Content warning: Death, Resuscitation, Suicidal thoughts
I mentioned in my previous post that on Monday last week I was admitted to hospital after an attempted suicide. I was a patient on the acute medical unit (AMU), which is usually the first ward that people get transferred to after being admitted to hospital via A&E. The typical patient on such a ward is elderly, perhaps with some respiratory or heart problems. There is a lot of noise – cardiac monitors bleeping, nebulisers buzzing, IV infusion pumps ticking – a lot of different staff members, and a lot of movement; the ward is bustling 24/7.
It’s very easy to get chatting with other patients if you’re in a bay with several bed spaces, because chatting passes the time, and time drags when you’re poorly and in hospital. I had lots of conversations with a lovely elderly patient opposite me, P. We entertained each other, kept each other smiling, and when it was time for me to be transferred from the hospital to the psychiatric ward, P said “I’m going to miss you.” I gave her a big hug, and wished that she would get well soon. “You take care of yourself, won’t you”, I said – a phrase I say when I probably won’t cross paths with a person again, but I know they’ll remain in my memory for a long time, and I genuinely want them to be well and happy.
On Tuesday afternoon, a patient was moved into the bedspace next to me. Gwen. Her daughter, husband, and 4 grandchildren all came to see her, concerned about their loved one but knowing she was in safe hands in the hospital. Gwen was having difficulty breathing due to a chest infection, and had to wear an oxygen mask as a result. She complained that wearing the mask was making her too warm, and kept taking it off to “get some air” – bless her. She really enjoyed eating some ice cream for pudding, which she ate before her main meal – this made me smile. Her family left at around 8pm, her grandchildren each saying “See you tomorrow, Nan.” Those four little words would later break my heart.
At about 10pm, Gwen started sounding very chesty, as though a big cough would bring up a lot of rubbish from inside her lungs. Her oxygen mask had been switched to a nasal cannula, so that she was less likely to pull the oxygen supply away, but she was definitely still struggling with breathing. The only way I can describe the sound of her breathing is by saying it was the same noise as when you blow bubbles into a glass of fizzy drink through a straw. It got worse and worse, and I realised that she couldn’t just cough it up – she tried to say something, but it was incomprehensible; it sounded as though she was talking from under water.
It sounded like she was drowning.
My memory is jumbled up, so I’m not completely sure of the order of events that followed, but the concerned words of the team of staff have stayed etched into my mind:
“Oh sweetheart, your chest sounds terrible doesn’t it”,
“We need to get a blood test”,
“Let’s sit you up a bit, Gwen”,
“I can’t get any blood from her”,
“Could one of you call her next of kin, now, please?”
Very quickly, it became serious:
“She has no radial pulse”,
“Come on Gwen, let’s try and get you back”,
“We have a carotid pulse, but it’s weak”,
“Have they called the next of kin?”,
“She’s crashing again”
“We can’t get in touch with her husband, we’ve left a message and we’re trying her daughter”
“I don’t think we’re going to be able to get her back.”
And then the final words:
“Are we all in agreement to stop CPR?”
I’ve never witnessed death before. I tried to reassure myself that that wasn’t what had just happened; I listened out for the under-water breathing sound, tried to convince myself that I could hear it, but I knew I couldn’t. Tears had been silently rolling down my cheeks since I heard “Could someone contact her next of kin, please”, but after the agreement to stop CPR, I was sobbing. Silently – staff were clearly so busy and I didn’t want to distract anyone from more important duties – but I was doing the type of crying that takes your breath away so that your chest starts to uncontrollably convulse. I’ve imagined and wished for my own death plenty of times, and of course I’ve seen the dramatic deaths portrayed in hospital dramas on television, but I never thought death could be like this.
At 10pm, Gwen was struggling to breathe slightly more than she had been for the rest of the day, and staff were a bit concerned. By 11:15pm, she was gone. It happened so quickly. I didn’t think death could occur so fast.
The nurse in charge, the ward Sister, popped her head around to my bed space – all of the curtains around our individual bed spaces had been closed whilst the fight to keep Gwen alive took place, to protect us, to preserve her dignity. Sister was just wanting to check if I was OK, as I’d been suffering some chest pain earlier on in the evening. They’d done an ECG, and taken some bloods – and she’d come back to see how the pain was. I didn’t care about the pain any more, though, I was a blubbering mess thinking about poor Gwen and her family who probably didn’t know yet. Sister asked me what was wrong, though I think she knew already, and I just vaguely gestured towards my left – where the other side of the curtain Gwen’s body lay, lifeless. I just about managed the words “Her 4 grandchildren… they said… ‘See you tomorrow, Nan’…..” before I burst into floods of unstoppable tears. Sister grabbed a box of tissues and came to sit with me, a reassuring hand on my back, letting me cry.
“We don’t want you to know what’s happened, obviously, but you already do. She was a very poorly lady, and unfortunately tonight she just couldn’t fight any more”, Sister said.
I asked, “How is it fair that I’m sat in here, receiving treatment because I tried and failed yet again at willing my body to shut down and die? And right next to me, there’s a patient who fought so desperately until the very last minute, wanting to live and pull through, but she couldn’t make it?” Of course, there isn’t an answer to this question, because it’s not fair. “It’s just not your time yet, you’ve still got some life ahead of you”, was all sister could say to me.
“Nurse, how do you do this? How do you manage to get through this without breaking down every time it happens? How do your team come together like that, try to save a patients’ life, and just cope when it’s not possible to?”
“We have to”, she said, “I love being a nurse, but in doing this job we have to be prepared to handle both life and death. You must think I’m so cold, because I’m not visibly upset, but it does hurt us, too.”
“I don’t think you’re cold – you must have seen this so many times, and you’re all angels, you nurses and healthcare staff. I just can’t get my head around how you cope with it. I feel silly, for being so upset, when you witness this type of fight every week.”
“If I was poorly, in hospital like you are right now, I’d probably be broken down, too. You’re not silly for being upset, you’re human. It’s heartbreaking, and it breaks our hearts a little each time too.” She reassured me, making me feel less guilty for how much it had upset me. “But we have to carry on. We’ve got the rest of you to take care of, we need to make sure all of you are OK. So we cope just because we have to. We cope because we learn how to, in time.”
The actions I witnessed from the staff following Gwen’s death will stay with me forever. I heard several members of staff talking to Gwen whilst they cleaned her body and made her as peaceful as possible, calling her by her name, calling her sweetheart, just like they did with every patient in their care. Just like they did with me. I suppose that must help the staff cope in a way, too, treating her in the same way as they would should she be alive. They showed more dignity and respect and compassion than I could ever have imagined, consistently talking to her: “Let’s put another pillow behind your back, Gwen, make you as comfortable as possible.” “That’s it, sweetheart, let’s lay you back down.” I sat listening to it all, sobbing, I just couldn’t get the tears to stop. I was awake for hours, I definitely remember seeing the clock hit 5am, replaying the events of the evening over and over again. Sister kept checking on me, making sure I was OK, asking me if I wanted hot chocolate, asking me if I needed to talk. She genuinely cared about how I was feeling, and it was heartwarming that even though something so tragic had just taken place, she was still the kind and caring nurse in charge of the shift who just wanted to make sure all of her patients were OK.
I got up to go to the bathroom, and I must have knocked the curtain slightly because on my return there was a slight gap visible between my bed space and Gwen’s. I instinctively looked through it – I didn’t have time to think – and I saw Gwen. I was shocked, I looked away, but then I realised that she looked comfortable. She looked like she was out of pain. I’ve never seen a deceased body before, and seeing her in the moment was absolutely accidental, but it was comforting that she looked at peace.
I think witnessing the death of Gwen awoke a feeling in my mind that I hadn’t felt for a long time: Life is fragile. It’s really, very delicate and it can be stripped from us at any given moment. At the click of a finger, or the drop of a hat. It seems terrible that I had to observe something tragic for me to remember this, but if Gwen’s death taught anyone anything, it taught me to be thankful – for the life of my friends, of my family, and my own life. I looked at my body, still recovering from the pills, still hooked up to various machines and monitors and infusion pumps, and felt a sense of gratitude. I’m still not sure about the future, and whether it exists for me, but I’m certainly aware that my body is sturdy. And for that, I should be grateful.
I can say with confidence that Gwen had the very best care from the nursing staff, right from the time of her admission until her last moments and beyond. The staff were fantastic, and I’ve passed on my compliments through patient services at the hospital, because their actions really were commendable. I’m almost certain that her family will have been grateful that the lovely ward Sister and the rest of the team were right by Gwen’s side at the time of her passing, because they handled it so perfectly. Nurses really are angels. The fact that it happened so quickly is a blessing in a way, because she wasn’t suffering terribly for a prolonged period of time. But the words “See you tomorrow, Nan”, spoken so reassuringly and with such certainty by her grandchildren, have truly broken my heart.