Life lessons from a dying man

From the Fall 2012 issue of Scrubs
On my first night on the oncology floor, I met Bernard and his family. Bernard was a 60-year-old man who was in great shape until he started to have diarrhea every day. He’d been diagnosed with pancreatic cancer, and by the time he came to my unit three months later, he was dying, having failed a few attempts at chemotherapy. His wife was a short, intense redhead who was determined that he wouldn’t suffer. He had three children, a daughter and two sons, all grown. The daughter was married and had a new baby. They were all with him. He was a mentor to everyone who entered his room, even me. He was teaching peace and forgiveness and joy. All his lessons came forth from his body, which had been starved by the cancer and from his bones, which were birdlike and fragile. He had IV morphine if he needed it, but he liked to be awake. He no longer had control of his feces and his rectum was red and swollen against the flat bones. He didn’t have enough fat left to have buttocks. The room smelled like a barn, but most of the time I didn’t notice it because Bernard’s eyes were always exploding with blue happiness at all the family that came and went.

His children decided they wanted to do something special, and because I was the nurse he had gotten closest to, they wanted me to be there. They prepared a slide show for him from family photos and they wanted me to be there when he saw it. I told them I could take my dinner hour and do it; otherwise I wouldn’t be able to leave my other patients uncovered. They agreed and we picked a time. I brought extra cotton gauzes and ointment and blue plastic Chux, and pain medicine just in case he needed it. I knew the other nurses thought it was a problem that I would spend my dinner break with him. “You’ve got to set limits with these people,” one nurse said. “Please,” I said. “I hope when I’m dying no one sets limits with me.” They just shook their heads, they were so sure I was wrong. And maybe I was, but I felt like an honored guest. The invitation was like crystal between Bernard and his family and me; it shimmered and it sang.

I will never forget what it meant to be in the room with Bernard and his family as one by one the slides of his life flashed on and off the screen. All the early pictures were in black and white, and in them he was handsome, and his children were laughing, climbing on him, being pulled in a wagon, splashing him from a small pool, while his wife looked on. It was impossible to be removed from the tears in the room; his joy and his grief were rising in the air together. His children caught their breath, and one by one they stood beside him and held his hand. I stood behind him between the wall and his bed. He was turned away from me watching the photos click into place. The entire hour I was there, blood oozed from Bernard’s rectum. Periodically I wiped it away and applied soothing cream. I rolled up the old Chux and laid a new one, and wiped, and tried to keep him dry and comfortable in the most unobtrusive way. Something was happening to me as well, some split in my heart was widening. The floor felt rubbery. I noticed partway through the slides that Bernard’s skin was clammy and I knew the blood loss was taking a toll. I felt his pulse by sliding my hand under his elbow, and he reached back and squeezed my fingers. I knew as well as he did that he was inching closer to the time he would die. In the squeeze of my fingers he was saying, let it go, don’t let anything interrupt this time. I knew I should take his blood pressure, which would be low, then increase the IV fluids and lay his head flat, but I honored his silent request, and there he was, in an old photo, reading the Sunday paper on a porch swing while his son leapt up to scare him. He was pretending to be frightened, rocking back on the swing, throwing his arms up, but it was clear to me there was nothing he was afraid of in an ordinary day.

After the slide show was over, I finally did the things I might’ve done sooner. His pressure was dropping, the blood was pouring from him now. I called his doctor and we talked to the family and they all decided, along with Bernard, not to do anything else. When he got cramping pain in his back, we increased the morphine, and he was fading and it was like the tide going out, an almost unnoticeable retreat, except suddenly the water was gone and the rocks were exposed and against the sand little minnows were jumping. Bernard died peacefully about 20 minutes before I went off shift. I offered to stay and do postmortem care so the night nurses didn’t have to. I wanted to spend those last seconds with his body after his family had laid their kisses on his face. After they had packed up his comb and bathrobe and slippers, and after his wife had taken his wedding band off his ring finger and put it on her thumb, I hugged them all good-bye, and I didn’t know it then, but they were changing the way I would live my life. They had been teaching me a way to be with my own mother and father.

Bernard’s body, its sharp bones and translucent skin, rose in the lightness of the day, in the successful exit of his soul and his breath.

Excerpt from Beautiful Unbroken: One Nurse’s Life. Copyright © 2011 by Mary Jane Nealon. Reprinted with the permission of Graywolf Press, Minneapolis, Minn., graywolfpress.org.