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The Sound of Silence I have attended to many deaths in my short career as a nurse. I guess that is the hardest part of geriatric nursing. I remember one man in particular, Joe . He was a veteran of World War II, and a retired mechanic. He was nearly 90 when I met him. His beloved wife of 45 years, Sara, had died only months earlier.
He was diagnosed with Chronic Obstructive Pulmonary Disease (COPD). In this disease, the lungs lose their elasticity and begin to fill up with fluid. Eventually, a person will literally drown in his or her own secretions. It is slow and sometimes very painful for a person to endure. Taking report from the off-going nurse, I was not surprised to hear that Joe was taking a turn for the worse. The physician had been called earlier and ordered some Morphine to ease his pain.
The unspoken thoughts exchanged between us had been the same, This is it. As I prepared for the long night ahead, I looked over Joes chart. He was listed as a DNR-Do Not Resuscitate. His wishes were to die without any All names have all been changed to protect privacy life extending means, only comfort measures to ease his pain.
He had listed only one son as a relative. I proceeded to call his son, Jack, to inform him of his fathers change in condition. As a nurse, this is especially hard to handle. Most often, you expect families to react in grief and sorrow. Sometimes, you encounter a cold, uncaring individual who does not want to be bothered. Fortunately, Joes son was very concerned.
He had planned his usual weekend visit, but, considering this news, would be up as soon as possible. Hanging up the phone, I felt glad that Joe would be with his family. So many elderly die forgotten and alone. As I made rounds, I could hear the familiar sounds of the night in a nursing home: soft snoring, an occasional soft voice, televisions and radios, the familiar hum of the oxygen machines and feeding tubes throughout the corridors. Even though Joes room is just off the nurses station, I saved it for last knowing I would need more than a couple of minutes to tend to him.
As I walked into his dimly lit room, the familiar smell of shaving cream and soap filled my nose. Kim, a nursing assistant, had taken care of Joe for two years and was emptying a pan of water and straightening his room. Joe was particular about his appearance and even in his diminished capacity, the nursing assistants knew he wanted to look well-groomed. I touched his hand as I came to his bedside. His eyes opened, piercing blue and full of pain. I told him that the pharmacy would be bringing his stronger medicine within the hour and that his son would be coming soon to be with him.
He smiled a weak smile, nodded and squeezed my hand. I proceeded to take his vital signs, being careful not to inflict undue pain. His blood pressure was extremely low and his breathing was very labored and slow. He wore a nasal cannula that provided warm, moist oxygen. His body temperature was well below normal. Kim kept a couple of warm blankets on him and the room heater on low.
He was emaciated, resembling a skin covered skeleton. The bell of my stethoscope was as wide as his forearm. At 6 3, he topped the scale at only 92 pounds. His skin was tissue paper thin, with many small, dark purple bruises everywhere.
He was propped on pillows to ease the pressure of his spine pressing into the mattress. As I left him, I knew in my heart that he would not make it through the night. As I began to chart, the pharmacy soon arrived with Joes morphine serum. I decided to page the physician once again. With Joes vital signs being as diminished as they were, the morphine may have depressed his respirations to a point that they might cease. The physician, a long time friend of mine, returned my paging.
As I made him aware of the situation arising with Joe, he instructed me to try to wait until his son arrived before I gave the morphine. I hung up the phone, and laid my head in my hands on the desk. I hated being placed in this situation, my patient needing the relief and his son needing to spend a few moments with his dying father. I know that my injecting Joe with the morphine would hasten death to within fifteen minutes.
In nursing school, we are taught that we are not causing a death, it is a side effect of the medication. However, when I am standing at a patients a friends bedside, it doesnt feel like a side effect. It feels like euthanasia. Jack appeared, his clothes were disheveled and his salt and pepper hair was covered with a baseball cap. The tall, barrel-chested man in his early fifties was a carbon copy of his father at that age. The pictures in Joes room confirm the resemblance.
Jacks wife, Karen, clad in an overcoat and the same wrinkled attire was standing at Jacks side. Their worried expressions and mine spoke volumes. I prepared them for what would happen with administering the medication. Immediately Karen began to cry, I have to call the kids.
I directed her to the phone. Jack was standing silent, I touched his shoulder. Go see him. , I prompted. Soon after the phone calls were made, three grandsons, one girlfriend, and a couple friends of the family all gathered. Within minutes, Jack emerged from the room.
Joe had asked for me. My heart was in my throat. At Joes bedside, I touched his hand, his eyes met mine. I asked if he was in pain. His voice was barely audible, Im ready. , he whispered. I left the room and prepared the medication.
Upon returning, everyone left the room except Jack. As I injected the morphine, Joe closed his eyes and squeezed his sons hand. I stoked Joes hair briefly, kissed his forehead and left. Minutes later, Jack appeared in the doorway, his eyes filled with tears as huge his son. I went back into Joes room. Placing my stethoscope on his chest, I here a sound that will ring in my ears forever, the sound of silence. 5
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