Walking out the Soul

It was the height of the pandemic; our visits had declined significantly to the emergency room, but the acuity had gone up as people had put off coming into the hospital unless they were really very ill. This was the case as someone who had rung the call bell and I was the only one available to answer it. The patient was in isolation as according to the COVID screening she had symptoms that could be linked to COVID. I gowned-up, privately wondering in my head if this was the person who was going to expose me to COVID and if I would get ill, or worse, make my family sick.  

I gowned-up, my hair covered in a bright scrub cap, the cap’s pattern being the universe. Wearing safety goggles over my glasses as well as a plastic shield over my face, I was already sweating, and I hadn't even gone into the room yet. Once I open the door and pull back the curtain, there is a silhouette of a frail elderly body, curled up and contracture into a fetal position. I could see their respiration rate as I walked into the room was already elevated and their color was green/pale. They looked like they were struggling to breathe. I quickly tried to get vitals and was unable to get a blood pressure. Their pulse was in the forties and their oxygen level was in the eighties. I’m quickly assessing what I already know this is - anything but a good situation for the patient - when the ER doctor popped his head in the door.

“Hey Jenn, are you in there?” he asks.

“Yes, umm, what is the plan with this patient? Their respiration rate is up, SpO2 is down, and I can’t for the life of me get a blood pressure?” My voice nearly wavers and I’m worried that other patients have overheard my question. 

“It says here they are from a long-term care home and came in for shortness of breath,” he informs blankly, looking at the chart. “Do you need something for the breathing?” He looks at me, his head cocking to the side.

“Actually…if they are from a long-term care home, are there advanced directives? I think the patient is trying to pass” I say a little too bluntly.

“They’ve been in palliative care for a few days it looks like, then their breathing changed so the nursing staff were concerned and sent them in.”

Ugh. I inwardly curse as it’s obvious that the patient is clearly in the last stages of dying and was already palliative at the care home. The patient was known to be actively dying and the staff were either not comfortable with them being there or were thinking something else (like COVID) was going on. The patient’s breathing is fast, laboured, they’re not responding to voice or touch. Their pulse is starting to slow down and the longer I stand there the clearer it is that they are no more than thirty minutes away from dying. I ask my doctor for some sedation or pain medication. He says he will have someone draw it up for me as we have been trying to limit the number of times various staff go into different isolation rooms in the emergency department. I think about what else could be done in this situation, thankfully reminding myself that my section of the department is empty, and I have the time to sit here with this patient. I poke my head out of the room to ask my charge nurse if anyone has contacted the family and if they had been notified of the patient’s deteriorating condition.

“Not yet,” says my charge nurse.  

“Can we try to give them a call? It’s 5am and I doubt if the long-term care home has called them.”

“Sounds good,” my charge nurse nods. “We’ll try and track them down and update them. How long do you think we have?” 

“Not long. Get them in here as soon as possible if they would like to say their goodbyes,” I quietly say.

I went back into the room and pulled up a chair by the patient. I lowered the rail of the stretcher and pulled the chair close. I held the patient's hand close and holding it in my gloved one. Looking at the patient, I noticed their emaciated frame tenting the thin white sheet. A tiny shadow of a person. Who were they really? What had their life been like? What had been their dreams and fears? 

I did not know so I filled in the gaps. 

I watched their eyes, open but not focusing on anything specifically. Their breathing began to slow, having more periods of pausing in between breaths, becoming more and more shallow. As I sat there and held their hand, I imagined they were my own grandparent, close to death and my own family not having enough time to get there for their last moments. I imagined that the patient had a loving family, led a full life, raised children during the 1950’s and had so many moments of joy mixed in there. I pictured it. I saw them in their prime, raising a family just how I was and wondered how that comparison could stand. Maybe we weren’t so different after all. Just one of us a little more ahead of the other. 

 Time passed quickly. I realized and noted again the patient’s breathing was slowing more and more. The pauses becoming longer, their pulse slowing during these pauses. I told them it was okay to go, that I was there so that they weren’t alone. It’s a personal mantra that no one dies alone in my ER. Not if I could help it.  

I can only imagine the fear and what goes through someone’s mind as they die. Do they know what’s happening, or are they blissfully unaware? Thankfully they didn’t seem to be in pain as I continued to wait for the pain and sedation medication from my colleagues. We just sat there. I held their hand and rubbed the back of it. Telling the patient repeatedly it was okay to go. It got to the point where the patient was on the cusp of death. I brushed their hair back and told them it was okay.  

I have witnessed a lot of death in my years but have never been the only one to hold the hand as someone died. Just them and I. I watched them take their last breath, I watched the life drain from their eyes, I watched as their face relaxed, and their head fell to the side. It was unsettling, but it was peaceful. My eyes started to burn, letting me know that tears were on their way. It was all I could do to take off all my isolation gear in proper order before the tears started to fall. I just needed a minute to collect myself. I got halfway down the hallway to the break room when I forgot to do what I always do when someone dies.

 I forgot to let the soul out.  

It may just be my silly tradition with death, but I believe that when someone dies, their soul is released, and I like to help direct it to the outdoors as we never have windows in the ER that we can simply open. I went back to the room, opened the door a crack and said out loud:

“Okay, I’m so sorry, but sadly you have died. I’m sorry but it was your time. If your soul would like to follow me, I’m going to take it outside.” I say into the room, directed at nothing specifically. 

I make a follow me motion with my hands at the door and walk towards the exit. My charge nurse is standing there, and I know she’s heard me but thankfully she says nothing. I think most of the nurses I’ve worked with have figured out my quirks by this time, and no one really says anything about it. I buzz myself through the two sliding doors to go outside and I stand in the ambulance bay. I feel a rush of cool dark air pass behind me reminding me that it’s a rainy, cool, cloudy, dark early morning. I look to my left and only see dark, brooding storm clouds and hear faint rumblings of thunder in the distance. I go to turn to my right and there seems to be a hole in the clouds. Funny, I think as the entire sky was seemingly one giant angry storm cloud waiting to pelt us with rain. Then I saw it. The most beautiful and well-defined rainbow I had ever seen, seemingly, making a hole in the storm clouds. It was then I lost it fully. I cried and looked up at the rainbow and knew it was her. I quickly rushed inside to tell the others about this gorgeous rainbow. We all ran back outside trying to latch onto a happy moment, however brief, and it was already gone. Everyone else went back inside and when the door closed behind them and I’m still outside, I chuckle to myself. I realize that the rainbow was for me and me alone. I like to think of it as a thank you from the patient. I smile, my sadness still there but less profound, less intense, less engulfing. She was at peace now and I’d had a role in helping her find that. 

It was a win, and I took it.