As a nurse, I have always felt particularly called to give care to people at the end of life and do what I can to comfort and support their families. Where I grew up in the country, people sometimes talk about babies being “marked” by experiences of their mothers during gestation. Perhaps I was “marked” to care for individuals exiting this life because I was conceived and born while my mother (a nurse) cared for her mother as she died of cancer—a process that was initially expected to last 6 months but became 4 long years of in-home care. My mother was the youngest of 14 children and, as a nurse, was also the natural caregiver for many of her siblings through illnesses and death. As such, my childhood was spent in close proximity to the “human condition” at one of its most basic levels: caring for the sick and dying. This stands in stark contrast to the lives of many student nurses whom I have taught over the years. It is common to encounter students who have never seen a dead body or even attended a funeral, much less been present at the moment of death. Students often encounter death for the first time in nursing school, or even in post-graduation nursing practice, and may find caring for those dying to be distressing. For me, it was always an expected and accepted duty, as well as a privilege, to care for family members through their last moments of life. When I became a nurse, this also translated into viewing caring for dying patients as a privilege.
My first direct experience with being a nurse and family caregiver came with my mother's death in the early 1990s. My mother passed away in a way that probably conformed closely to her “second best case scenario.” Her own father dropped dead in a field while plowing with a mule and she always said that this was the best way for the individual (i.e., a sudden, quick passing), but hard for the family; I think that would have been her first choice for the “way to go.” She was not that lucky. She had a lingering cough and shortness of breath that were originally diagnosed as pneumonia, but that she suspected of being lung cancer long before her physician did. Upon admission to the hospital, my sister (also a nurse) and I discovered that mom had hidden weight loss by padding her clothes and hidden her waning strength through multiple clever ploys. Having cared for her own mother through a prolonged death from cancer, as well as a beloved brother through chemotherapy, radiation, and a lingering and painful death, she was adamantly opposed to and fearful of being subjected to those same treatments.
Anita and her mom in 1986. Photo courtesy of A. Tesh.
Mom did not get a sudden death and did not die at home, which I know she would have preferred. However, she had a dignified death in which her wishes were respected. Upon entering the hospital, she was admitted to the intensive care unit, but was transferred to a regular hospital room at her request. She was given oxygen and a morphine drip to ensure comfort (at that time and place, in-home morphine drips or other adequate comfort measures were not available), and died with her two daughters at her side. My sister and I were able to provide her physical care and comfort needs during her last days; we stayed with her around the clock and ensured she was not disturbed for blood draws or other unnecessary procedures that would not change the imminent outcome. This required only mild advocacy because the hospital staff at all levels were eager to support her and us in this journey. I am proud to say that this attitude on the part of the hospital staff was initiated and promoted by nurses.
Mom's last words, mumbled within an hour of her death, were a soft “I love you, too” in response to our “Mom, we love you, we will miss you.” However, my sister and I had the sense that she was only minimally still present with us; most of her essence was directed toward her next journey. When she passed, it was gentle and peaceful. My sister and I sat with her for approximately another hour, then prepared her body for the funeral home. All of this was hard to do: sitting by her bed through those long hours, caring for her wasting body, letting her go, and placing that long list of phone calls, saying “it's over.” However, it was also the final, most profound and most loving gift we could give her, and I will be forever grateful to have had the opportunity. It was my duty and privilege, and it was also a gift that I had the chance to be with her at the end, see her wishes followed, and personally attend to her comfort. This has been a source of great strength to me over the years. Rosa (2014, p. 2) wisely said, “Nurses know the human truth that every moment contains a lifetime and, in that, an opportunity.” Being a nurse at the moment of my mother's death, I had the opportunity, knowledge, skills, and abilities to attend to her needs and wishes. Being her daughter, I had the loving will and courage to do so.
- Rosa, W. (2014). Nursing education: The marriage of mountaintop and marketplace. NLN Report, 21, 2–3.