After I hurt my shoulder, had surgery, lost my scholarship, and I had to leave school, I had to rehab my shoulder and go through a second operation when the first didn’t do the job, I had to get back into nursing. It was what I wanted to do.
I considered all sorts of foolish options. I had heard the LPN test could be challenged but I had little practical experience. I considered become a housekeeper at the local hospital but they never returned my calls.
I took the exam to become a certified nursing assistant and I passed. The only job I could find was as a night CNA at a nursing home.
That is where the next two patients became my shades.
The first was a right amputation below the knee. She was not unlike the first haunting patient in that she was jolly and wanted her caregivers to smile. After four months she became very sick and I became aware that she was a DNR, a do not resuscitate. This was foreign to me, and after research, I found out that of the four halls in the nursing home, three were filled with DNR patients. The other, the blue hall, were patients who were in the nursing home for rehab.
She got sicker and sicker, her abdomen swelling and the abdominal pains coming more and more often. One night, her CNA came to me and told me that she had died. None of us knew what she had died of, none of us knew her diagnosis. That CNA and I were to pull her curtains and prepare the body for the funeral home who would be before dawn.
This was my first patient who I had been close to who had died. She and I used to talk books and Reader’s Digest and she was dead.
She had died in horrible pain, and black blood spilled from her mouth onto her hospital gown. Knowing what I know now I have an inkling to her diagnosis. And also, knowing now what melena smells like, and remembering the blood that spilled from her mouth as we turned her and bathed her one last time, I know that she died of an intestinal process. It could’ve been an ulcer or cancer that had eroded in her gut. But she had died.
She taught me that a sense of smell was valuable, and once you smell it, you will know. As a young person, (23, a baby!) giving time to the elderly in the form of conversation around what she wanted to talk about, was also beyond worth. To her and to me, as I was beginning my health care career.
The second patient who died while I was a nursing home CNA died suddenly, without warning. Mrs. M was non-verbal, she was mobile, and she was always up at 0400. I imagine that her career was as a baker, or a teacher. I never knew, there wasn’t a lot in her chart and she couldn’t tell me. It was my job to get her out of bed when she got up at 0400, help her to the bathroom, and get her dressed. She would be brought out to the nurse’s station, freshly cleaned glasses on, hair neatly brushed and she would sit and watch us as we made our last rounds before day shift arrived and the nursing home woke up.
One morning, at 0515, she was sitting, as usual, watching us when she began to grunt and rock in her chair. This was not uncommon behavior from her. I was doing what little charting we had to do as CNAs, vital signs I think, and I looked up at her. She saw me looking at her and she smiled and rocked faster. She didn’t seem to be in any pain, and her grunting stopped. Imagining that she just wanted one of us to look at her, I went back to my writing. When I looked up, she was slumped over, glasses askew.
Twenty years later, I think she had a heart attack. At the time it was shocking and I was left to wonder if she had been in pain when she began grunting and rocking that morning.
But she smiled at me.
She taught me that life can be over in a finger snap. I wish I had left off my charting and gone to her. But I didn’t know enough yet to do that.
Between those two deaths I began to form my idea of a good death. I think people should not die alone, that there should be light, and all efforts should be made to make people comfortable.
Death is inevitable, but it should never be in the dark.