What It's Like to Be a Hospice Nurse

Snapshots of life at home.
June 19 2013 5:30 AM

Approaching Death

A nurse goes from the ER to a hospice, and changes the way she thinks about life and its end.

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Illustration by Robert Neubecker.

This essay originally appeared in I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse, a collection edited by Lee Gutkind, out now from In Fact Books.

A child is dead.

There is a terrifying, soul-piercing scream that a mother makes when she loses a child. This scream is so universal that everyone, in every corner of the emergency department, knows what has just happened when they hear it.

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On a sunny summer morning, a young mother of a 3-year-old watched, stunned by ultimate dread, as her little boy ran out into the normally quiet street. On that day, however, the driver of a rainbow-painted Volkswagen bus careened through the neighborhood; 20 minutes later the mother stood in our trauma room, looking as if she might collapse. She told us, through tears and broken English, how she had heard the screech of tires, the crumpling thud. She ran into the street, knelt down to her son, and gathered the little boy into her arms.

It may have been clear to the paramedics, when they arrived, that this child had no life left in him, yet they knew to move with the kind of energy that infuses hope into impossible situations. They did everything in their power—oxygen, monitors, IVs—an all-out resuscitative effort. It is hard to imagine anything worse for a parent than to watch an aggressive attempt at her child’s resuscitation. Except, I suppose, to see no effort at all.

The little, broken body was transported to our emergency room, and we put on a similar show—a collective swoop of doctors and nurses and technicians. We focused the exam lights on him and looked, listened, strained to detect some tiny morsel of life with which to run; it’s not just for the benefit of the parents that we go all out, even when mottling has set in. We, too, need this cathartic effort in order to begin to grieve. Seeing a child die is never easy.

Years ago, it was customary to keep families out of the room when a crisis was in progress. But nowadays we know that one last look, one more moment of hope can be vitally important to the process of saying goodbye. The mother, looking stricken and white, stood by the door and held onto the arm of a nurse. When the initial moments had passed, the chaotic energy in the room suddenly changed. The doctor lowered his voice and called the time.

And so, the scream.

I left the room to find the father in the waiting room down the hall. I paused at the door before entering, wanting to wait as long as possible before destroying his world. He took one look at my face and fell to his knees, his forehead slapping onto the scuffed white floor. I waited while he groaned to his feet, then led him to his wife and dead child. So the parents could sit with the little boy, the team had tried to clean him up and had pulled the tube from his nose. I motioned the father into the room and left them alone to say their goodbyes. I had to rush to the next emergency.

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Courtesy of In Fact Books

That was the moment when my edges began to wither and I felt a hardness creeping in. Was it really possible that my response to the intense anguish of two broken parents was to push them into a room and run off to finish my job? When had I become so callous? I remembered myself as a new nurse—one who made it a point to touch every patient, even when she wasn’t examining them; who had a gift for sensing what a psychotic patient needed in order to de-escalate; who was known as the one to call when a battered woman needed to feel safe enough to talk—but this memory was distant and faded.

I was overly sensitive, even as a child, to the suffering of others. When I watched Westerns, I would get teary when the cowboys yanked at the mouths of their horses. “Think about how lucky those horses are,” my father had said, trying to console me. “They get to run all day.” I became so upset when I read Black Beauty that I hid in my room and cried for hours. I know the story has a happy ending only from secondhand accounts as I’ve never been able to bring myself to finish it. In the fourth grade, I jokingly pulled the chair out from behind a shy and quiet classmate, the way I had seen it done on The Three Stooges. The boy fell and hurt his back, and I was so distraught over his tears that I never spoke to him again. While working in a bookstore, years later, I happened to glance through the pages of an autobiography written by a man who had been viciously abused as a child. I went home sick that day because I simply couldn’t function with those pictures in my head.

How does someone with these pathological, debilitating reactions to distress function in a world of endless pain and struggle? Easy. Build walls and stay busy.

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