Dying With Grace And Courage: A Nurse’s Role
Abridged Article by Vonna L. Smith, RN © 2017 All Rights Reserved.
"In genuine feeling, the deeper it is, the more ambiguous it is. In genuine art, the deeper it is, the deeper the ambiguities." These words of Brother David Steindl-Rast remind me of the chord that can so masterfully be struck with a solo piano or violin. They call to mind the soulful resonance of the Irish whistle and the heart-wrenching sound of the bagpipe. Music that is richly ambiguous has the ability to elicit feelings of joy and sorrow, simultaneously. This story, in a way, is about that sound.
Jerry was 61 years old. He was a tall man with pale blue eyes. His hair, although grayish, hinted at having once been blond. Finnish/Irish he was. He successfully managed a large real estate firm. He had also created a remarkable family. Jerry and Joyce had two exceptional sons, Mike, 35 and Pat, 31. Both were married and Mike had a baby girl. Both were slender and tall like Dad but they had the dark Spanish eyes of their mother. I was Jerry’s nurse.
Jerry had a history of glomerulonephritis that resulted in chronic renal failure. During the last couple of years he had been managing his own peritoneal dialysis and enjoyed the freedom this method allowed compared to hemodialysis. He came to the ICU after suffering a ruptured abdominal aortic aneurysm, which was repaired emergently.
I soon took a personal interest in Jerry and developed a privileged bond with him and his family. Jerry was in my care day after day, stretching into weeks. I worried about him on my days off and hoped that upon returning I’d find him faring well. Joyce stayed for long hours every day and would go home to rest near the end of my shift at 11:00 PM. Jerry’s course was stormy with numerous false starts toward recovery. Following his initial post-op extubation he was re-intubated and returned to a ventilator four times. This repeated dashing of hope was tearing Joyce apart.
On Mike’s birthday he and Joyce were at the hospital and had taken a cafeteria break when suddenly they heard overhead, "Code Blue. Room 3020." Jerry had suffered an iatrogenic hemothorax during the insertion of a subclavian Quintin catheter for hemodialysis. As a result of the hemothorax he ended up back on a ventilator with a chest tube. After the “code” the family was afraid to leave Jerry alone. Joyce always stayed with Jerry through most of the day.
Although she spoke openly with me about what emotional turmoil she was going through Joyce kept her tears private.
For a while Mike and Pat alternately held vigil through the long nights. Pat's young, lovely wife, Stephanie, herself a pediatric nurse, often stayed late as well. Stephanie possessed an aura of gentleness that was captivating. She and Pat had finely tuned sensitivities. It was Joyce who told me that they were vegetarian in an effort to minimize harming. Stephanie told me that she was Catholic but that she had found Buddhism, as portrayed in the movie, Kundun, inspirational. When I met Stephanie she was toting the book, Teachings of the Compassionate Buddha. I was drawn to her.
Joyce was abundantly warm toward me, with her Spanish eyes, with her generous words, and with her touch. She once said, "Vonna's been with us so much she's part of the family." I felt honored and privileged to be in the company of these people.
Being back on the ventilator and unable to speak, Jerry spoke with his eyebrows, raising them in greeting. One day Joyce teased, "What's with the eyebrow's Jerry? Every time I tell you that Vonna’s going to be your nurse you wriggle your eyebrows! You stop that or I'll have to request an old, homely nurse in her place!" To this Jerry raised his eyebrows, as if to say, "What? What?" Joyce told me that I was their angel. I was moved to live up to her confidence and appreciation.
During his stints off the ventilator Jerry would do well on 2 liters of oxygen via nasal cannula. Both physiological and emotional/anxiety components contributed each time his respiratory status became compromised. Jerry survived the hemothorax insult and the code and was making nice gains toward recovery. In his last go without the ventilator he was extubated by me the evening of April 5th. I gathered figures to present to Jerry’s skilled and personable young surgeon, Dr. Florio, whom I called at home that evening with the hope of convincing him to let me pull the endotracheal tube. After presenting my data I asked with an expectant and hopeful tone,
“Can I extubate him?"
Vonna Smith retired from nursing in 2016 following a 39-year nursing career. 25 of those years were spent working in the ICU where death and dying were routine events. Vonna continues to use her skills as a hospice volunteer as well as being a member of a mission team that provides surgical services for needy people abroad. She'll be serving the team as a post-op recovery room nurse in Peru in May of 2018. Vonna completed the End of Life Doula Certificate Program at the Conscious Dying Institute in November of 2017 and is currently in the process of Facilitator Training for the Living Inquiries, which guides people through a method of meditative inquiry using specific tools for finding freedom from mental suffering and limiting beliefs.