When Helping People To Die Is Your Work
By Leah Carey
June 7, 2016
Most of us will witness no more than a handful of deaths in our lifetime.
Nurses, on the other hand, may witness that same handful of deaths in a month, or even a week. Whether through old age, illness, or accident, death is a part of their profession.
Experienced nurses tend to show a facade of cool efficiency. But there is much going on behind that professional exterior, especially as they deal with the death of a patient.
“We have faces that we can put on,” Christina Courville said. “It’s not necessarily cold, it’s just trying not to show emotion until we walk out of the room.”
Christina has been a nurse’s aide at Littleton Regional Healthcare for three years and has just begun nursing school to become a registered nurse.
“We break down to each other,” she said. “There are some [deaths] that we still talk about that happened a long time ago. Because it just affects you. It really affects you.”
Christina often works the night shift with Christa Simmons-Beniash, a registered nurse at LRH. The two make a good team.
“We do blend well,” Christa said.
“It’s always nice to have that,” Christina said. “It’s nice to have her because she can understand what I’m dealing with and I can understand what she’s dealing with.”
“It’s important to have somebody who you can talk it over with,” said Christa. “I can’t go home and talk about it. But I can diffuse with her.”
“Someone who gets it,” Christina agreed, nodding her head. “The nursing world is its own world. They get things, they talk about things that no one else would understand … Especially night people because our group is so small. We’re such a small family. We rely on each other a lot.”
Choosing health care
Christina chose nursing as a career after experiencing the deaths of her grandmother and grandfather.
“My grandfather passed and then my grandmother passed a month after and she was completely, it seemed, healthy. She completely gave up after my grandfather died and left exactly a month after. I was 20 or 21 and I got into health care just a few years after that,” she said. “It’s rewarding. I think it’s the most rewarding job out there.”
Christa came from a different direction.
“Health care is not something I ever saw myself doing,” she said. But with an interest in alternative health care, she saw it as a means to understand herself more fully. “Learning and understanding others and myself. I think that’s where I’m at, right now anyway, in my own personal process of growing and learning.”
Family by blood and by choice
Prior to nursing, Christina worked as an aide in a nursing home. Getting to know people over an extended period of time, she found herself growing close to her charges. That sensibility has followed her into the hospital. “They become my family member. They really do,” she said. “And that started at the nursing home because they were all like my grandmothers and grandfathers. I was there for four years and I got very attached to these people.”
But at the hospital, there is much less time to spend with each patient. “Nurses have six patients at a time,” Christina said. “So you have a dying patient, or maybe even two…”
Her voice trailed off as Christa started nodding.
“I want to be more present with each one and I’m not able to be,” she said. “Sometimes we’ll have time to be able to sit and talk. But often our conversations can be somewhat brief. But that doesn’t mean that we don’t want to share in learning more about them.”
Then with tears welling in her eyes, she remembered the night that her own grandfather died in the hospital and she wasn’t able to be with him because she was on shift. “I was working and I didn’t get to … I was so busy that I didn’t get to take him through. During my shift, I couldn’t go spend time with him.”
A gratifying experience
Both women said that being at someone’s bedside as they’re dying makes them wonder who they were during their life.
“It makes me want to know more about them,” said Christina. “But I don’t ever. And I wish I did. I wish I knew them before the end so I could just …”
Once again it’s clear what a cohesive team these two are, as Christina pauses and Christa picks up the thread of the conversation.
“I think that’s probably why we’re the ones that are there though,” Christa said. “It may not have been as easy to do what we do, knowing them in that deeper way.”
Then, almost in the same breath, they both describe the experience of being someone in their final moments as “gratifying.”
“That’s mostly why I do what I do,” said Christina.
Nodding, Christa added the final word.
“I want to tell that family: Thank you for letting me be a part of that. Thank you for trusting in me to be that person for them. It’s a big thing. It’s a really big thing.”
At Northeastern Vermont Regional Hospital, Lyndi Medico works as a nurse in the Intensive Care Unit and in the Cardiac Rehab Unit.
She said that finding a way to separate work from home is essential to her ability to do her job.
“You have to find a happy medium. You have to be able to be present emotionally in the dying process, but you also have to be able to go home at night and be able to sort of separate yourself from it. Because if you don’t, you wouldn’t be able to do this for very long.”
“It’s taken a lot of practice,” Lyndi said. “My husband and I will have 10 or 15 minutes to talk about work and then we’re HOME. Which is a little bit harder for me, obviously, because of confidentiality. But I can go home and say, I had a hard day.”
As a result of her work, she feels it is imperative to have conversations with her husband and other loved ones about end-of-life decisions, even though they’re all relatively young.
“I’m going to be 29 years and my husband is 31. And I’ve said to him, if something were to happen to you, what do you want us to do? And I’ve said it to my parents and I’ve said it to his parents,” Lyndi said. “I think everyone should be able to die how they want to.”
Watching medical shows on television is a challenge for Lyndi because she sees how many things are glossed over or “would never be done that way.”
“You know, chest compressions and intubation,” she said. “They’ve seen someone intubated or they’ve seen someone do CPR on TV. But they don’t necessarily know, how do we get to there and what happens after that process is done? And what are your chances when those things happen? … And I’ll say this: I don’t want that. I absolutely do not want that.”
Also at NVRH is Mary Young-Coathup, a nurse on the Med-Surg floor.
She also spoke about the need to hold her patients’ confidentiality, while still processing her own experience at the end of the day.
“My husband is like, how did your day go? And I’m like, um, it’s been better but it’s okay,” she said. “We both have jobs that we can’t talk about. But depending on how I answer him, he knows that work’s hard. Whether it’s a confused patient or someone that’s dying, or someone that’s well, or someone that’s just being a brat. He knows that I can’t talk about it. But I can kind of tell him with my responses that it’s been a difficult day.”
And like Lyndi, Mary is clear about what she wants and doesn’t want for her own end of life.
“[Nursing] allows me a broader aspect of things, that I can say what I want and I don’t want. If I’m not going to be myself and know who I am and where I am and everything, I don’t want to be here. And my family is aware of that and my husband is aware of that. It just makes me respect my own self and my patients and their feelings,” she said. “I hope when I pass away, if my organs are good and I can donate, that … I hope to help somebody to live. Pretty strongly.”
I wanted to be the person holding my mom’s hand as she took her final breath. I wanted my face to be the last thing she saw on this earth.
But, as a wise philosopher often tells us, “You can’t always get what you want / But if you try sometimes you might find / You get what you need.”
What my mom needed at the end was nursing that I couldn’t provide. Her symptoms had become more than we could manage at home, so just 12 hours before her final passage, we moved her to the hospice room at Littleton Regional Hospital.
Due to HIPAA regulations, Christina Courville and Christa Simmons-Beniash can neither confirm nor deny that they were part of my mom’s care team at LRH. They can’t talk about any of what I am about to tell you.
But I can.
We had met both women when Mom was in the hospital a few months earlier. Of the many nurses we met, Christina and Christa stood out in my mind thanks to the gentle kindness and dignity with which they treated Mom.
It was a relief as we entered the hospice room in December to learn that Christina would be on night duty. I knew we were in good hands.
It turned out to be so much more than that.
Mom’s final minutes were a struggle for her. As much as I wanted to be the one holding her hand, I couldn’t. I couldn’t even watch.
Christina stood in for me as a surrogate daughter.
She held Mom’s hand. She stroked her hair. She murmured gentle and loving words to her. She let her know that it was okay to let go.
She couldn’t make Mom’s exit gentle or peaceful, but she made it as comfortable and loving as was possible.
She did everything I wanted to do, but couldn’t.
When Mom’s final journey was complete, it was Christa who arrived to pronounce the time of death: December 20, 2015 at 1:15 a.m.
Despite having many patients to tend to, the two women sat with us, giving us time to absorb that the long-dreaded absence was now real.
What I remember most is that they didn’t try to comfort us. They listened. They shared in the few stories we told. They cried with us as we read a poem that had been written for Mom’s passing. They didn’t try to make it better – which was good, because no one could have made it better. But their presence made us feel a little less alone in a terrible moment.
Christa and Christina, you are grace personified. You will stand in my memory as angels in human form.