The Toothless Smile

I got to know you late in the game, but I am so glad to have had the chance to care for you. You were another sweetheart.

You were quiet and your words came out in mumbles because you had no teeth. All your teeth had to be pulled prior to your transplant to decrease your risk for infection. Your toothless smile warmed my heart.

I tried so hard to comfort you, but you were so fearful of death. You asked me if you were dying often. You were so afraid of a painful death you shared that you hoped when the time came, that you would pass away in your sleep. I comforted you as much as I could, but it was never enough. I could see in your eyes you still feared death. You prayed often, reciting Bible verses. You asked me if God would protect you. I wanted to say yes, but I had learned to never make promises I can’t keep.

It was my third shift in a row. I was exhausted and emotionally drained. When I started my shift in the morning, I could see you had deteriorated rapidly overnight. You had a blank stare in your eyes. You were nonverbal. Your arms were flailing around without purpose. You had these cyclic episodes of vomiting, which required suctioning because you were unable to clear your own airway. It broke my heart to see you in this state. I demanded the team come see you ASAP because I had no idea what was going on, and you were still a full code. I knew if you stopped breathing and we lost your pulse the last thing you would want is for us to start pounding on your chest. Advocating for a change in your code status was the least I owed you. Now that you were unable to advocate for yourself, it was all on me. I was lucky however, that you had made it clear to me what your wishes were.

Once the team was able to come see you, they were also stunned and confused. Your doctors, although puzzled themselves, attributed your decline to a presumed fungal pneumonia that had invaded your brain. Unfortunately, it was too late to intervene. Just a few days before you declined you mentioned to another nurse it was your time to go. You knew it all along.  Patients always know.

After the doctors talked with your wife, you were transitioned to CMO, or comfort measures only. I couldn’t stop thinking about how often you told me when it was time to go that you wanted to go peacefully. Once we had you on a morphine drip, I gave you all that I could to keep you comfortable.

When your family arrived you were lethargic, but somewhat arousable. Your family understandably was shocked at the decline of their loved one that had occurred in such a short time. Your wife and your daughter nearly dropped to their knees when they saw you lying there in the bed. The cries they let out were so loud I had to close the door behind me. These cries crushed me to the core.

Your wife asked me if it would be okay if she ran home to bring back a few things that were important to you. She asked if you were going to pass within the next hour. I told her that you likely only had hours, but that anything could change at any moment. She requested that I everything I could to keep you awake until she returned. The pressure was on. This was a tough spot to be in because I owed it to you to keep you comfortable. However, the more medications I gave you, the more sedated you became. I already knew it wasn’t possible to please you both.

Your wife was still gone, but you were becoming increasingly restless. I tried to hold off on medications as long as I could, but I had to do what was best for you, so I medicated you. It was just one more dose, I thought. Before your wife returned you fell unconscious. You were no longer opening your eyes. My heart sank. This was exactly what your wife feared. How was I going to face her when she finally returned? How was I going to explain to her that you would likely not open your eyes again?

You looked so comfortable, but you weren’t awake. I had achieved what you wished for, but in doing so, I failed your wife. She was absolutely devastated. It broke her to know you wouldn’t wake again. She wanted to be by your side, holding your hand when you shut your eyes for the last time, but she was gone, all because I said it would be okay.

I immediately regretted telling her to go home and gather what she had wanted to bring back for you. She would never get that time back. The guilt I felt left me speechless. I slipped out of the room, and when I did, the team of doctors was outside the room. I started walking away when one of the doctors asked me if I was okay. In that moment, all of me broke down. There was no more strength to hold back the tears. I was humiliated, so I ran off the unit. I needed to breathe, but I felt suffocated by my emotions. I couldn’t get the sound of your wife and daughter’s cries out of my head. It took me a bit before I could face your room again. It wasn’t even an hour later that you passed away.

I’ll never stop regretting telling your wife to go home to grab your things. I’m so sorry I took away your last moments while you were still “awake” from her. It pains me to this day.