Last Words

I’ve seen a lot of patients die. And by a lot, I mean too many to count. Some deaths I remember clearly, perhaps because the patient was alone or had a large number of family and friends at the bedside, perhaps because he or she was close to my age, or perhaps because of religious traditions that took place during or after the death. It’s odd then, that when I think back to last words of patients before they died, I am at a loss. 

It could be because many of our patients followed a similar pattern prior to their death. Many were on mechanical ventilation which was withdrawn after many days, weeks, or months of progresses and setbacks. Most were unresponsive, either due to sedation or their disease process. They may have spoken their last words in my presence, but at the time I may not have realized that they were the last words they would ever speak. 

I do remember the last words of one patient in our unit. She was my grandmother. After a fall with a resultant hip fracture, she was transferred to us several weeks after surgical repair of her hip. Her oxygen requirements were increasing and she was becoming more and more agitated. In our unit she was treated for aspiration pneumonia, given anxiolytics, and supported with more and more supplemental oxygen each day.

We, her family, knew her wishes – she didn’t want to be intubated – and we respected that. I was working night shift, not as her nurse, but would stay much of the morning to help with her am care and to be there for rounds. On one particular morning, she was coughing and vomited. She had a hard time catching her breath. I called out for her nurse to suction her, when my grandmother grabbed my hand and said “No more.” We spoke of what that meant; it was a pretty intense conversation for a young nurse to have with her own grandmother. Then I called the rest of the family to explain our conversation and ask that they come to be with us. 

Everyone arrived throughout the day and we did what we could to keep her comfortable. We all spent time holding her hand and chatting with her when she was able. At one point, my grandmother asked for a grape soda. I found one for her and as she sipped it through a straw, she said to me “Lisa, I won’t be at your wedding.” “I know,” I said, “Grandmom, but you will always be with me.” Her response was “Yes… and grandpop knows what to give you.”

And those were her last words to me. I knew that she was referring to a wedding gift, and I laugh now when I think about it, because that was typical of my grandmother. She was an incredibly generous woman…always fighting over the check at dinner and pushing to pay at any cash register. These final words make me smile and think of who she was, not laying on that hospital bed, but as my grandmother.

What made me think of this was a recent book I just completed. In Looking for Alaska by John Green, the main character has a fascination with last words. He reads countless biographies and has memorized last words, even making it his mission to discover the “Great Perhaps” mentioned in the last words of François Rabelais. It was a good read, definitely thought-provoking, and I thank my niece for recommending it to me.

As nurses, some of us work with dying patients on a daily basis, while others, only rarely or sometimes. Regardless of your experience, do any last words stand out in your memory?

Posted: 11/25/2012 2:45:06 PM by Lisa Bonsall, MSN, RN, CRNP | with 5 comments


Comments
Lisa Bonsall, MSN, RN, CRNP
Debra,
Thanks for sharing your experience and for the reminder that nursing truly is a privilege. Please keep me posted about your book - would love to read it someday!
Lisa Bonsall
6/24/2015 2:52:13 PM

Debra Culver
January 3. 2013 02:25
As a heathcare professional of almost 40 years I have seen many many patients pass away. So many stick out in my memory and though I may not remember every name I can't forget each face. Two simple words will always stand out at me. One very special pt. looked at me with the sweetest eyes and said thank you before he went to be with God. As I held his hand and watched the last p wave flicker I knew he was gone after a long long struggle with cancer. At that moment I was so thankful for the privilege of being a nurse. To all reading this-please remember Nursing is an art and a science but never forget it is a pri
6/24/2015 2:51:53 PM

Lisa Bonsall, MSN, RN, CRNP
October 19. 2012 16:23

Kathy & Michele,
Thank you so much for sharing your stories.
Lisa
6/24/2015 2:51:16 PM

Michele Brookman, RN
October 7. 2012 16:42

This past March, my brother died in the hospital from complications of pseudomonas pneumonia. He had ben bed-ridden for 16 years due to TBI, and my mother who is also a RN, cared for him at home with my help. HE was 48 when he died due to the M.D. assigned taking advantage o the fact that he had been made a "No Code" 3 years prior, and failing to order appropriate antibiotics for which to treat the virulent pseudomonas. After 3 days in the hospital, 2 of which were with ZERO Abx, his lung began to hemorrhage, and by day 3 when I arrived at the hospital after working at another hospital, I witnessed the worst possible case scenario from which he would not recover and advised the rogue MD to cease intervention and begin comfort care. He would have exhausted himself in trying to breath with one lung filled with blood. I could not take the day off the next day to sit bedside with a Dilaudid drip running, and asked that I be notified when the nursing staff though it was close. I arrived at the hospital the next evening with my 11-year old daughter and kneeled beside him in his bed with my mother's 80's white nursing dress on. The Chaplain came by, and a very chatty nurse which I resented as she was commenting on my retro dress and was inquisitive about me while I was cherishing the last few hours I would ever spent with my brother, who had also been my first patient in a home care setting for the past 16 years. He took his last great an hour after I had arrived, with me holding his hand and hugging him. 16 seconds after what seemed like the final breath, was just one more and his eyes rolled back. Two days prior, before the lung began to hemorrhage and before comfort measures were even a remote option, my 11-year old daughter felt angels in the room and began to cry. I thought that she was crying because she was tired and frightened,but she said that she was overwhelmed by the presence o angels. At the time when she felt this my brother lie sleeping and smiling in his sleep, which I attributed to the Morphine given hime for the pneumonia, and did not correlate to my daughter's tears. When I asked her what the angeles were doing there she said that without speaking directly to her, they told her without words that he was going to be all right. Apparently, he was also aware of the angels and knew where he was going, hence the immense smile on his face while he slept.

Disappointing is the present state of medicine, where the caring aspect is down played by level of reimbursement or the costs of care. The healing art of nursing ought only be practiced by those who truly care and not sought by anyone who seeks job security and recognition.
6/24/2015 2:49:34 PM

Kathy
October 6. 2012 23:33
These were not last words, but last moments, so I appologise for not sticking precisely to the question, but it was my most profound experience in caring for dying geriatric patients. I was working on a dementia unit and a favorite patient of both staff and residents was actively dying. My shift was over and I was at the nurses station doing my documentation, when from down the hall I heard the most beautiful baritone voice singing Amazing Grace. I stood and walked toward the dying patients room where I found one of the CNA's from the day shift and her daughter, a volunteer, sitting at the residents bedside. At the foot of the bed was one of our new residents. He was a tall and strapping man, very fit as his was a sudden change in mental status that took him from his life of freedom and brought him to our unit only a couple of weeks earlier. I walked to the other side of the bed and took the patients hand. As "Charlie" finished the hymn, "Gertie" took her last peaceful breath. I went over to the man and told him how lucky Gertie was to have him there. Without skipping a beat, he looked up at me and said "God gave me this gift, and he told me it was time for me to use it".
6/24/2015 2:48:16 PM

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