1. Bowdoin, Carol T. PhD, RN, CCRN

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He struggled for each breath as he lay in the hospital bed. The sound of his breathing was harsh, bubbling, and interrupted by an agonizing cough. "I don't think I can do this much longer," he muttered.


Mr. W had end-stage chronic obstructive pulmonary disease. After a lifetime of working in coal mines and smoking cigarettes, his lungs were giving out. Mr. W was 68 but looked years older.


It was 1973, and not much could be done for him short of a lung transplant. He did not want heroic measures to be taken, including endotracheal intubation or mechanical ventilation, yet something was holding him back. He fought for each breath, holding on for something to provide him with release. When he looked at me, a single tear rolled down his cheek, and I found that tears were welling up in my eyes, too.


Mr. W and I had been together for several evenings-the new RN and the dying patient. Each day he grew weaker. His seven children and devoted wife dutifully drove the distance each day to visit him. Mr. W was the glue that had held his family together.


That night, as I began my shift, he seemed particularly fatigued. He began to talk about his family and his worries about how his wife and younger children would "make it" when he was gone.


Mr. W was the sole provider for his family. His wife of 50 years never learned to drive, pay the bills, or balance the family checkbook. Each visit, he tried to talk to one of his children about how to "help Mom," but they brushed him off with, "Oh, Dad, you'll be better soon, then we'll talk about it." I realized that he was struggling to hold off death until he thought his family was ready to go on without him.


The next afternoon, the family's grief was palpable when they came to visit. As they huddled in the waiting room, one daughter approached me. We talked about her father, and I shared my observations about how he was trying to prepare his family for his death. "Does the hospital have a chaplain?" she asked.


As the family talked with the chaplain, a plan developed to put their dad's mind at ease so he could let nature take its course.


Later that afternoon, the family, their preacher, the hospital chaplain, and I gathered around Mr. W's bed. One by one, his children came forward, took his hand, told him how much they loved him, and said how they wanted his mind to be at ease because they would each take over a part of the family responsibilities. As each one finished, they made a circle around his bed holding hands.


The preacher spoke to Mr. W about the value of his life and that it was all right for him to rest and go to his reward in heaven. Mrs. W sat on the bed, hugged him close, and told him that she would be all right now; he could rest.


The circle of love and courage remained into the evening. He passed peacefully. I stayed to take care of Mr. W, complete end-of-life procedures, and help his family through this last phase of his journey.


From this experience, I learned about the healing power of presence. The ability to be open and present during life transitions has become an invaluable part of my daily nursing practice. It is a competency that I endeavor to teach my nursing students so they too will have a very valuable tool to use when faced with life's inevitable transitions.