"I Could Never Work In Hospice"

Almost invariably, when I tell another nurse that I worked in hospice, I hear the same thing: "I could never work in hospice!"

My first job as a new grad was in the SICU, and back then I probably would have told you the same thing. I imagined hospice to be a depressing and hopeless place to work, and I never thought it could be gratifying or rewarding. After all, how could it be when all of your patients end up passing away no matter what you do?

The patient deaths I experienced while working in critical care were completely traumatic for me. I'll never forget the sickening cracks I felt the first time I performed chest compressions on a patient. I can't tell you how many patients' last words were "I don't want to die." It felt like I was going toe to toe with death himself, and I didn't stand a chance. I was stressed, depressed, and burnt out. 

My entire outlook changed with a single patient and her family. She was older, intubated, and on CRRT, so I had her as a 1:1 for all of my shifts that week. She had 2 adult daughters that were so, so close to her. I sat with them through the night shift, taking care of their mom and getting to know them. We laughed together, we cried together. By the end of that week, I considered them dear friends.

The unit I was on was amazing. We had an excellent team, and we really tried every single thing we could to help that patient. We fought for her, and we fought hard, but by the end of that week we could see that it was a wasted effort. Our patient was dying. Mom was dying, and I had to come to grips with that. Then, I had to break the news to my dear friends.

There were so many tears shed that night. I held their hands, tears running down all of our faces, while the doctor explained what a DNR is to them; when he explained what terminal extubation means; when they finally signed the papers that meant the end of mom's life. 

I was with them when they held her hands, saying their final goodbyes and singing Amazing Grace while mom took her last breath. I fell to the floor with them, doing my best to hold them together while their hearts shattered.

I fought against the hospital administration that tried to rush mom's body out of the room instead of allowing time for the last family member to get there and say goodbye. I made sure that she could be picked up by a close family friend and funeral director instead of having to spend time in the cold, clinical hospital morgue. 

That patient was intubated when she got to my unit, so she'd never actually spoken a word to me, but she became one of the most important patients I've ever had. Looking back, her death was the most profound experience of my hospital career.

Losing her really did break my heart, but I am so eternally grateful for it. I am so thankful that I was there to hold her daughters while they grieved for her. I am so thankful that her last moments were Amazing Grace instead of broken ribs. I am so thankful that she was my patient when she died.

Very soon after that, I left the hospital and went to work for a home health hospice company. I lost every patient I had, and I am still so thankful for it. I'm not glad that they were dying, but they were going to be dying anyway so I am so glad that I was able to be there for it. Their families were not alone. I made sure they were comfortable, I eased their pain, and I protected their dignity. I held hands. I shed and wiped tears. There were times I stayed with them all night just to be sure they weren't alone in their last moments.

It was sometimes completely exhausting and emotionally draining, but I cannot begin to express the relief I felt from the burden of trying to save a patient that death had already claimed for his own. I didn't have to be a nurse anymore. I got to be a nurse.