His skin was bruised and pale. His hospital gown was light blue and covered with butterflies and little birds. Ten or more patient belonging bags were lining the window sill. The charge nurse told me about this patient’s situation. He had been in the hospital for three months, had undergone open heart surgery twice, and had been on ECMO for over a month. He was not a transplant candidate. He was 87 years old with end stage heart failure and a laundry list of complications. He had fallen into a coma this past week, and his doctors did not expect any improvement. And yet, his family kept him alive through medical intervention. By machines breathing for him, feeding him, and by nurses giving him fluids. This was what his life had become, the antithesis of independence. This was his new normal, but it’s not like he was aware of it anyway. As I reached to remove the pillows from under his head, my arm brushed past his. It was warm. When I removed the IV from his arm, his skin bled.
The charge nurse turned to me.
“Hannah, there are things worse than dying. Suffering is worse than dying. Being kept alive when your body is begging to be let go is worse than dying. This is not living. This is not humanity’s finest. I have worked on this floor for five years and every day I am reminded to be thankful for my working body, and that when my time comes, I’ll be ready to let go.”
Ready to let go, I thought. Sure, this older man was 87 years old, and dying was the logical next step in his life trajectory. But what about the 53-year-old mother down the hall? Are her chest tubes, ventilator, and ECMO machines torture? What did her children think? This gentleman had been in the hospital for three months, and the mother for less than 12 hours. Both patients would die, it’s a biological certainty. But it seemed so much harder to let go of someone with so much life left to live. Keep her alive, I thought. What if she was the exception to the rule?
The charge nurse and I got him in the body bag. I walked back to the break room to grab my lunch box and water bottle. It was 3:45pm. Security was on the way to take him down to the morgue. There, his family would decide between burial or cremation. I changed out of my scrubs and into jeans and a shirt. I grabbed my keys and headed to my car. Cremation or burial? I started the car and rolled out of the parking garage. Could they even do an open-casket funeral in his condition? I headed towards home, taking the long way.
Hannah Omodt is a student at St. Olaf College and is known for her love of Garfield and the elderly. In her spare time, she enjoys tossing plastic discs, interviewing people on her radio show, doing Pistol Squats, and basking in the sun like a lizard..