death in the icu
There are a lot of things on my mind lately. I kind of have whiplash from the last 3 years that I am still coming out of.
In January of 2023, my stepdad died suddenly one morning and a week later I started the nursing program. I was in the throws of an intensive program for 2 years straight while life kept moving along in the background. I made as much time for friends as I could, but during school I worked full time and was helping to raise my teenage nephew, so I was rarely, if ever, available for socialization.
Once I graduated, I accepted a job in the ICU, which has only felt like more school. Similar to those first semesters of nursing school, working in the ICU as a new grad has felt like "drinking from a fire hose" with all the information and learning you do in such a small amount of time. Don't get me wrong, I have loved it. It's been so incredibly fulfilling and enjoyable to learn like this and from some of the smartest people I've ever met, but it's not been without struggle. Then in the Summer, I decided to start my Bachelor's program online, which has added, again, to my plate.
The reason I share this is because my life feels like it's finally finding a strange balancing point. I am truly participating in my dream job, but that job takes a lot from me. I am learning to take care of myself all over again and to find time for the people I love and the friends who breathe life back into me as well.
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My dad died in the ICU in 2006. I think about this almost every time I work now. It feels like it cannot trigger me if I'm always kind of aware of it. When people lose their loved ones, I am often there to offer kind condolences, and more importantly, to walk them through the process of death. Death is not the hard part. It's biological and scientific and it makes sense to me. Death is like birth, a transitional moment in our life cycle. The hard part, as I've learned, is living after that person has died. It's having to grieve them. Grieve them and also do paperwork and write an obituary and plan a funeral and make a hundred phone calls. It all feels so cruel when all you want to do is feel the sadness of loss.
About a month ago we lost a patient without really knowing why she deteriorated so fast. She was only in her early 60's and was a really tough lady. I cried with her family and did all I could to be a comfort in the worst days of their lives. I still wish I could have offered them the clarity of "why" and it still hurts me to think that they will have to wonder that for the rest of their lives.
For my dad, we knew why. He had cancer. It was pretty advanced by the time he was diagnosed. Looking back, it seems absurd how long it took, but when you are in your 40's, it's definitely not the first thing a doctor would consider.
My stepdad had a bad heart. He had some other comorbidities that made him seem to have aged faster, and when his heart finally had enough it stopped.
This last week, we lost another patient with a completely unexplainable brain injury. Our best guess was that he had flash pulmonary edema, but we could never find evidence of what might have caused it. He was also in his early 60's.
It never gets easier. People have died who are my mom's age, people have died that are my age. I think about how close I am now to my dad's age when he passed and it's truly scary. I don't want to be done yet. I have a lot to do and a lot of love to give. As I said, I'm just now hitting my stride. I wonder if that's how my dad felt.
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In the ICU, death is common. Something I try to remember is that it isn't common for the patient or their family, even if it is for me.
When my dad was in the ICU back in 2006, I went to visit him without knowing he was on a ventilator and that it would be the last time. It was a sweet nurse who saw the confusion and fear on my face and gave me all the information and patience I needed. I was 18 years old and I knew my dad didn't want to be intubated. I knew he'd die when we took him off that support. I knew then that it was the last time I'd see him alive. He couldn't speak to me, but when I leaned in a whispered that I loved him, that I would take care of Joe, he blinked at me. I know he heard me. I know he knew I was being strong, but I was crying. I apologized cause he hated when I cried.
Now Joe is gone too.
Sometimes I wish they could see me now. See that even after all the years of searching and grieving and growing up, I have become someone and something they could be proud of.
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It is not a medical disaster.
It is a bodily process, like giving birth or like going to the bathroom, or coughing, having an orgasm 'cause your body knows what to do. Your body knows how to die. How cool is that? OK, here's what to expect. In the last month of your life, you're gonna stop getting out of bed. You're gonna eat and drink a lot less, and you're gonna sleep a lot more.
Now, delirium is very common, and some people say they get this feeling like time stops being real.
OK, two to three weeks out, you're gonna need help with all daily activities, but my favorite part of the dying process- I've been talked to about my enthusiasm. I should dial it back. Your body knows what's coming, and it goes into a state of ketosis, which decreases hunger and pain. And it increases the sense of euphoria. And when you start active dying--
Oh, active dying is a sacred time--at least, it used to be. And it still is in some parts of the world. It's the moment when you're very close to death and your body starts shutting down.
In the act of dying, you won't be fully conscious. And your jaw muscles will relax. Your breathing changes. And there might be this gurgling in the back of your throat caused by something unfortunately called terminal secretions.
And when you are very close to death, your breathing goes into a cycle of deep, slow breaths, and long pauses. And then eventually, there is a breath out that is not followed by a breath in. And that's it.
And at a certain time, if you're just feeling too weak or, you know, too much pain, or you're just done, you can talk to me about sedating you, but then you'll be unconscious. I wanna feel everything for as long as I can.
Wait. I forgot to tell you about the rally. The last week of life, some people experience what's called the rally. And it's this just surge of energy and mental clarity. So enjoy the rally. Just know that you're another step closer to death. OK?
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