1. August-Marcucio, Kassandra RN, APRN, ACNP-BC


In nursing, there's often a delicate balance between worlds.


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My arms are burning. I am sweating. The hairs on my neck stick to my shirt. I notice a streak of blood on the wall. Scattered around the room are wrappers and empty vials. IV lines hang from the ceiling-an eerie jungle of tiny bubbles and potions meant to prolong life.

Figure. Illustration... - Click to enlarge in new window Illustration by Jennifer Rodgers

I take a deep breath, to slow my racing heart. I should use the bathroom. Do I feel sick? I can't tell. A flashing light grabs my attention. I focus on the flat line across the screen, unwavering, steady, dead.


Death is here. Gooseflesh prickles my skin. His brown eyes are open, gazing at the ceiling. My sweaty gloved hand reaches to close them. I tell myself the things I always do-it was his time, we did everything we could. I can hear someone crying outside the room.


The hospitalist draws back the curtain. Not a candidate for organ donation-no autopsy requested. I nod. I turn to the body. The purple shade of death is already pooling in his flesh.


I take the air out of the endotracheal tube and gently pull the tube from his mouth. One last agonizing gasp. I remove the lines; blood beads, briefly. I place gauze and pressure tape over his wounds.


He has soiled himself in the last efforts of life. Another nurse and I clean him, replace his linen, and place his hands over the crisp white sheet. Baby powder that we keep hidden for times like these freshens up under his arms and under the pillow. Ironically, he smells like a newborn. The nurse touches my shoulder knowingly before she leaves.


I notice his wedding band and fight with his swollen finger to get it off and include it with his personal belongings. I stop when I notice he has sputum on his chin. I get a cloth and warm the water. I chide myself, why do you care if it's warm?


The family knocks on the door. The wife is helped to her husband's side. Tears stream down her face as she tenderly strokes his cheek. I can see 50 years of memories in her eyes. She brushes a stray hair from his forehead; it seems a gesture she has done a thousand times before.


Her blue eyes are piercing and searching when she asks me, "Did he suffer?"


I swallow the panic that I feel. I know the comfort that she seeks. I think of the compressions, the lines attempted and failed, the not-so-gentle intubation-no research can ever prove that people don't suffer during resuscitation attempts.


I smile weakly. "No, it was quick."


She nods. Quiet and still, frozen on the precipice of death and life, hello and goodbye, hope and devastation. She kisses his cheek. She turns and hugs me, her tears staining my shoulder. "Thank you, dear," she whispers, and turns to leave.


I can feel the tears on my shoulder cooling with the air. Thank you? I was his nurse and he died! Yet I stand there, calm, collected, tending to my patient even when all that remains is his vessel.


Then we are alone again, he and I. I open the body bag. It smells like a brand-new shower curtain. I carefully tie the tag on his toe. My colleague and I confirm the patient's information. The exaggerated zip of the bag is final.


We transfer him onto a stretcher to transport him to the morgue. Another nurse accompanies me, as if my patient might suddenly come back to life if I went alone. The stretcher draped with its white sheet is a heralding sign of our failure. People avert their eyes as we pass. They do not want to invite death into their rooms tonight.


The security guard meets us. He opens the steel door and fog rolls out when the air mixes. I push the stretcher into the freezer. A feeling akin to abandonment overcomes me as I step out into the warm hallway. The guard closes and locks the door.


I arrive back on the unit. Suddenly, I am exhausted, tired, hungry. I must use the bathroom.


"Your patient is here from the emergency room." The clerk thrusts pages into my hands. The words are blurred. I want to cry. I want to scream.


I walk into the room where my last patient had lain. Is the mattress still warm? My heart is racing again, pounding in my ears. My mind is shouting-I have touched death tonight! Get out! Death has been in the very bed you now lie in!


Instead, outwardly, I appear calm, collected, prepared to care for this patient until her last breath. I smile. "Hello, I'll be your nurse[horizontal ellipsis]"