I stood at the nurse’s station, taking a breather. It had been a hectic night and it was almost midnight, but there were still a few tasks to be completed before I could dig into the paper work. But most important I wanted to devote some time to my dying patient, who had taken backseat all evening to more acute patients.
I wheeled the palliative care cart down the long dim hallway to the last private room. The cart was a gaudy baby blue renovated tool box with squeaking wheels that made me cringe. Despite its looks, it had the noble purpose of providing supplies and comfort to the dying patients and their families. It contained hand-made throws from volunteers, a cassette player with soothing music tapes, the book “Chicken Soup for the Soul”, and a Bible. Its crowning glory was a touch lamp that would give a room a gentle dim glow.
Miriam’s room was dark except for a small night light at the head of her bed. She was alone. Her husband, exhausted from caring for her at home, had left soon after her admission. She had had multiple admissions over the last two years while she battled cancer with surgery, radiation, and chemotherapy. Now there was nothing more anyone could do except keep her comfortable until the inevitable end.
Miriam’s breathing was deep and slow, slightly irregular. I glanced at the PCA machine with its illuminated window showing the continuous infusion rate of morphine. This is the patient controlled analgesic that is a blessing to people in severe pain who no longer have to wait for a busy nurse to relieve them of their misery. I could tell at a glance that she hadn’t given herself any extra doses. Her slowed respirations made me anxious, although we would do nothing to revive her if it were her final moments. This was her wish.
I plugged in and turned on the touch lamp, and the room took on a warm golden reverent lighting. Under the pretense of needing vital signs, I went to her and gently shook her shoulder, saying her name in a quiet voice.
“Miriam, I brought you a lamp to light your room. Isn’t it beautiful?”
Miriam opened her eyes and focused them momentarily on the lamp at the foot of her bed. Then her eyes drifted upward toward the ceiling, and seem to be trailing something that settled to her right.
“It’s so, so beautiful,” she whispered staring into the dark. She was definitely not describing the lamp. I searched the dark, straining my eyes trying to see what she was seeing, and feeling uneasy.
“What’s beautiful, Miriam? What do you see?” I whispered urgently.
“It’s so beautiful,” she repeated before seeming to slip back into sleep.
I left the room quickly, feeling uncomfortable psychic shivers. I reasoned with myself as I walked down the dim hallway that felt like a long dark tunnel. Yes, Miriam is pain free. Yes, her respirations had become slow, about 12 per minute—but she had been easy to arouse. Had she been hallucinating? I wasn’t sure. Maybe she was seeing the other side with her soul. Maybe her brain was becoming oxygen deprived. I called the doctor, and although he didn’t think the patient was receiving too much morphine either, he did order that the PCA’s continuous dose be reduce. Miriam still passed a pain free night, but without further hallucinations. She died before I got the chance to work with her again.
This wasn’t the first time that I had a patient nearing death who was seeing things that I couldn’t. A man, also with cancer, had been trying to grab at things floating in the air around him, minutes before he slipped into a coma. Unfortunately he was talking in a foreign language and I am left wondering to this day what he was seeing. Drug induced hallucinations? Another elderly lady sitting in a lounge chair, could not be aroused from a state of unconsciousness, until she was lifted by four nurses back into her bed. She suddenly ‘awoke’ when her body touched the bed. She told us that she had been visiting with people she hadn’t seen before and people that she hadn’t seen in a long, long time. Dreaming—or something more?
Another patient, an elderly lady with a pacemaker stated straight forward: “I’ve died twice and I don’t know why I’m alive.” Assuming she was talking about her present state of health, I stayed briefly to console and educate her. She floored me with her next remark.
“It’s so beautiful on the other side and I don’t know why I came back.”
“Me, too,” said the neighboring patient, “I died too.” Unfortunately, I was pressed for time and the physical needs of other patients took precedence over my spiritual needs. I was unable to learn more from either of these ladies that night.
People who are dying sometimes seem to be waiting for something. They wait for a certain someone to come or to leave. They also tend to wait for certain holidays to give up the spirit. Christmas seems to be popular. So is Easter weekend. At one hospital I worked at, nine patients had died on our medical floor over the Easter weekend. I remember one veteran nurse remark: “The Angels were busy this Easter.” That idea left an impression on me.
Dealing so often with death, nurses seem obsessed by it. A few minutes to relax on the job and we open up the Daily Journal to the Obituary, looking for familiar faces or names. We chat with each other about how sweet and kind that person was, and how supportive the family was—and how death was a blessing to end the suffering that person had endured. But I think we are always searching for the least thread of continuity. I am always vigilant when a dying patient tells me they are seeing something. I always try to see it too. So far I haven’t been able to. Maybe we have to each wait our turn.