December 05, 2009

Name: RN Clara Hart
Posting date: 12/5/09
Stationed in: a military hospital in the U.S.
Email: [email protected]

End of life, withdraw care, comfort measures -- whatever nice euphemism you want to use it all means the same. We are going to remove the breathing tube, disconnect the vent, turn off all the life sustaining medications and devices and allow you to die.

Twice in my last three shifts I have done that. With two separate patients and two different families. The strange thing is I don’t remember the faces of my patients. I remember the families, the encouraging words I said, and the arms I opened to hug the grieving. But I don’t recall the faces of those I cared for. Is there something wrong with that?

I asked my significant other that question. He’s far away fighting a war and I see his face and hear his voice on my computer screen thanks to webcam and video conferencing. I tried to explain it’s not really the patients we are taking care of at that point, but rather the families, who now require all of our attention. I spoke of the drain on our psyches caused by engaging with so much emotional energy. He understood. He even said the same words at the same time as I did.

After my most recent patient died, I quietly tapped on the door in which a husband sat in sorrow. As I slowly entered the room I saw him standing at the bedside of his deceased wife combing her hair. “I’m not very good at this, but she always liked her hair to look pretty,” he told me. Wordlessly I walked to the other side of the bed, and with tears streaming down my face helped him comb her hair.

Then I left him alone with her and walking silently from the room found my coworker standing in the hallway. He came over, wrapped me in his arms and held me while I cried. “I’m glad it was you taking care of her today," he told me. I simply stood there, numb. As my day ended and I changed out of my scrubs in the locker room another nurse stopped to ask if I was okay. I nodded my head. “That family was lucky to have you as their nurse," she said. "You are so good at that.”

“That” being end of life care. I don’t want to be good at “that."  It means I have done it far too often.


Sounds like a coping mechanism... I very nearly lost my wife last year in an ICU. The doctors had started their peaceful termination protocol or whatever they called it, but she decided to get better anyway, and survived. She is in the hospital a lot, I have learned a lot about coping.

I am reminded of a MASH episode where Margaret had chewed out a nurse for being soft, and then had a breakdown herself after a camp dog had been run over.

God, Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

It's been awhile since we chatted here or on the phone Clare. When last we did I live in Georgia. Since retirement, have moved to a ridge in the Ozarks of Arkansas.

As you may remember I was with a Hospice in Georgia. Am now connected to one here and have the honor of supporting folks there, especially our Vets.

I agree with Phil and the Serenity Prayer. It has helped me and countless others when in time of need.

Sometimes we feel helpless as Caregivers yet we know in our hearts we have given the best we can. For me, it has been an honor to be with the Vets (and others) when it's time to go Home. I'm reminded Life is Eternal and that the time here on Mother Earth is but a part of that.

Clara, I am so, so happy you have 'hung in there' with the job you've chosen to continue.

Yes, there are those moments we have to take a brake and find time for the Self. I'm glad you know that and do it.

May you have Peace, Love & Happiness in your Journey.

Although you may not feel it at times, Clara, God has given you gifts. The gift of compassion, the gift of empathy, the gift of love, and the utltimate gift of unselfish service to "the least of these".
Turn to him for the strength to sustain you and comfort you.
Life is eternal, love is imortal, death is a horizon, and a horizon is only the limit of our sight.
Thank you from the bottom of my heart for your service.
You are in my thoughts and prayers.
Rev. Cara

Of the five toughest people I have met in my life (and I have worked with SEALs, Rangers, SAS, SBS, and the French Foreign Legion) one of them was my Mom, an emergency room supervisor at the only trauma care facility in our county. To give the extraordinary care that you nurses provide takes a toll that only another nurse or close family member would understand.
I’ve written you before to say how much I respect you and that you are in my prayers. At the end of my life I hope that someone comforts my daughter, hugs her tight as I won’t be able to do. Because death just doesn’t terrify me anymore; the sorrow I feel is for the people I love and who I want to be the shoulder and hug that are always there for them. You serve that purpose at the end for those who are departing, and surely God looks down at you as one of his special angels. Hang in there Kiddo.

Hi Clara,
We have lamaze classes for the start of life, but nothing really for end of life. There is one book that I found really helpful: The Dying Time: Practical Wisdom for the Dying and Their Caregivers, by Joan Furman and David McNabb. The day you are no longer moved to tears when witnessing someone else's sorrow is the day you should leave nursing. Until then, empower yourself to cope: rejuvenate through leisure and exercise, divert your focus with a 'time out', use positive affirmations (no doubt the universe is unfolding as it should), socialize with others, play cards, learn something new, reconnect spiritually through your own cultural practices or those of others.
Be Well, Clara. Compassion fatigue is a real phenomena of secondary trauma. Your partner at the VA, Merri

Glad to know that you are still standing watch, and that you bring me along to what I never get to see or cry over on the rest of the internet or television - you remind me that I am still a little bit of a human being, it feels so good to be sad for all the right reasons, it is good to care.

I was wounded in Iraq in 2007. Thank you for what you do, and for being good at it. I doubt that you're good at it just because you've had practice - I suspect that you're good at it because your soul knows how to heal people in these situations. Maybe if you thank whoever you think is responsible for giving you that gift, God or the Universe or your own soul, it will help fill you up with love for yourself and strength to keep doing what you do. I bet there's a lot of people out there thanking you from the bottom of their hearts for being there for them. I know I do that frequently, sending prayers of thanks and strength to all the doctors and nurses who made my recovery possible and bearable. Again, thank you for doing what you do.

Wow...powerful and I am sitting here with tears and wanting to say so much with no words wanting to come out of these fingers. You are amazing, and although you would rather being good at something else. This is your calling, you must be a gentle kind soul and the families are lucky to have you. It seems you have a great support group yourself.

It may be hard to be known as good at the end of life care. It sometimes means the most. My grandfather passed in August. He had 3 nurses for the one week of care he was in the hospital. The one nurse we were very appreciative for how great care she gave. When he started to decline in the middle of the night she called. We arrived too late and he has passed. She was waiting at the elevator for us when we arrived. Her comfort ment the world. It really did help in a small way know that she was there.

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