Distant memory still stirs emotion

While working in an emergency department in rural New England years ago, Martha Phillips, BSN-RN, experienced one of her most beautiful moments of grace.

Martha, who now works at PeaceHealth St. Joseph Medical Center in Bellingham, wrote about this tender time, proving that even years cannot dim vibrant, heart-breaking and heart-warming events.

Here is her story, in her own words.

The ice storm persisted, unhurried but undiminished, for three straight days. We were caring for our usual assortment of northern winter storm maladies – broken wrists from slips and falls, exercise-induced heart attacks from vigorous shoveling, neck pains from slip-n-slide fender benders and attacking telephone poles.

 But the ice on the roads kept almost everyone in the state inside, and it was quieter than usual. The nurse came up to me as I sat at my desk.

 “Can you come look at something for me?” she asked, quietly. I followed her over to one of the rooms designated for critically ill patients.

 The woman in the bed was old. Her eyes were closed, her hands resting gently at her sides, a blanket pulled up to her waist. She was so peaceful that she could have been sleeping, save for the profusion of IV drips and multicolored cords snaking up from the neck of her gown to the monitor on the wall, and the endotracheal tube between her teeth. The ventilator next to the bed inhaled and exhaled for her with soft, endlessly rhythmic sighs.

 “What happened?” I asked.

“Huge hemorrhagic stroke,” the nurse replied. “She was playing cards with her friends at the retirement home, complained suddenly that she didn’t feel well, and then she laid her head on the table and never moved again.”

 She pressed her lips together tightly, and I recognized the subtle expression of sorrow I myself had made more than once in the ER. I nodded.

The woman lying in the bed in front of me was already gone. She was not dead, but the person she had been, her memories, her thoughts, her fears, her loves, all of her very self, had been erased in an instant.

 “Any family?”

 “A nephew in the city.”

“Ah,” I said, suddenly seeing the situation in a new and terrible light.

 “He can’t get here in time, can he?”

 She shook her head.

“It would be suicidal for him to drive on these roads and he knows it. The doc spoke with him for a while, and he wants us to honor her directives sooner rather than later. I’m just waiting for respiratory to get here and then we’ll extubate her and let her go.”

 It was the right decision and a compassionate one. I was impressed and moved by the decision of the nephew, trapped in an icy city four hours away.

 I glanced at the other nurse.

“So what did you need me to look at?”

 She met my eyes and I was surprised by the flash of panic I saw there.

 “I’ve never done this before.”

 My jaw dropped.

“Never?” I asked, incredulous.

 The ER where I was working was busy, almost daily, with critically ill patients.

“I mean, I’ve seen people die before during codes, when they’ve crashed and we can’t get them back. But never like this. Not when I know it’s coming.”

 She stared at her patient.

 “I don’t want her to suffer.”

 “She won’t,” I said firmly. “You won’t let her. And I’ll help you.”

 We hung IV medications for sedation and pain relief. We placed a small patch behind her ear to dry up any secretions in her mouth and throat. We took off the pulse oximeter and the blood pressure cuff, and shut off all the alarms on the monitor. All that was left on the screen was the constant, simple green tracing of her heartbeat.

 The respiratory therapist arrived and after a bolus of meds from the IVs, stopped the ventilator and pulled out the breathing tube in a smooth, easy motion. He nodded at us briefly, unplugged the vent, and wheeled it out of the room, his mind already on his next critical patient.

 We knew from her head CT that the bleed was so large that she would never again breathe on her own. All the critical functions that sustain life had been destroyed in the initial injury.

 Now that her blood was no longer being artificially oxygenated, the tissues of the heart would eventually seize and die from the lack of it and then it would be over. But the heart – for lack of a better phrase – has a mind of its own. In the absence of any other messages, it will just do its thing; beating, beating, beating, until it can physically no longer do so.

 We watched the monitor for a few moments. Her heart kept beating, unconcerned, determinedly following its own directive. The other nurse quietly reached for a stool and sat on the right side of her patient’s bed.

 She took her right hand.

 I pulled the trash bag out of the trash can, flipped it over and sat on it on the left side of the patient’s bed.

 And I took her left hand.

 It was cool, pale, soft. Empty.

 We sat there together, neither of us speaking, neither of us needing to. We could hear the muted buzz of the ER outside the door of the room.

 But in that moment, deep in the night, our hospital draped in the deadly glitter of the storm, we three were alone in the world.

 Her heart slowed down, confused by the lack of oxygen. Then it raced ahead, a rapid fluttering tattoo to try to compensate somehow. Then a slowing. And then a pause. Then a normal beat. And then another pause. Stubbornly, unwilling to relinquish its raison d’être, it persisted, a burst of beats here, another long pause following. We sat at her bedside, holding her hands, waiting patiently.

It was a rare moment in my career, one of deep serenity. It was a time out of turn, a time of stillness and grace, of bearing witness.  

The door of the ER room opened quietly. A third nurse poked her head in the room, a concerned look furrowing her brow. She saw us at the bedside and her gentle features relaxed.

“Good,” she said, without waiting for us to speak. “I’m glad you guys are here.”

“What’s up?” I asked softly.

She shook her head.

“Nothing,” and then gestured to our patient. Compassion shone from her eyes.

“I just wanted to make sure she wasn’t alone.”

Here’s an interesting twist. While Martha’s experience happened on the east coast, little did she know that nurses of a kindred spirit on the west coast recognized similar sad circumstances and prompted PeaceHealth to begin the No One Dies Alone program at PeaceHealth Sacred Heart Medical Center in 2001. (Read more about the beginnings of No One Dies Alone in Modern Healthcare.)