A Messenger of Joy

It is an honor to be of service to patients and their families, especially in supporting them while the person passes on to the next world.

To an experienced and organized nurse, having a death on ones shift is an event one can be well prepared for. Experience tells us, for example, that it is an advantage to have a mortuary previously selected, because a newly-bereaved family member can find choosing one at the last minute too overwhelming. So as nurses we have learned things which make everything go more smoothly.

So, even though I sometimes say [to myself or staff], "Don't die on my shift," it's not too difficult an event to deal with. At the previous nursing facility where I worked, a woman was on hospice, had some falls during her stay, and as she was currently dying [hospice folks sometimes use the word "transitioning"-- I don't know why], had sublingual atropine drops to help control oral secretions. The family in California phoned that evening to see how she was, and instructed me to tell her to "hold on until the weekend," as that was when they planned to visit. She did not hold on, but had a couple of atropine drops, a harmless dosage, and quietly passed on.

The family freaked out, questioned the atropine drops [as a different dose and route can be used as a potent medication for cardiac events]; brought up her history of falls; demanded a head-to-toe x-ray and a full autopsy. Guilt. The assigned physician phoned the family and sorted them out. Things can be a little rough.

So. At Homeland yesterday, "Mr. Scot" transitioned away from us into another realm. I had a particular affinity to Mr. Scot, as he was two years older than me but wasting away from cancer mets to the brain when he was admitted to Homeland from Harborview on Hospice care. Over the last two months or so, he lost a significant amount of weight, lost the ability to swallow, developed an open area on his behind which was unavoidable due to his lack of ability to take in nutrition and his cachexic [skeletal] condition. We managed his pain with morphine, which was appropriate.

At last he was failing, and died just before I came on shift yesterday. He had a non-related friend assigned durable power of attorney for medical and financial affairs, and a selected mortuary. The day shift nurse was from agency but had seemingly done everything she should: notified Hospice and the MD, and placed a "STOP" sign on the door to warn people not to enter. She had been unable to contact the POA, who came into the facility to see him just after change of shift and was informed of his passing. She asked us to delay phoning the mortuary until 5 PM due to expecting a friend of his from out of town who might wish to pay her last respects.

About an hour later, this friend arrived harried and breathless after battling traffic for two hours on the way down and getting lost trying to find the facility. She asked for Mr. Scot at the front desk [the agency nurse had forgotten to notify the receptionist] and breezed past the nurses station and the STOP sign, into his room, and right back out again, crying that he wasn't breathing. She was horribly shook up. We took her into the nurses station and sat her down, gave her tissues and water, and did what they teach in school as "therapeutic communication", i.e. listening to the person until they feel better. When she was ready to go I gave her a hug and directed her to the nearest Starbucks and some restaurants near I-5.

At five PM I phoned the mortuary, who let me know that a power of attorney appointment ends with the death of the patient, and asked if we had listed any next of kin. I gave the number for the POA, the number for the ex-spouse, and was asked if there were adult children. I said, names were listed but not numbers, and I had no idea of their ages. [This is often why people assign POA's: there are no viable next of kin.] The director said he would look into it and call me back. I pointed out that a significant period of time had passed and asked how soon they could pick up the remains. He stated that there was a law that he had up to twenty-four hours to collect the remains. I said that I could guarantee this gentleman was not going to remain in my facility for any twenty-four hours. We were at an impasse.

I was whining about this to another nurse and she explained that a durable power of attorney means that the relationship continues after the patient is deceased. So I called the mortuary with this information. Over the next two hours I phoned the mortuary three times, speaking to the receptionist, to find out whether or not they would accept this patient. Finally I phoned the Hospice to explain the problem. I was talking with the social worker when the mortuary called and said they had spoken with the POA and would be on their way ASAP.

Meanwhile the CNA's discovered that the day nurse had forgotten to remove his Foley catheter. I had just finished with this task and was emerging from the room when the two morticians arrived, status-post teenagers in suits. They were courteous to me, I think because they saw me with a garbage bag in my hands and thought I was a flunky. They were quite rude to the other nurse, eye-rolling, probably thinking that she was the head honcho. Mr. Scot exited the facility 8 1/2 hours after his passing.

Anyway, I imagine Mr. Scot got a kick out of the whole thing.

"Death is a messenger of joy."

~Baha'u'llah