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(As part of the School of Nursing's Compassionate Care Initiative, all nursing students keep journals to record their experiences, and reactions while on their clinical rotations. Special thanks to Casey Holmes, BSN '12, for her contribution here.)

February 4, 2012

"Without a doubt, this was the most difficult clinical day I have ever experienced. When I went in to prep for my patient, I noticed that her chart warned that she may pass during the night. However, this was warning was listed on three different days, and she was supposed to be discharged to home hospice during my shift. In the back of my mind, I wondered if she would pass away while I was there, but I tried not to let it worry me. When I arrived on the unit the next morning, I did my normal routine – I printed out my PTP, found my nurse, and followed her to hear report. I was with Patricia. As soon as she finished report on the first patient, we were alerted about (my patient's) status. She was quickly declining.

"My worries from the day before were becoming very real. Patricia and I rushed to room 80 to find (the patient), laboring to breathe, with four of her five daughters and a granddaughter standing around her in tears. I don’t remember exactly what went through my mind at the point. I think I saw the situation, and all of a sudden, I was back in my aunt’s hospital room almost three months before. I recognized the signs – her breathing went from rapid to slow. All we could do was promise the family that we would be there for them when the inevitable happened. After I left the room, I lost it. I was struggling not to cry while I was in the room because I didn’t want to take the attention off of the family’s suffering. I tried to find a place where I could cry alone and get it out of my system, but I didn’t do a very good job. I went into the soiled utility room, where I was comforted by two of the janitors. They were so kind and comforting, and even throughout the day, they checked on me to make sure I was ok. After I could compose myself, I went back into the room to be with the family. When I got back, I saw (the patient) take her last breaths. The chaplain and the priest were there to comfort the family. The chaplain noticed that I had been crying and asked me why I thought it upset me so much. I told him about my own experiences, and he encouraged me to stay with the family as long as I could. Talking with the chaplain really helped me, because I realized that it wasn’t an accident that I was given this woman as a patient. I was placed in the situation because I could, in a sense, understand how the daughters felt. After my conversation with the chaplain, I decided that I needed to experience everything that this situation had to offer, no matter how hard it might be.

"As the day went on, I frequently checked on the family. It was hard to find a balance between leaving this alone with their mother and being there to support them. Whenever I felt it was appropriate, I would ask them questions about their mother. (This patient) was obviously a very special patient to 8West. One of the night nurses didn’t even leave until around noon because she was so close to the patient. Seeing that, I felt very blessed. There was something very sacred about the entire situation. I was honored to be a part of someone’s very last moments on Earth. Later, after the last sister arrived and had time with the mother, Mechelle and I did post-mortem care. At first, I was very hesitant about doing it, but I knew that I needed to have the experience. Looking back, I am glad that I did it. As we washed (the patient's) body for the last time, I couldn’t help but tear up. However, these weren’t tears of sadness. All of a sudden, I was filled with an overwhelming sense of peace. (The patient's) spirit was gone – gone to a much better place. She was no longer suffering in her tired body. She was laughing and singing in heaven. In that moment, I couldn’t be sad for her. As we finished preparing her body, I said a silent prayer asking God to take care of (the patient) in heaven.

"After (the patient's) body was sent to the morgue, I went to lunch but I couldn’t eat. My mind was busy going over the events that had just taken place. I felt like I had lived days in just a few hours. I couldn’t stop thinking about the last sister. I hope that she doesn’t feel guilty for arriving late. I remember in my own experience, I got the call about my aunt early on a Friday morning that my aunt had one hour to live. It took me three hours to get the hospital, but I made it there right before she passed away. I can’t imagine what the last sister was feeling. I tried to comfort her as best I could, and I hope she can be at peace with the situation.

"In the end, I hope I made a difference in (the patient's) daughters’ lives. I feel honored, and not sad, that I was able to be a part of such a pivotal moment in their lives. It was difficult, but also very fulfilling. I think I finally realized how close to death we are in nursing. If I want to be a nurse, I will have to be able to deal with death and dying, no matter how hard it may be. Obviously I will always think back to my own experiences with death, but I think in this situation, that really helped me to help the patient’s family. When I got home from clinical, I immediately called my mother to tell her what had happened, and we both cried together, remembering my aunt’s death. We both decided that this situation was just another reminder that everything happens for a reason."