The actual moment of death… the second that the heart, after years of repeatedly doing the same rhythmic movement, stops.
The final breath… this can vary… as sometimes, it can be abrupt and just as regularly as one is breathing, suddenly, they stop. There could have been some warning signs – some pauses….which as crossing over grows near, they grow longer. Until finally…the breath never returns.
In other situations, the last breaths can be dramatic… something called agonal breathing. This tends to be loud, groaning and unsettling breathing. The final gasps of a dying body.
Some have a “rattle” or secretions in their throats. It’s typically quite loud and can be haunting. With the swallow reflex gone and the throat muscles too weak, our loved one is too weak to help pass them down the throat. It might sound horrific, but, that’s only to us. Medications can’t and won’t help that. But, repositioning and oral care will.
I remember the first time I saw a patient die. It was many moons ago and I was still a baby nurse working on a Med Surg floor. The patient had a ruptured abdominal aortic aneurysm and was sent up from the ER to a room to pass away peacefully instead of being in the chaos.
He arrived to the room, moaning slightly. But, it wasn’t the moan of pain. His hair was salt and pepper, to be honest, more salt, and slightly damp as I reached over to fix a wayward strand. His eyes were blue – a deep dark blue like the Mediterranean in summer. They were only partly open. I introduced myself, what he didn’t know was I literally had to push my knees against the bed to prevent them from knocking because I was so nervous.
His death was imminent. Not like this week or tomorrow imminent. Like in the next hours or minutes imminent. I tried explaining to charge that I had never dealt with a death before but, she smiled and said “Got to start sometime, kid!” I remember telling myself over and over to be calm. Piece of cake. People die all the time, right?
My aide helped me slide him from the stretcher to a bed as gently as we could. I tried to explain everything as we were doing it but, I never did get much of a response. I don’t remember exactly what happened, but the aide was called out of the room urgently and I began assessing vital signs.
Blood pressure cuff on and pumping up. I placed my stethoscope around the area of his heart and began to count the beats… 10, 11, 12, 13……… silence nothing…. no beat… my eyes had been closed because of course, closed eyes helps you hear heart beats better, snapped open and looked up. As my eyes found his face, it was almost as if there was some magical hourglass that was sitting out the color in his skin. In an instant, the rosey tone dripped out and a distinct (I didn’t know this at the time) color that can only be described as death took its place. His lips went instantly pale. I knew he was gone but for some reason I kept moving my stethoscope around thinking I could find a heartbeat somewhere.
Suddenly, I heard something and got way too excited.. it was just his belly… growing and making noises. “Dummy!”, I thought.. confusing belly sounds for a heartbeat. Hey, I was a newbie. I called out for my charge nurse, who called for a doctor to come and make the pronouncement. The poor guy’s family hadn’t even made it up from the ER before he passed, so, finding them to let them know was not exactly fun.
That day also taught me about post mortem care. Most people shy away from it. For me, it is almost like the last gift or the last act of respect you can give to the one that has passed. Sending them off, with dignity …
This particular blog entry came about because of a discussion had with a friend, a fellow nurse, who told me how terrified she was about death. She has been a nurse for a while and has never been witness to a death. Each death is different and no two are ever the same. But, there are some threads woven through the tapestry of every death. By talking about and sharing our experiences with death and dying, maybe the next baby nurse (or not so baby nurse… or not even a nurse) won’t be so terrified about what happens at the moment of death.
It’s ok to be afraid.
It’s ok to be nervous.
I have been a nurse for a long time and have been a hospice nurse for almost 2 years … guess what?
I still get nervous.
I still get afraid.
I’m less nervous and afraid but I think if the time comes when I am not nervous or afraid, I should retire my stethoscope.
Through communication we can peel back some of the layers of fear around the act of dying which those witnessing it experience…