Sep. 19, 2017

The Talk

I’ve worked in nursing homes for almost twenty years. I’ve dealt with dementia, Alzheimer’s, Parkinson’s and so much more. I think it goes without saying that I’ve also dealt with death, however, my way of handling it was not like the others.

Impending death has distinct symptoms. The patients’ eyes will glaze over which is often referred to as, “the death gaze” and their breathing changes. Although the medical term is called rales, in laymen terms it’s called, “the death rattle.” Some patients even begin a molting process where there is no blood circulation. Usually it begins in the feet and their skin turns a pasty white.

The most phenomenal thing I’ve ever noticed was the distinct smell of death. Some of us could literally smell Death and his scent in the hallway days before someone took a turn for the worst. We may not have known who Death came to collect at the time, but we usually knew he was there.

Whenever I came on the floor and was told someone would most likely pass on my shift, I would go down to their room and have a talk with that person. I calmly explained to them my situation.

“I do not handle death very well,” I would explain. “Please wait until in the morning after I’ve gone.”

At first, the other nurses would laugh at me … at first. They quit laughing when they realized it worked with me. After witnessing this for a few years, some of the nurses referred to it as ‘the talk.’

My nursing assistants, who worked the graveyard shift with me, were the first to quit laughing. They would often instruct me, “Now go on down there and have ‘the talk,’ with Mrs. X so she doesn’t go on us,” (They hated post mortem care).

In all of the years that I worked in geriatrics and nursing homes, I have had maybe ten patients die on me. That is amazing if you consider the odds of people passing away and the number of patients that I’ve cared for in that twenty year span of geriatric care. That low number alone tells me my theory works. Since hearing is the last sense to leave us, I was sure they heard my pleas.

I recall one patient I went in and had ‘the talk’ with. She had been holding on for two days already. Even so, I was sure my chat with her would be just as effective as any other day.

“She’s just waiting for you,” Jennifer snickered as we counted on/off shift narcotics.

“We’ll see about that,” I responded and promptly went to the room. I said to the patient, “I know Margaret is your favorite nurse and you’d like to say goodbye to her. She works in the morning so please, just wait for her. She’ll be here at 7:00.

That talk was on a Friday night. Margaret didn’t come to work Saturday. I did it again, Saturday night and again, Margaret didn’t come to work on Sunday. I was nervous as I repeated my request that night and when Margaret didn’t come in on Monday, I decided to look at the schedule. She was off until Tuesday morning. She had a three-day weekend.

I went in to explain the situation. “I know I said for the last three nights that Margaret would be here in the morning and she didn’t show up. According to the schedule, she’s going to be here for sure this morning. I promise she will be here and on time. Just hold on.”

The patient had already been holding on a total of five days so, needless, to say, I was pleading with her. It didn’t work, though. Around 5:00 that morning, she decided she had waited long enough and it was time to leave us. When Margaret came in, I told her what happened.

“Well, she held on as long as she could,” Margret sympathized.

“I think she did it out of spite because she thought I was lying to her,” I admitted with a chuckle. “I didn’t mean to lie to her, though.”

I believe my worst experience was during the spring. The aides came to tell me that our newest patient had passed away in her sleep. It was a sudden thing, absent of all impending symptoms of death. Even his odor escaped us. She was just gone almost as fast as she came to us. As I went to call the doctor, I realized it was Mother’s Day.

I called the Assistant Director of Nurses and told her what happened. “Did you call the family?” Martha asked.

“No, and I won’t, either,” I responded.

“Why not?” she asked confused that I refused to make the call and notify the family of the death. “I know patients don’t usually die on you, Michelle, but come on! It’s part of the job. Why won’t you call her?”

“Because, it’s Mother’s Day and I will not call her daughter and tell her today that her mother has died. If you want to wait until tomorrow, fine. I’ll call her then, but it will not be today.”

Martha made the call. When Margaret came in that morning, I told her what had happened during our report.

“I just couldn’t call her on Mother’s Day and say ‘Your mom just died, Happy Mother’s Day!’ I just couldn’t do it,” I explained. “Not today of all days. You know what else? I can’t believe she died so suddenly, either.”

“It’s okay, Michelle,” Margaret said sympathetically as she patted my back. “You’ll have to forgive her. She didn’t know the rules or that she had to wait for ‘the talk’.”