the real goodbye

a few hours after i posted my last message, my friend, marian, called me from work. she's more than a colleague. she has become one of my best, most supportive friends. and she knows how i feel about nurse patient. that's why she called. i assumed that marian was calling to give me the same update that i had heard yesterday from my charge nurse friend - that nurse patient was starting dialysis, that she is getting sicker, and is now in multi-system organ failure. this in and of itself is bad news.

but today, there is more. marian called to tell me that nurse patient's husband and family have decided to withdraw care. what that means in laymen's terms is to "pull the plug," to take away all artificial life support and allow the body to slip away. i was shopping in eddie bauer when marian told me. i cried while pacing back and forth, blue dress in hand. i was not in shock. just utter disappointment. why did transplant fail nurse patient? why is she dying TODAY? when i am not only NOT at work. but when i had called in sick. because i am legitimately sick. and shouldn't be on my unit. "what should i do marian" i pleaded.

saying goodbye to a patient is hard. saying goodbye to their loved ones - harder. nurse patient would likely be sedated. i could squeeze her hand. say i enjoyed caring for her. admired her bravery and courage. that i will miss her presence. and because her eyes will be closed and there would be no response, it would feel almost safe. not easy, but not impossible. but to pay your respects to the living is beyond challenging. because there are NO words to heal that kind of loss. because everything sounds stupid. because loved ones can hear. and respond. because there are unconsolable tears. and silences. and sometimes there are questions that i have no answers to. but i knew i owed it nurse patient, to her husband (and family), and to myself to grieve and to say goodbye.

so i went.

and here i am.

crying at home.

sad.

the scene in nurse patient's room: nurse patient lying peacefully amidst a sea of pillows. her green and purple striped blanket hiding her swollen abdomen. tubes coming out of every orifice. a stuffed elephant to the left of her head and a stuffed pig to her right. a breathing tube protruding from her mouth. her husband cradling her body and stroking her head. her 18 year old daughter sitting nearby, but not too close, blowing her nose. her 13 year old daughter sitting in the corner, alone, crying. michelle, her best nurse friend, pacing back and forth at the foot of the bed. and her nurse, carolyn, charting at the computer.

all eyes were on me when i walked in. nurse patient's husband softened as we made eye contact. michelle looked at me kindly. carolyn (the nurse with whom i work) welcomed me into the room. i had nothing to say. so that's what i said. "i literally have nothing to say. i came to say goodbye. and to say how sorry i am that we cannot save nurse patient." her husband said, "isn't this a wild thing?!? [long pause] you don't have to say anything. just walking in the door says enough." i squeezed nurse patient's hand while sharing with nurse patient and her family that in the last three months, i have spent more time with her than i had with any other person in my life. that i have come to love nurse patient like a friend. and that i too feel devastated by this loss.

my heart was bounding out of my chest before i walked in the room. but somehow, once in there, i felt almost at ease and had plenty to say. i asked about the stuffed animals; nurse patient's oldest told me the elephant, babar, had been the patient's as a child. it became nurse patient's daughter's during her childhood and as we surrounded the bed, she picked babar up, put a paw in her mom's hand, and said "soak up all the love babar because you will forever remind me of her." i wept. i told nurse patient's daughters how brave they both were to be at the hospital, to support their mom during this time.

i stayed maybe all of 10 minutes. and when i decided to leave, i hugged each person individually. michelle i hugged mainly because she is losing her best friend AND because she is a nurse, just like me, and has likely felt this loss numerous times. when i hugged nurse patient's husband, he kissed me on the cheek and began to cry. he started to say that he can't thank me enough, that i made a huge difference in nurse patient's life. but i interrupted and said he need not say anything. i know he appreciates me; he so freely shared his gratitude on a daily basis and rejuvenated the loving nurse in me. my relationship with nurse patient and her husband likely ended today; but i left the door open and said if he EVER needs anything, he can find me on my unit. last but not least, i hugged her girls. i didn't want to make them feel awkward. but they both willingly stood up and we shared a three-person hug. i said, "i know i don't you very well. but i love your mom. and i am sad. i know she loved you. and i know you will be okay." the 18 year old let go rather quickly, but the 13 year old held on for dear life.

i cried as i exited the room. and waved to nurse patient's husband.

and that's that.

i will go to work tomorrow like everything is okay. there will be another patient where nurse patient lies now. her family will be beginning their grieving process. but mine, mine is supposed to be complete. they teach you in nursing school to have boundaries. to remain professional, you talk only about what is relevant to the patient and their care. you don't reveal information about yourself. the relationship should be one-sided. nurse nursing patient; never visa versa. but that's not what happens. that's not the way i nurse. in some way, nurse patient nursed me. she motivated me to come to work. to work hard. to love what i do and respect myself for a job well done. and i am proud to have developed a relationship with my patient. and i'd be happy to tell my nursing professors that my tears are not a sign of weakness or unprofessionalism, but instead, a sign of compassion and humanity.