Death in a hospital is always sad, but it's especially sad around the holidays. There's something even more heartbreaking about watching the outside people enjoy meals and traditions and festivity when there is a person in a tiny hospital room who is saying goodbye to it all, ready or not. But sometimes, you get to spend a few hours of a shift with someone who knows they are dying, with a family who loves them, and who made sure to share jokes, smiles, and wisdom while they're going.
I worked an overnight on Thanksgiving Eve which is usually one of the biggest party nights of the year. Perhaps you know it as this. I recognize it as Amateur Hour because it's the first time all the newly minted 21 year olds are in one place after school has started. High school friends reunion, drinks galore, and the subsequent ER visits because of course - most of the time it's hell to work this night. But this shift was pleasantly uneventful, and it was slow enough that I was cut 3 hours early. Fortunately this meant I got to spend all my time in one room.
A nice elderly gentleman fell while getting into his bath for the night, and hit his head against the tub. He came in "just to get checked out" even though he had no current complaints and experienced no LOC. He was alert and oriented on arrival, and while age had made him frail his wit was as sharp as ever if the jokes he sent my way were any indication. A head CT was done since he was on coumadin, and sure enough he had a massive subdural with a smidge of midline shift for good measure. The ICU was full until more staff could be called in, so I let his family know that they would all be hanging out with me for much of the night until a bed was available.
Every fifteen or twenty minutes I'd check on him and do repeat neuro assessments. Within an hour, he started to have a bit of a headache. Then his blood pressure started to elevate. Then he couldn't remember my name, even after singing me numerous dirty songs that made me blush and his family snort laughing. The neurosurgeon came in and discussed options, and all fourteen of his sons, daughters, in-laws, grandkids, and one next door neighbor crammed into the tiny room. It was bleak - do nothing, and die within a day or so. Brain surgery, and maybe still die. Definitely a long and painful road of rehab if he did survive surgery.
He decided to do nothing. "I've had a good life. I raised my kids and loved them all and helped them start their lives. I buried my wife last year. I can't get out of the house to work on my boat anymore, and it's real tough to be a burden on my kids for the things I'm too weak to do. I know more dirty jokes than anyone in this building. I traveled the world and saw everything I wanted to see. It's time for me to go," he said. "This has been the best of lives and I'm ready."
He died before I went home that night. And it was heartbreaking, but in a good way. Once again I am thankful that I get to be a nurse and to share these moments with complete strangers, which help shape me in the most profound of ways.