People often ask “How do you do what you do?”

Blog Post #2

Hi. Me again. Welcome back to Kelly’s Blog

People often ask us “How do you do what you do?” “Why? It must be awful seeing death every day….” I accept that we are a unique band of nurses, its true. We’re deep emotional creatures. Armed with a common thread of quirky humour and an extensive clinical knowledge of our field. Fiercely supportive of one another and the families we care for. But that neither answers nor explains the “how” or “why” we do what we do. We do what we do because, in my view, there is nothing so humbling, so empowering or as exquisite as being part of a beautiful End of Life journey.

Not everyone gets the chance to plan for their End of Life. Those that do choose a myriad of pathways. Some choose to go down swinging, fighting to the last moment. Some surrender to the powers that be and let it unfold as it will. Some choose the fast train, all action and bright lights and noise, stopping at all stations in a carriage full of others in the hands of a faceless but qualified conductor. Others choose a gentle gondola ride through familiar streets, dim lights, soft music with friends and loved ones at the oars…. Opening and guiding conversations and helping people work out and plan for their own End of Life transition is just incredibly rewarding work. What ever the person chooses, it is just the best feeling when they get to fulfill their chosen path.

I am reminded of a patient in Boreen Point. A wonderful woman who was in and out of our sights for several years as her battle with cancer waxed and waned. A spiritual woman who had explored every twist and turn in this mortal coil. She went deep. But inevitably she reached a point in the trajectory of her disease where the end was in sight. Her liver was failing. Her body was saying “I’m done….”

I arrive at the home with the knowledge that this woman is not long of this world, maybe weeks, likely days, and she wishes to die at home. Boreen Point is remote in regards to swift response health care. You can’t even get bread and milk after 7pm, let alone a doctor or nurse. Her Daughter and Granddaughter have arrived and will stay “to the end”. Our patient is at this point mobile, alert and independent in her intimate cares but she is heavily jaundiced with marked ascites…it won’t be long before these blessings of ability to self-care will no longer be hers.

I enter the bedroom where our patient is laying in bed, her Daughter and Granddaughter at her side and at her feet. I’m struck with an image in my mind of three pale frightened faces peering up from the bottom of a well. It’s heart breaking. Everyone in the room knows why I’m here. I’m a palliative care nurse. I’m here to talk about dying. And so, we do. We talk about symptoms and how we will manage them. We talk about activities of daily living, like washing and toileting and how we will manage them. We talk about equipment that will ease the physical burden of care, which Little Haven will provide easily and at no cost tomorrow at our next home visit.

We talk about medications and how they will ease symptoms and how they will be given. We talk about Advanced Care Planning and “getting affairs in order”. We talk about bodily functions and how they will respond to they dying process…and then… we talk about life… the past, the future…and emotions…love… fear… loss… grief…

I leave the house that day with a list of clinical chores to attend to. Equipment, such-as a shower chair, a commode for when toilet trips become too far, over bed table for creating a little micro space of special and essential items, slide sheet for assistance moving Mum around the bed as she becomes too weak to make these physical adjustments to comfort herself, and a few sundry items that complete a clinical care space in a domestic setting… Faxes and letters to the GP for scripts and Standing Orders in place for safe and appropriate management of anticipated symptoms…. A nursing schedule that ensures daily visits and 24hour support over the coming days.

I return the following day. The image of three pale frightened faces peering up from a well is gone. Instead, I am greeted by the same three faces resolute, bold, and despite their fear, prepared to face the inevitable and imminent parting of their Matriarch. I am honoured when the Granddaughter voices her gratitude for yesterday’s conversation and how they feel ready, prepared and able to give their beloved the death experience she deserves and desires.

I’m struck by an image of a vast calm lake of depths unknown upon which three women float. I am confident that when one fails, as she must, and slips away, the remaining two will eventually strike out towards the shore.

My Sister in Nursing, Amy, was the Little Haven Nurse that attended the final moments of this particular patient. They played out over a weekend and culminated with the patient gently and graciously passing from this world into the next. Amy attended and sat with the family and held the space as death moved on and grief moved in. She guided the family as they tended their loved one’s body for the last time….and she provided documentation required for under takers to begin their role in End of Life business and our patient left her home for the last time.

Amy also takes joy in the knowledge that this daughter and granddaughter will sit upon the shore of that great lake and revel in the pride that they richly deserve, calm in the knowledge that they gave their beloved a good death. She died as she wished to die. Calm and comfortable in her own home surrounded by loved ones confident that after she passes, they will be supported and comforted.

Little Haven Social Workers and grief and loss counsellors, Lisa, Karen and Jodi will sit on that shore with our bereaved clients for as long as they need. Sometimes we nurses return to particular patches of sand where we left our departed clients and we find their loved ones there sifting through sand and pearls with one of our beautiful Social Workers. We’ll stay for a while and help sift… and then move along the shoreline and strike out onto that lake “do what we do”. We give people the confidence to choose to die at home.

That is how and why we “do what we do”… and it is an honour. 

Next time I’ll chat about little victories.  ‘Till then…. Bless.