When We Do Not Start the Conversation in Time, Sometimes, There Are Just No Time for Answers:

Tonight I wanted to share from the first edition of my book, The Last Adventure of Life. It's one of the most powerful stories in the book - a poignant article from the American Journal of Nursing that came to my attention thanks to a hospice R.N. The nurse shares in this piece a thought-provoking incident she was a part of when she encountered a dying man on her shift at the hospital. More than anything he needed compassion, and yet she felt she was unable to provide this for him in his last moments of life. She may have provided more than she realized by her very presence, even though the hospital’s protocol left much to be desired. I found myself wondering how things could have been different for this man’s last hours on earth if he, his doctor, and his family had started a conversation about his death much earlier. Then, he might have been able to be on a hospice or palliative program when the following circumstance unfolded.

No Time for Answers: When Clocks and Heartbeats Pause

Mike Soreneson was the second patient on my initial rounds that afternoon: A man in his fifties, youngish but with a tired heart. From the doorway, I could see his distress. It filled me with dread. He was drenched with sweat and his breathing was labored and choked with rattles. Fear was in his eyes. I knew from a report that he’d already suffered two myocardial infarctions, and it was clear that his damaged heart, stretched and weakened from cardiomyopathy, was rebelling against its unrelenting workload.

It took just a nanosecond to sprint from the door to his bedside, apply the blood pressure cuff, and push the call light in frantic summons of the cavalry. Before it arrived, in those seconds that dragged with waiting and the taking of vital signs, he grabbed my wrist and turned his bewildered eyes toward me. Struggling to sit up, he whispered in a voice tight with panic, “Where am I? What’s happening to me?” There was no time for answers as he crossed quickly into the shadows.

Time can stop. It did that afternoon. In that diastole of realization—when clocks and heartbeats pause—I saw him wonder at things beyond my mortal edges. And then, in a finger snap, his eyelids flickered and drooped, and he sighed once before leaving me suddenly alone. Tensions and years eased from his face. He became youthful and handsome, with the promise of life seeming to stretch before him.

As he fell back slowly onto his pillow, the world rushed in: resuscitation, in its chaotic and technical splendor, took control. The room filled abruptly, people crackling with energy arriving together as if from the same train. White coats snapped like battle flags. The code cart, red and bulky, was pushed squealing into the room; a defibrillator and an electrocardiogram machine followed quickly around the corner. A leader barked orders. Sterile packages were ripped open and disemboweled. Mike’s body was stripped and assaulted with needles and tubes. White adhesive tape fringed the room, and us, in little strips, while drops of his blood, imbued with drugs that proffered false hope, rubied sheets and shoes. Paper banners snaked and curled around our feet, documenting the story of a dying heart in unemotional peaks and valleys. Then, straight lines. A life ended.

As the code stopped, I was standing where I started, next to a heart I had compressed and shocked yet never known. The cavalry scattered, as the empty room filled with the smell of defeat. I trembled with adrenaline, yet felt drained. After removing tubes, catheters, tape, and electrodes from Mike’s body, I covered him with a clean sheet and began to clear the debris. Strips of tape had wandered away on the bottoms of shoes to other units, other crises, as this corner of the hospital settled back into familiar routines.

A colleague helped with postmortem care. We talked of the code as if in instant replay, even sharing quiet, guilty church laughs about comedic moments. We didn’t speak about Mike. We didn’t know him. We treated his body with professionalism and respect, but without memories or words of goodbye. I didn’t tell her about his fear. I didn’t mention his last words. They somehow seemed too raw and private, still undigested in my mind.

For weeks after Mike’s death, his impersonal end filled me with sadness and regret. I wish I had comforted him in his final moments—did he recognize my detachment, and feel one final, mortal ache? In the many years that have passed since that afternoon, I’ve made an effort never to shrug away compassion. With every finger-squeeze of thanks, I was enriched. And I hope that when my death is near—before stepping into bright beginnings or overwhelming silence—I will feel a caress on my cooling cheek, or smell the salt of a single tear. Smiling, I will turn from the shadowlands to see someone who loved me, standing in a pool of soft porch light, hand raised in goodbye.                                          --  Pamela Sturtevant, R.N.

There is a land of the living and a land of the dead and the bridge is love, 

the only survival, the only meaning.

— Thornton Wilder