Critical care visitation, End of life, Families



  1. Stambovsky, Mark MSN


Some simple nursing interventions can have extraordinarily therapeutic results for patients and families. A man was transferred to our intensive care unit after suffering a devastating head injury. Knowing he would not survive, I felt that his wife needed the opportunity to lie beside him one more time. Her response prompted me to write this in hopes of enlightening other nurses who may, for whatever reason, be reticent to try this approach to healing.


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My patient was ejected from his car after hitting a patch of black ice. His injuries were numerous. But it was his closed head injury that set free the sand that now tumbled through the hourglass of his final day. I took report from the night nurse as family and friends streamed in and out of the man's room in our intensive care unit. There are times when enforcing a visitor policy is necessary. This was not one of them. The visitors gathered in groups of twos and threes. They whispered and solemnly nodded their heads in disbelief.


By the door of her husband's room, the wife stood motionless. Fragments of voices swirled in her head. Faces appeared and dissolved. Bodies moved about her like ghosts in a dream.


Some of the visitors searched my eyes and knew that the man's heart-that heart that beat so many years in unison with the woman's-would soon stop, and the body that warmed her would grow cold. The soul that united them and illuminated their path would slip away.


A few assured themselves that miracles dwelled in places like this, primed by titles and the gleam of technology. Others doubted our despair, questioning our understanding of the man's inner strength.


Nearby, nurses tended to their own patients.


"He's not good," I replied when another nurse asked about the man. To her, or any other nurse in the unit, the phrase was all too familiar-code words of a passing soul, little more than an epitaph.


From the periphery, I watched the earth slowly crumbling beneath the woman's feet. Weeks later, she would write to me, confirming what I was sensing. It was "[horizontal ellipsis]everything my heart wanted but my lips were afraid to ask."


I approached her and said there was something we needed to do.


I announced that, for the time being, there'd be no further visitation. Once the last visitor had gone, I led the woman into the room. I rearranged the mechanics of life support, gently slid the man over to one side of the bed, and lowered the rails. "You need to lie down with him," I said to her.


In nursing schools, holistic and unconventional approaches to patient care are often discussed with passion and in great depth. But in practice, most nurses are either too busy or simply uncomfortable to apply them. Yet, this is the field we have chosen. And in it, we have the potential to distill out of our practice the essence of humanity.


The woman looked at me as if I had just told her I could transport her back to the day before-when her husband was home, holding her hand, lost in her eyes-and I had never existed. Tears welled and rolled down her cheeks.


I helped her up onto the bed. The woman drew her body in toward the man, nesting against him, denying the air between them, perfectly silhouetting his form. She then cradled his head and cried as if she would never breathe again.


"You can hold him as long as you like," I whispered, my hand on her shoulder. "No one will disturb you." I covered her with a blanket, pulled the curtains, and closed the glass door behind me.


In her letter, the woman told me that being afforded the opportunity to fully embrace her husband, on that final afternoon of his life, left her with a peace that would warm her for the rest of her life.


With just a little imagination, we nurses can lead people through realms of such intimacy that, sometimes, we can begin to heal broken hearts.