1. Rumery, Lori Willis RN, CCRN

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"It's almost over, it's almost over," she said as she rocked back and forth with her son gasping for breath in her arms. He was dying. She had been his rock for his entire life, and now she supported him once again as he faced his toughest moment.


Jay had been diagnosed with paranoid schizophrenia as a young man. Now at 40, he was divorced, he had a teenage daughter whom he had not seen in a year, and he was unable to keep a job. His mother, Nora, had provided everything that a mother could over the years. She provided him shelter, emotional support, and love while at the same time trying to grant him independence and autonomy. She brought him to his appointments, followed up with his social workers, and contacted clinics for guidance. Widowed by an alcoholic husband when Jay was just an infant, Nora had the job of a single mom and primary caregiver to a child with mental illness while working from a very tight budget. There was no money for "extras." I didn't realize it at the time, but Nora would teach me a great deal over the next few days. I would be blessed with the experience of meeting this incredible woman during the most difficult time of her life. I would put my critical care skills aside and focus on the compassion, empathy, and presence that makes nursing so rewarding.


Nora found her son lying on the floor of her living room on March 17. He had vomited, was making attempts to move, and then collapsed. An ambulance was called and found Jay to be in complete cardiac arrest. They began CPR and transported him quickly to the emergency room. After a lengthy resuscitative effort, a pulse and blood pressure returned and Jay was admitted to the Critical Care Unit. During the next 24 hours, the grim prognosis became clear. Jay had suffered severe anoxic brain damage from which he would never recover. His initial serum sodium level was a critically low 100 and his urine output within the first several hours of admission was over 6.0 liters. Jay had been known to drink too much water as a result of his mental illness (psychogenic polydipsia) and had driven his sodium level down to the point that he had developed seizures. It became clear through neurologic exams and EEG that only limited brainstem activity was present and that Nora now had critical decisions to make.


I met Nora during Jay's first 24 hours in the Critical Care Unit. She was a small but strong woman, with lots of patience and an easy smile. She didn't cry when she sat with her son, who was being kept alive on a ventilator. Instead, she talked of his many friends and how much they meant to him, and he to them. She spoke of how he had touched so many lives. Nora spoke of how Jay had loved her, and had been a kind, gentle man. Together we talked of how she felt to "look at his body and know he's not the same Jay that I knew." We talked about moving on without him and how the memories would help her. Nora turned to me and asked, "What if I could have found him sooner? Might I have been able to prevent this?" We held hands as I reassured her that she gave Jay every chance of survival and that there must be a bigger plan for him. She smiled again and looked to her son. "I'll see you again," she said to him.


March 20 was a cold day. It was raining; it seemed appropriate. Nora moved back and forth from the waiting room to the bedside, knowing today would be the day that her son would die. We had met that morning: Nora, the physician, and me. Given Jay's prognosis, Nora had decided to withdraw life support. She asked to wait until Jay's daughter arrived to see him one last time. The daughter and her mother were arriving by bus late that afternoon. When the visit was over, we would disconnect Jay from the ventilator and let him go. As I sat with her in his room, she asked if Jay would suffer. I assured Nora that if it looked like he was having any difficulty at all, I would give him morphine to be sure he was comfortable. We looked at the clock, knowing that his daughter would arrive soon.


Jay's daughter and his former wife arrived at 5:30 pm. After a brief visit, Nora told me that it was time. I took her to the waiting room and told her we would remove the breathing tube and I would come to get her to be with him to the end. As we disconnected Jay from the ventilator, his breathing was immediately labored and fast. I knew it would be over soon. I went to Nora and we walked back to the room together, holding hands as I told her that it would not be long. As we entered the room and closed the door, Nora cried. She reached down and slid her arm around his back and chest, lifting him up to cradle him in her arms. She rocked back and forth, repeating "It's almost time; it's almost over. You've been a good son." There were no critical interventions for me to perform, no drips to adjust or readings to record. I would not need my critical care skills here. Instead, I found myself returning to the foundation of nursing practice. I asked her if there were any prayers that she would like to say. She began reciting the "Hail Mary" and I wished I knew all the words. We spoke softly together as she guided me through the prayer. When we were finished I asked, "How about 'the Lord's Prayer'?" We began again, this time a more familiar prayer to me. She spoke quickly and nervously and I was thankful I could slow her down with the words. We talked to Jay about the family members he was about to see again in Heaven. Nora listed them one by one for him and told him, "...and I will see you there again some day, but they will watch out for you for now."


The monitor showed his heart slowing and finally, he stopped breathing. We sat for a few minutes more before I said, "It's over, he's gone." She held him in her arms a minute more and then quietly allowed him to rest back in the bed. She turned to me and said, "Thank you for everything," with a sadness and loss that I hope to never know. She turned and smiled again, a tearful one, and said, "He was a good son."