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Fluids & Electrolytes
WALTER DEVLIN, 83, had been admitted to the telemetry unit 2 days earlier with end-stage chronic obstructive pulmonary disease, pulmonary hypertension, and dementia, which manifested as angry and aggressive behavior. During change-of-shift report, I was reminded of his do-not-resuscitate status.
As I performed a head-to-toe assessment, I recognized the familiar signs of right-sided heart failure. This will be a long night, I thought.
I introduced myself to Sarah, his wife, and asked if I could speak with her in the hallway. Then I asked her what concerns and questions she had. She expressed not only fatigue but also embarrassment at the things her husband of 54 years was saying and doing. Before the dementia, he'd been the kindest person she'd ever known.
Their only child, a son, had been killed in a car crash 2 years earlier. Now Sarah was alone and afraid of her husband. She knew he'd soon die, and she wished she could share the last transition of his life with him. She didn't want this to be her last memory of him and their time together.
Returning to his room, I asked Walter if he was warm enough. Instead of answering, he became very agitated, moving from side to side, swearing, and spitting on the floor. Sarah, a tiny woman, sat in a corner of the room, gripping a big black purse in her lap as if it could protect her.
Because I needed to distract him, I made up a story about doing laundry and dishes, then moved smoothly around the room cleaning and straightening while talking calmly about everyday things. Watching me, he gradually calmed down. "You missed this one," he barked suddenly, indicating his plastic water glass. I "washed" it and dimmed the lights.
But he soon became belligerent again, so I tried different tactics-including combing his white beard. Finally, I found something that worked. Using my fingers, I made long, soft strokes across his forehead and down to his temples. The touch seemed to mesmerize him. His eyes closed for a while, and when they opened they were softer than before. Maybe this was a glimpse of the "real" Walter.
I helped Sarah bring her chair up to the bedside. She smiled tentatively and cautiously took his hand. He let her. Knowing that sometimes asking questions can cause agitation, I suggested that she talk to him about some happy experience from their past. She reminisced about their 35th anniversary cruise, and Walter seemed to listen.
Around midnight, I returned to Walter's room to give Sarah a blanket. I found Walter looking pale and diaphoretic. Sarah said, "I tried to rub his forehead and it didn't work."
Walter's respirations were irregular, and his level of consciousness was decreasing. Sarah held his hand and talked. Time was passing so slowly. Walter was dying, and he seemed to know it. Suddenly he gripped Sarah's hand tightly. She looked surprised and smiled. He looked straight into her eyes and said, "Sarah?"
She answered softly, "Who else do you think it would be?"
He closed his eyes and smiled. "No one else."
He reached over with his other hand and patted her forearm. They stayed like that for quite a while until his hands relaxed and Sarah leaned onto him. I helped her into a comfortable position and left them alone. Two hours later, he died peacefully.
I hadn't changed the outcome of Walter's condition, but with some extra time and a dose of compassion, I'd helped ease the transition and given Sarah one last glimpse of the husband she loved.
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