1. Gerber, Lois MPH, BSN, RN

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ONE AFTERNOON, I picked up the home healthcare agency phone to hear Mr. R's frightened voice. "My mother's dying. Can someone come?" Taking a deep breath, I asked, "Is it an emergency?"

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"No," Mr. R said. "She's home from the hospital and a friend recommended we call your service if we needed help."


"Give me your address and the name of your mother's physician," I said. "I'll come as soon as I can."


Bad spirits

Thirty minutes later, with end-of-life orders from the physician in hand, I arrived at Mr. R's house. He told me that the family had moved to the United States from Mexico about 3 years earlier. His mother, 74, had been doing fine until about a month ago, when she'd had a massive stroke. "She's been in and out of consciousness since we brought her home from the hospital last week," Mr. R said. "My sisters think there are bad spirits in the hospital."


I asked if he believed that, and he said no. But his sisters insisted that she come home instead of going into hospice. "I'd do anything to save her, but there's nothing left to do," he said. "We haven't had enough time to prepare ourselves. We've been taking care of her around the clock since she came home. The rest of the family is in Mexico or they'd be here helping. One of us sits with her all the time. We don't want her to die alone or suffer." I verified that the physician had signed a do-not-resuscitate order.


Nearing the end

I entered the bedroom to assess Mrs. R. Propped up on pillows and wearing a flannel nightgown, she lay in the middle of a double bed under a comforter. The sound of her raspy breaths filled the room.


Mr. R. introduced me to his sisters, who were standing by their mother's bed. I assessed Mrs. R. Her cold extremities, thready pulse, irregular respirations, and diminished reflexes told me the end was near. She appeared comfortable.


"The four humors were in better balance yesterday," one of the sisters said. I remembered the Mexican belief that the forces of hot and cold needed to be in harmony for a person to be healthy.1 "What have you done for her?" I asked.


"We bathed her in warm water and keep her covered with blankets. It's not working. Maybe she got cold or maybe we aren't praying enough." They also told me that the curandero, or faith healer, had been visiting.


Tears filled both women's eyes. "Why don't you sit around your mother's bed?" I said. "Put your hand on her arms, legs, or face and take turns talking to her. Hearing is often the last sense to go."


I walked to the kitchen and worked on my charting. When I returned to the bedroom, Mrs. R looked peaceful, and her children's tears had dried. Seeing me enter, one of the sisters said, "The priest was here yesterday and gave her the sacrament of Annointing of the Sick, but how do we know if she has sin on her soul? I worry."


Mr. R said he'd call the curandero, who arrived an hour later. He and the family made a circle around her bed and prayed, and the curandero said that Mrs. R was at peace. Mrs. R took an abrupt deep breath, a breath that I knew was her last.


Tears ran down her children's cheeks, and tears filled my eyes, too, as I placed my stethoscope on her chest and confirmed her death.


"You can stay with your mother for a while," I said.


"Yes, we need to be by ourselves," Mr. R said.


He put his arms around his sisters and wiped their tears from their faces. I gathered my supplies. "I'll notify her physician. Is there anything else I can do for you, like calling the funeral home?"


"No, I know what to do," Mr. R said.


He walked me to the door and grasped my hand in both of his. His fingers felt cold. "Thank you," he said.


"You're welcome," I replied. "I'm glad to have met you and your family."


"Nurses," he whispered. "What a godsend."




1. Centers for Disease Control and Prevention. Promoting cultural sensitivity: a practical guide for tuberculosis programs that provide services to persons from Mexico. 2008. [Context Link]