A guest post by Victorian nurse Elisabeth Hall, who has changed identifying features about this patient whose dying, she says, is not atypical of her nursing experience.
I walk quickly, efficiently down the corridor, checking the six patients in my care this evening.
My lady in 24’s still with us. Drifting in and out of consciousness, her mouth hanging wide open revealing naked, pale gums, her dentures have been soaking in a plastic container on the bedside table for the last few weeks. It’s been a while since she could chew, and anything thinner than honey will slide into her lungs. All she can tolerate now are teaspoons of water mixed with thickened and, on good days, finely crushed tablets mixed with strawberry jam.
I wipe the corners of her dry lips clean of the white crusts remnants from the last time she tried to swallow some medication, reminders of how little dignity she has left; so little autonomy she can no longer dab her mouth with the monogrammed linen hanky she used to tuck up her sleeve, long since relegated to a bedside drawer, by the clothes she wore when she could still choose, and the large print mysteries she once used to escape the hospital.
At least she looks peaceful for the moment. Last night I gave her all of her prescribed ‘as needed’ morphine and midazolam, and still she cried out for her mum, long gone from this 90 year old woman’s life, to help relieve her pain.
Her bed has been lowered to the ground, with a mat on the floor beside it, just in case she falls while she’s trying desperately to find a position that is, if not comfortable, at least bearable.
I check on her often, gently changing her position, moistening her dry mouth with damp cotton swabs and minty lip balm, cleaning her frail body in stages so it doesn’t exhaust her. Jutting bones lie beneath parchment soft skin that I assess for signs of pressure injury, as I talk to her about what I’m doing, and the setting sun only I see through the curtained window.
I don’t know if she can hear me any more. Before she was so far along, when she asked me to please help her die, she told me she would have no visitors, had outlived most of her relatives and friends, had no children of her own.
Her wasted muscles are rigid, and she moans when I move her. Her face shows the pain, the discomfort and the utter aloneness that has dragged on for so long.
When my shift finally slows down, I go in and sit in the dark on the mat next to her. I hold her cold, gnarled hands and talk to her quietly, trying to soothe her; this intimate moment feels like a single drop of comfort in an ocean of unrelenting suffering.
I pump hospital-stock moisturiser and massage her hands, comb her shock of white hair. Her breathing is uncomfortable to watch but I’m certain it’s much more uncomfortable to experience.
This woman, with her brow furrowed in mostly quiet suffering, is a palliative care patient. She has been cared for by nurses, visited by doctors, ministered to by a chaplain. They have all done what they can to ease her pain, her breathlessness and her distress. We do our best to care for her, but cannot release her and end her terminal suffering.
All we can do is wait, watch her deteriorate and hope we never have to see a loved one in the same situation, swear to ourselves that we’ll find a way to end it if it ever happens to us.
We go home, make our family or friends promise them that they’ll help if we ever end up in such a way. We go to bed at night and replay our shift, cry quietly to ourselves, feeling both silly and useless. This isn’t even one of the awful ones.
Many of us will think of assisted dying, and hope that one day the laws will have changed so that we can help other patients end their journey on their own terms, without pain and with their dignity. With someone holding their hands, in the place of their choosing, and with relief in their heart.