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End-of-life care decisions through the family's eyes

Section Editor(s): Davis, Charlotte BSN, RN, CCRN

Nursing made Incredibly Easy: May/June 2018 - Volume 16 - Issue 3 - p 4–5
doi: 10.1097/01.NME.0000531878.63531.14
Department: Editorial

Clinical Editor • Nursing made Incredibly Easy!

Surgical-Trauma ICU Nurse Educator • Ocala Regional Medical Center • Ocala, Fla.

Clinical Adjunct Faculty Member • Clayton State University • Morrow, Ga.

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We're only here on this earth for a moment in time. We think the ones we love will always be here, likely because the thought of them not being with us is too raw and painful to contemplate. For 22 years, I was married to the love of my life and my best friend. I loved him more than anything. He was one of the kindest and most unselfish souls anyone could ever meet. And he had the most amazing blue eyes. Every day for 22 years, I framed his face and said, “If I could spend my day with anyone, I would always choose you.” Then illness came and I watched this amazing man suffer with pain that no one should have to endure.

Instead of planning for years of memories, we had to plan for weeks to months. Those days flew by so quickly. They evaporated like water despite how tightly I tried to grasp them. Then time ran out and I had to fulfill a promise I never wanted to make. I had to give him the last gift he would ever receive—the gift of me letting him go.

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The promise

I'll never forget a conversation my husband and I had 3 days before he passed away. He smiled, blue eyes twinkling, and said, “We're all dying from the moment we're born. None of us gets a get out of death free card. So you have to promise me something. If something happens to me and I can't be me, or would end up hurting more than I do today, promise me you'll let me go. Don't keep me here in this world unless I can be the same me I've always been. And promise me that if that time comes, you won't be sad. That you'll travel and write, and find happiness in the big and small things that life has to offer. Remember to stop and breathe, and take care of you because you're horrible at that! Surround yourself with people who know how lucky they are to have you in their life. You need to be surrounded by people who, if they had to choose to spend their day with anyone, they would always choose you. Promise me that, okay? And I'll give you 1 day a year you can be sad after I'm gone, but please don't waste the whole day with it because as you're now seeing and me, too, all of our days are numbered. Do the things that bring you joy.”

Thinking he was likely just struggling with our new reality, I kissed his hand, kissed his cheek, and agreed to make that promise. I couldn't imagine a life without him; it wasn't an acceptable or reasonable option for me. But 3 days later, I had to honor my promise.

I watched helplessly as paramedics raced him from my home to the hospital where I worked. After 45 minutes of CPR, they were successful in getting a heartbeat to return. My body was in a state of shock, numbed by the day that wasn't supposed to ever arrive. My mind was trying to process the words that were being spoken around me. I listened to the arterial blood gas results being relayed by the respiratory therapist to the physician and I understood what each devastating number meant.

Despite everyone's attempts, I was told that there was nothing more that could be done for him. The beautiful mind, spirit, and personality that made my husband who he was no longer existed, while his courageous heart still continued on with the assistance of numerous drips. Worried that his heart would soon tire, I was asked to make a decision. Would I honor my last promise to him? The choice should've been so clear, but it wasn't. Then I closed my eyes and heard his voice from our conversation 3 days before. I kissed his hand for the last time, holding it tightly when he took his last breath as his pain ended and mine began.

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A closer look

So, my fellow nurses, when we have families who can't grasp letting their loved one go, please be patient with them. The journey is a raw and emotional one. It's easy to just see the cancer patient whose family refuses to sign a do-not-resuscitate order, but I challenge you to take a closer look. Lying in that ICU bed is the family's everything; their mother, father, brother, sister, child, spouse—their world. They'll ask questions, sometimes the same one over and over. They aren't looking for a different answer; they simply can't process what's going on. Take a deep breath and give them time. Thank you to all of the critical care nurses out there for the care you provide to families when their loved ones can't be saved. You're amazing!

As for me, the week while I'm writing these words marks the 2-year anniversary of my husband's passing. I'll be taking my once-a-year day this Friday, honoring my promise by returning from the beach—his favorite place—to do positive things as he would want until next year.

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