I spent my final year of nursing school training in an intensive care unit at one of the nation's top hospitals. For a student who had only previously taken care of relatively stable medical-surgical patients, having the privilege to work alongside such highly experienced nurses was a dream come true. My preceptor had been a nurse for almost 50 years, and she instilled in me as much wisdom as she could in just a few months. Together, we cared for some of the most critical patients in the region: those who had massive heart attacks, lung transplants, heart failure, or could be kept alive only by machines. Although these patients in the ICU were so fragile, I had never faced the reality of a patient's death until recently.
It was a Monday morning, and my preceptor and I were assigned to a young patient whose heart was failing him. He was kept alive by an extracorporeal membrane oxygenation (ECMO) machine that pumped his blood, almost like an artificial heart. Without this machine, he would die instantly. The ICU physician had explained to him the previous day that the only option left would be a heart transplant and that this surgery carried considerable risks, including death. If he even survived the surgery, the recovery would be long and painful. He had a tough decision to make.
As I walked into the patient's room, I noticed that he did not appear as one might think such a critically ill patient might. He was not sedated, but instead completely alert, reading the morning paper and eating breakfast. We chatted as I examined him, discussing the recently cold weather and the three inches of snow the city had gotten that night. If it were not for the tubes protruding from his chest, you couldn’t tell that this man was so close to death. But overnight, he had made up his mind.
He wanted the ECMO machine removed.
He knew this meant he would die, but he also knew that he would be dying with dignity, on his own terms. He wanted to donate his organs and tissues. At first, I was shocked. In my head, I wondered why he didn't want to go through with the heart transplant. Didn't he want the chance to live? He had so many years left!
However, as nurses, we are required to respect our patients' decisions, even if they differ from our own. My preceptor let him know that we understood and respected his decision. These medical interventions are only a small aspect of what nursing care truly is, and I was able to witness this firsthand.
Per the patient's request, my preceptor invited the hospital chaplain to come pray with him, had a cot delivered to the room so that the patient's mother could spend one last night with him, and coordinated with the ICU physician to set a time for the patient to go to the OR in the morning and have the machine removed, allowing him to die peacefully.
At first, I was left feeling equally depressed and disturbed knowing that this young, alert patient would die so soon. On the inside, I was angry that he did not want to continue living. However, as the day progressed, I came to understand, accept, and even support this man's decision to die with dignity. My preceptor and I made sure to let him know that he had fought his disease with strength and that his final decision to donate his organs and give others a new chance at life was exceptionally admirable.
That evening, the organ transplant team came to obtain the patient's consent for his donation. He slept soundly, with his mom next to him, and in the morning, he was taken to the operating room. As the doctors and nurses rolled his bed to the elevators, staff lined the hallways for an “honor walk,” paying respect to the patient and thanking him for his gift of life. Among this conglomeration of people dressed in every shade of blue scrubs, some people bowed their heads, others offered the patient a smile, shook his hand, or shed a tear. Admittedly, I was one of the many who cried, although mine were not completely tears of sadness.
The patient passed away that morning, surrounded by his family members and our ICU team. After his family said their final goodbyes, the patient donated numerous organs to patients all across the country. In the ultimate act of selflessness, he made the best out of the terrible illness he had.
For many seasoned healthcare professionals, death is not something to be feared. In fact, accepting the reality and inevitability of death is a crucial element of their career—something I have come to find truly admirable. As I grow older, I've begun to accept this inevitable consequence of being alive: all people must die. One day, I will take my last breath, my heart will beat one last time, and I will cease to remain, just as you eventually will, too. However, what we do have authority over is how we spend our limited time on this Earth. So, exhibit kindness to others, be a good friend and neighbor, and show your family that you love them. In the end, these are the elements of your existence that endure all constraints and limitations that this world has placed on our physical bodies, and ultimately have the capacity to affect others long after any of the 37.2 trillion cells in our bodies have ceased to function.
In the words of Ernest Hemingway, “Every man’s life ends the same way. It is only the details of how he lived and how he died that distinguish one man from another.”
Erika Gotway, MSN, RN, is a graduate of Saint Louis University School of Nursing and a member of Sigma’s Delta Lambda at-Large Chapter in St. Louis, Missouri, USA