My experience of End of Life Care

Where should I begin on what is such a taboo subject amongst the british population, I guess I will start at the beginning where I will lead you through a few of my experiences when nursing patients through their last few days of life. I have worked in nursing/care for the last sixteen years and as you can imagine I have seen, heard and smelt just about every function a human body can make this has been both very funny and very sad but I have always walked away feeling that I have done a great job and that the person is now more comfortable. My first experience with death came when I was about nine. I hadn't been well and was off school as my mum got herself ready for work there was a knock at the door, it was my neighbour he looked rather flustered and panicked my mum asked him what the matter was and he said that his brother was not making any sense and had fallen in the lounge as you can imagine my mum raced across the drive and I raced out of the back door to peek through their lounge window at the back of the house. This was when the nursing flame ignited itself within me for what I saw was a elderly gentleman laying face down as straight as a board on the seat of his armchair. I remember thinking I need to get in there and do something but for the life of me I did not know what that was or how I would do it. My mum as you can imagine came out confused and with a matter of urgency called an ambulance. When I look back on this now it had not just happened and I think the poor man had been there for sometime. Following this for the next seven years I went on with growing up and deciding what I wanted to do with my life always knowing in my mind that this would probably be caring for people and at the age of sixteen I enrolled myself on a care qualification and was placed in a elderly day centre in Ashford where I was exposed to my experiences of personal care and caring for people as a profession. 


On completion of my course I secured myself a job at the William Harvey Hospital where I was a healthcare assistant on a busy geniatric ward this is where my second experience of death came. I was on a night shift and like every other shift I attended the ward handover where you hear about the patients on the ward and the work that needed doing throughout the night. On this occasion I was asked If i would care for an elderly lady in one of the side rooms. She had fallen at home and was now unable to stand, along with her current conditions she had declined in health and was now entering her end of life. This at the time was very scary for me as I had never looked after someone like this and I really did not know what I was meant to be doing at all. I asked the staff nurse on duty for some advice and she told me she could still hear me and to make her last hours comfortable, with this I returned to the elderly lady and just sat with her, held her hand and spoke about whatever came to mind. I made sure she was comfortable, that her mouth was not too dry and that she was clean. At around 2 am her breathing began to change and she was taking less breaths but they were deeper, I asked the nurse whether this was normal to which she told me it was and that she was close to the end of her life now. I returned to the lady and assumed the position I had kept all night of holding her hand and letting her know she was not alone, at around 4am sadly the lady passed away, this made me feel sad but privileged at the same time, I had never met this lady before but I was the last voice she heard and the last hand she touched. The next part of this story gave me the fright of my life and made me think I could conduct miracles, as part of the process when dealing with the death of a patient you give them a wash and put them into a garment called a shroud to be taken to the morgue. As this was my first experience of this duty and as I was noticeably nervous I asked whether one of the nurses would be able to support me in this to which the night sister came. As we began to wash the lady the nurse working with me asked me the roll the lady onto her side so that she could wash her back, with this I began to roll her when the loudest deepest breath escaped the ladies chest and I jumped ten foot into the air thinking for a brief second I had conducted a miracle and that now the lady was alive. As you can imagine the nurse who had come to assist me could not stop laughing for I had been the victim of a very unkind trick. We finished cleansing the lady, putting her into her shroud and calling the porters making sure they knew this patient was for “Rose Cottage”.


My most recent experience of death was working as a Student Nurse with my local community nursing team. Me and my mentor had gone to visit a lady with chronic COPD in her home and when we arrived she was really struggling for breath and did not look well at all to top it off she had fallen off her bed and onto the floor. This posed many a problem as there was no hoist, extra staff and the lady was on the larger side. As she had already pressed her lifeline some 4 hours previous and the ambulance was on its way the first thing to do was get the lady into a more comfortable position so that she could at least sit up and regain her breath, with no slide sheets around this was a case of finding something to improvise with so I found a bin liner and a tea towel, by putting the tea towel into the bin liner and moving the lady from side to side I was able with my mentor to get the makeshift slide sheet under the lady enabling me to sit her up. Once she was comfortable we carried out some general observation and found that her oxygen saturations were at 89 which Is not unusual in a patient with COPD but still it was making the act of breathing very difficult for the lady. Once the ambulance arrived and had checked the lady over she decided that she wanted to stay at home as she felt if anything was going to happen to her she would rather be at home than in an unfamiliar environment such as a hospital. I visited her many times that week with my mentor and on every visit the lady had become progressively worse until the friday when we visited and found the lady approaching the end of her life. She was having great difficulty breathing and was using all of the muscles in her abdomen to draw breath. This alarmed my mentor and she asked whether the lady had a DNAR as in her opinion the lady was not going to make it through the day, the lady replied that she did not and but she would not want resuscitating when she passed away. My mentor advised the lady that unless she had a DNAR in place she would have to attempt CPR if the lady passed away, again the lady stated she did not want resuscitating. My mentor then called the ladies doctor who unfortunately was some 20 miles away, with her clinical experience she felt that a DNAR needed to be put into place immediately so that the lady's wishes could be followed. This would mean that my mentor would need to leave me alone with the lady whilst she drove to the GP to get the correct form. Whilst she was gone I spent two hours talking to the lady about her family and how her life had been. I found this to be very fulfilling as I had built a strong but fast relationship with this lady over the last week. My mentor returned a few hours later with the DNAR form and for the next three hours we all sat and chatted making sure that the lady was comfortable and had all she wanted. Sadly that afternoon she passed away with me and my mentor by her side. I reflected a lot on this in the following days and found myself thinking around how strange life is. One minute I knew nothing about this lady and had never met her in my life and the next I had been a constant visitor for the last week and one of the last faces she’d seen. 


In my opinion aside from all of the great qualities that every nurse and carer has when caring for their patients, you need to be a certain sort of person when dealing with the end of life. You need to remain human but also be able to put your feelings aside for the good of the patient and their loved ones, I guess this comes with time and experience. You would be no use to anyone if you broke down every time a patient died, you need to be able to be kind, compassionate, logical and be able to give strength to all involved in a very sad moment. You also need to remember you are human and that the passing of a client affects people in different ways, you should always seek support from your colleagues and management. I always remember to talk as talk will help you lighten your mental load

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