Bryan Adams sang about the summer of ’69 and I’m going to share a bit of my summer of ’89. I was a CAP, as we were affectionately referred to –members of the Clinical Assistant Program at Memorial Sloan-Kettering Cancer Center. A CAP was a paid nursing student approaching his or her fourth and final year of a nursing program. Each CAP was partnered up with a preceptor/buddy for three months. We were all shaking in our boots at orientation but they welcomed us with open arms and gave us the resources to feel confident.
I was twenty years old and continually out of my comfort zone, witnessing so much suffering of patients with neurological cancers such as brain tumors and spinal cord tumors. I was supported by enthusiastic nurses that embraced teaching and exposed me to new experiences. That included post-mortem care.
I can’t recall the patient’s name but I remember the experience vividly. She was a college student - just like me at the time – when she had a spontaneous cerebral bleed as a result of her leukemia. The bleed in her head caused her brain to herniate. Herniation occurs as a result of brain swelling. The cranium or skull prevents the swelling brain from expanding and as a result, vital brain tissue is deprived of oxygen, often resulting in death.
My heart was racing, my face was flushed as my preceptor and I attended to her in the D bed of the NICU. She oozed blood from her eyes, nose, ears, and sides of her lips, her vagina, her rectum, and any hole we created with needles or tubes. At the time, I didn’t understand this was a result of DIC (disseminated intravascular coagulopathy) in which the body can’t regulate its clotting ability. I assumed each body oozed this way when it dies, until my next patient that died did not ooze. What I did comprehend was that her heart was not pumping, her lungs were not breathing and I was zipping her into a body bag. This young woman was leaving this world and devastating her family. It was painful to bear witness to and yet I recognized what a privilege this career I was embarking on provided me.
It’s been twenty-five years since that death. I’ve seen many others die; for some, death brought relief after a long illness. For others, death came too early, moments after birth. Sometimes poor choices played a role such as the teens that crashed the jeep when drinking and driving, and there’s also the inconceivable death of witnessing a mother dying in childbirth.
Death doesn’t often give us a lot of options and as nurses we don’t always have the answers. I do know that if we can bring our whole being to the experience, be open to what presents itself and be the calm person in the room, we have given a remarkable gift to the patient and their loved ones.