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Stand By Me

Whatever life throws at us,
our individual responses will be all the stronger,
for working together and sharing the load.

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Stand By Me

Whatever life throws at us,
our individual responses will be all the stronger,
for working together and sharing the load.
                                By Queen Elizabeth II

As I drove to my dying patient that morning, I was anxious to see if his night had been peaceful.  I had been seeing him every week for several months and a bond had formed between us.  Even though I wanted to be the one to visit him every day, there were times when I could not get to everyone.  The report I got from the nurse who had visited him for me the day before, was that gurgling secretions rumbled in his throat.  The death rattle had begun.

When I arrived his wife, Gloria, led me to their bedroom.  His head was moving rapidly from side to side, his arms were thrashing and eyes squinting.  With fluid in his throat, he was struggling to breathe.  All I could hear was his piercing moan.  It was an awful sight.  While silently praying for guidance, I tried to figure out what to do first.  It was one of those moments when I had to rely on my training and years of experience.

When my assessment was done, I dug frantically through my supplies for a catheter; I gave medicines for pain and restlessness. After inserting the catheter, his pain from a full bladder was eliminated.  One step at a time I told myself, stay calm.  

His daughter, Jan, came through the door.  She took one look at her dad lying in the hospital bed and asked what she could do.  She paced from room to room, pleading for me to help.  She said, “I don’t care what it takes, just make him comfortable.”

I had given the maximum amount of medicine ordered.  It was time to wait for them to work.  I called the hospice manager and told her there was an acute crisis and this patient might need to go to our inpatient facility.  She would start working to get him a room.

After hanging up, I called the nurse practitioner, Debbie.  When I heard her voice, I felt like a lost child who had just found her mother.  I absorbed Debbie’s much needed support; her calmness penetrated me.  When I got off the phone, Gloria was holding her husband’s hand to comfort him.   As Jan looked at her father, I put my arm around her shoulder and said he would be comfortable soon, we had a plan.  I followed Debbie’s instructions, gave the medicine she ordered and waited for them to work.  Later he would be transferred to the in-patient facility if he was still showing signs of discomfort. 

When Jan seemed more relaxed, I walked over to stand beside Gloria.  Allyson, the hospice social worker, arrived.  She entered the room with open arms and gave Gloria a big hug, one of those long squeezes that show genuine concern.  Gloria closed her eyes during the embrace, and when she opened them, tears were in her eyes; Allyson had reached the sadness and some tension was relieved. 

Jan’s phone rang.  It was our hospice Chaplain, Mi Sook, calling to offer support.  There was a warm feeling inside me, pride in our hospice team, an awareness of the compassion coming from the human heart.  We were all working together to relieve more than the patient’s discomfort.

After an hour of giving the medicine and other interventions, he was comfortable.  Jan said she understood what to give him, so I left the home.  Allyson stayed to continue emotional support. 

I turned up the volume on my car radio while I drove to the next patient.  The song “Stand By Me” was playing.  I sang the words out loud, “If the mountains should crumble to the sea, I won’t be afraid, as long as you stand by me.”  Goose bumps appeared on my arms.  It was like some fabulous epiphany had just come to me.  This is what hospice is all about.  Our nurse practitioner stood by me, I stood by the daughter, our social worker stood by his wife, and our Chaplain stood by the daughter, and on and on.  It was beautiful!  

As I pulled into the driveway of my next patient, my cell phone rang.  It was Allyson telling me the patient had just died.  I return to the home for the death visit.  Jan was thankful her dad was no longer suffering.  When the funeral home director was on his way, Allyson and I left the home.  Walking to our cars she exhaled loudly and said, “That was so intense.”  While Allyson told me the story of what it was like to watch the patient take his last breath, I thought about the song, and with little bumps on my arms, I faithfully stood by her. 

Submitted by: Susan Randall, Hospice: Montgomery Hospice

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