Most people would define death as the end of life but I'd say it is the beginning of a journey into a place unknown. I have experienced a fair share of death in my nursing career. Patients who were declining, and I was part of a team that tried to resuscitate patients who died all of a sudden. In each of those situations, I was dealt with emotions surrounding what happened and ways if any, that I could apply in the future to prevent a recurrence. Nevertheless, the most recent case of a patient of mine and her process of death was a different one.
I was placed in a privileged position to play an integral part in assisting in one of my patients to die. Most commonly, known as euthanasia. This is now referred to as Medical assistance in Dying (MAID) and legal in Ontario. I was told a day prior to the scheduled procedure, and assisted in ensuring this patient had a vascular access for the medication administration. The transport to the medical imaging lab with my colleague, a nurse practitioner was a strange one as it was an unusual task for both of us, but it was something we had to do because for some reason, at the time, no porters were available to assist in the transport. Knowing the purpose of the trip, I casually glanced at the patient to assess her countenance. She was full of life. Her smile was so bright that the lights in the elevator and in the hallways to the lab seemed dim. Her daughter who accompanied us presented with a emotional exterior of strength but still had a worry and confused look on her face that drifted in and out of our conversations. I was happy that I was able to aid in her getting the vascular access that was instrumental in the procedure the day after. Alternatively, I was covertly dealing with some questions on the inside about how tomorrow will look like for me and for the patient. For both of us, it would be a first.
I remember reflecting on the day and how tomorrow would be while I lay on my bed the night before. Managed to watch some of my shows that I had missed the day before and slowly drifted off to sleep. Woke up in the morning, delayed my stay in bed as I got ready for the day ahead. I made a decision on having a big breakfast before I headed out for work. This decision turned out to be a wise one as the day was a long one both physically and emotionally.
Before the much awaited procedure, I met with the team that was actively involved in the process. They were so welcoming, professional and clear in their explanations. I felt like I knew them from years ago. I felt like I worked with them everyday. The communication between us was clear and detailed. After going over the medications and the legal forms involved, we headed to the patient's room where the patient and her family awaited our presence. It is important to note that I still got permission from the patient and family to be present during the procedure. I also did communicate who was going to be in the room during the procedure to the patient and family.
When we stepped in with the medications for the inception of the procedure, we were met with a mix of emotions. The patient was holding on strong. The strength I saw in her eyes was fierce, yet gentle and welcoming. It was something beautiful. You had to be in the room to experience it. She was in control of everything that was about to happen and happening in that room. Little did I know at the time that she was going to be the pilot of journey that she was about to embark on. Alternatively, her family was distraught. Sadness written all over their faces as they looked at us with tearful eyes. I felt their pain and sorrow but I couldn't provide any comfort but communicate non verbally to them via my eyes. The physician once again asked the patient if she understood what was about to happen and if she still wanted the procedure to take place. The patient stated that she was ready and wanted the procedure to go on as planned. The pain that the family felt was so palpable at this time. The physician then proceeded to administer the medications in succession and as expected minutes later, the patient was noted to exhibit no signs of breathing. When the doctor finished administering the medications, she assessed the patient for a pulse. No pulse was noted. The patient was then pronounced deceased by the doctor. This raised the sadness and outbursts of emotions from the family of the patient. We comforted them in ways we could and left the room to provide privacy and time to spend with the departed.
It is fair to say that this experience questioned the values that stem from my upbringing and profession (to do no harm to a patient). However, in this situation, no harm was done to this patient as the assisted death process was what the patient wanted to peaceful journey on to a place of rest while escaping a state of hurt that was subjective to her. Upon reflection, I understood that this situation was not about my values or myself. Nonetheless, it was a special moment that presented the patient with an opportunity of being in charge to make decisions regarding life, her health and death.
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