Last breath

Last night I experienced my first death as a registered nurse.

I wanted to write a post about this, not because I haven't experienced death before but because I am experiencing a rather odd set of emotions about the whole thing.

The lady, who i will call Mrs H, was very unwell, she had respiratory failure and was very acidotic. The doctors, along with the family, had decided that a resuscitation attempt would be futile so a do not attempt resuscitation (DNAR) form was in place

Despite this, and the fact that she wasn't expected to survive the night, Mrs H was started on non-invasive ventilation (NIV). This always seems a misnomer to me as NIV is very invasive, ok it doesn't involve putting a tube down someone's trachea as in endotracheal intubation, but it works by forcing oxygen into the lungs under pressure then maintaining a pressure during expiration to keep the lungs inflated. Many people struggle to tolerate NiV, the mask thy has to be worn is huge and I imagine very claustrophobic. But it can be a very effective way of assisting ventilation in respiratory compromised patients.

Anyway I digress, for whatever reason the decision was made to start mrs H on NIV. And she appeared to tolerate it well, was synchronising and there had been a small improvement in her blood gases.

At about 5am, whilst sitting at the nurses station, we heard the apnoea alarm sounding. This is triggered when the NIV senses absent or inadequate respiratory attempts from the patient.

Myself, the nurse in charge and a nursing assistant immediately went to her bedside. We were joined by the on call junior doctor. There was no visible respiratory effort and we were unable to find a pulse, either radially or centrally. We quickly removed the NiV mask. Easier said than done when it is strapped on tightly (it needs an airtight seal to the face in order to be effective-so many straps/fastenings, looks like something from Star Wars)

Then we waited.....nothing. The doctor started checking for heart sounds, we all waited, holding our breath. Then suddenly a gasp, then silence.......we started the process again. Checking for signs of life. A process that never fails to seem brutal; listening for heart sounds for 1 minute, checking the pupils for a reactions.......nothing......"are we all agreed?" asks the doctor. We nod out agreement when suddenly "did you see that? Her eyelids flickered?" Says the other nurse, we all peer at Mrs H and then "sighhhh" she sighs.
By this point it's almost become comical. It seems Mrs H is determined to keep going. There we are, the four of us gathered around her bedside. Unsure what to do. So we wait.

I am holding Mrs H's hand. I'm not sure why , it felt the right thing to do.if it was me I would want a reassuring touch as I took my last breath. The minutes pass. The doctor has her stethoscope to Mrs H'a chest. She shakes her head. Nothing. No more breaths. She had gone.

I feel strange because I feel very little. We remove the cardiac monitoring pads, take down the IV and, being a slightly superstitious creature, I make sure a window is open.

We lay the bed down, arrange pillows ad tidy the blankets. It's weird, although at a glance she could be sleeping. When you look closely it's like something fundamental is missing. Like an empty shell.

We leave the bedside and I return to my paperwork. I feel sort of empty. I wonder what the procedure is for expected deaths in hospital. I consider the practicalities. I think it is maybe this that shocks me. Do I have no heart?

Mrs H was not my patient. And yet I was there at the very end. Of all the big events in a persons life, I was present for this strangers final moment.

She was a person. She was Mrs H. Someone's wife, someone's mother . And I held her hand as she took her last breath.

What a privileged position we hold.