Night Shift

I watched Edna Powell die last night.  I sat at her bedside and held her thin hand as her breathing slowed.  I watched as her eyes became fixed and glazed, and her skin became pale and waxy.  I leant forward and put my ear to her lips as the remnants of her final breath whispered.  The death rattle signified the end.  

I let go of her cool hand and put my stethoscope against her chest to listen for a heartbeat that I knew was not there.  A life had been lived.  I stood up and took one last view of the scene before me.  Taking a deep breath to ground myself, I stepped out from behind the privacy curtain, and dimmed the light as I made my way to the duty station across the passage. 

Dr Bobat answered after four rings.

“Yes?” he said sleepily.

“Sorry to wake you Dr Bobat.  It’s Sister Turner from Ward 3B.  I’m afraid Mrs Powell has just passed away.”

“Edna Powell?  Really?” he asked, sounding surprised.  “I really thought she would hang on for a few more days!”

“So did I,” I said.  “I noticed she was struggling when I checked on her half an hour or so ago, so I increased her oxygen flow and sat with her.”

“Aah, bless you, Christine.  She was fortunate to have you with her.  They certainly don’t make nurses like you anymore.”

I smiled at his compliment.  “Shall I notify the family?”

“Please.  And could you draw up the death certificate, I’ll sign it in the morning during rounds.”

“Will do doctor.”

I disconnected the call, and fetched Mrs Powell’s file from the pigeonhole marked “Bed 12”, just as Avril returned from the tea lounge.

“What’s up?” she asked.

I told her about Mrs Powell’s demise.

“How sad.  Such a sweet old lady.  I really thought she would have been with us a few more days.”

She passed me a Notice of Death form from the top drawer.  It wasn’t unusual for people to die on our shift.  Ward 3B was where they sent patients who had exceeded all their options.  Many of these were “Do Not Resuscitate” patients for us to take care of and make comfortable in their final days.  Edna Powell had been one such patient.  End stage bowel cancer.  

I picked up the handheld and dialled the next of kin listed on Edna Powell’s file.  Her daughter sobbed quietly as I reassured her that her mother had not been alone and had passed away peacefully.

“Thank you, Sister Christine.  You have no idea how comforting it is for me to hear that you were with her in her final moments.”

She opted not to come to the hospital, preferring to remember her mother as she had been in life.  

“I understand.  Many families make that choice,” I said gently.

I explained that somebody would be in contact with her in the morning with a list of funeral homes and details for collection of the death certificate.  I reiterated how sorry I was for her loss.

“You really are incredible, you know,” Avril said as I hung up.

“What do you mean?” I said, picking up the form.

“Just the way you are with people.  I don’t think I’ll ever get used to telling people their family member just died.  You just do it so calmly and flawlessly.”

“Twenty years on the job,” I sighed, and wrote “11h23” next to “time of death”.

Avril notified the mortuary, as I quickly completed the rest of the details on the form.  When I was done, she went to check on the other patients in the ward, while I returned to Edna Powell’s silent room to prepare her body for the afterlife.  

Her oxygen mask lay where I had placed it on her pillow so as to keep her final breaths unfettered.  I disconnected the oxygen and her drip bag, and removed her veinous port from her hand.  My hands looked almost red against her translucent blue skin, which was colder than it had been earlier. Dropping the mask, port, drip bag and tubing into the red incineration bin, I listened to the familiar jingling of the equipment falling onto the used medicine vials.  I opened an antiseptic swab and began wiping her face and neck.  I didn’t wear gloves.  I preferred it that way.  I rolled her frail cancer-ravaged body onto her side and untied her hospital gown.  Working quickly, I cleaned her front and back, then placed an absorbent pad beneath her pelvis to catch the fluids that would soon drain from her body.  There was certainly no dignity in death. Finally, I positioned her thin arms close to her sides to make it easier for the undertakers when rigor mortis set in.  Once Edna Powell’s corpse was cleaned and positioned, I leaned over her face and peered into her lifeless eyes.  

“Goodbye old lady.”  I closed her eyes with the palm of my hand.

I was startled by Avril’s voice from behind the curtain.

“Need some help?”

“All done,” I said quickly pulling the sheet over Edna Powell’s face.

The rest of the shift passed relatively uneventfully.  The porters removed Edna Powell to the mortuary.  Mrs Johnson needed a sedative to help her sleep and Mrs Jamaal needed additional pain meds, which I administered from the schedule seven cupboard, documenting it carefully in the register.  I took my tea break on the third-floor balcony adjacent to Ward 3B. As I watched the sun rise serenely over the sleeping city, I thought about how today the world would be different because there was one less person in it.  

At 7 o’clock I left Avril to do handover to the day staff and fetched my bag from my locker.  I scanned my access card and took the elevator to the ground floor.  Taking the long route out the hospital, I turned left down the hallway where the employee of the year awards were displayed.  I paused to look at a framed photo of a younger me.  Sr Christine Turner, RN: Employee of the Year 2018.  I smiled to myself.  This is why I do what I do.  

On the bus home I gazed out the window and watched people starting their day.  The city was waking up as I was about to sleep.  I thought of Edna Powell, now permanently sleeping.  Death is a strange concept.  We always say, “rest in peace”, but do the dearly departed really rest?   Is peace not just the end of suffering? When it came to Edna Powell, I knew the answer.  Despite my long shift, I felt invigorated thinking about the role I had played in her passing.   I had held the hands of many people as they took their last breath and passed to the other side.  While most of them had been expected to die, not one of them had been ready to die.  Each family, every doctor had been grateful for me having been with the patient as they took their final breath.  In fact, I had been told that it was my empathy with terminal patients and their families that had led to my employee of the year award.

I exited the bus at my stop and briskly walked the short distance to my apartment.  I couldn’t wait to get home.  

Pushkin was waiting for me and curled his fluffy tail around my leg, meowing as I closed the door behind me.  I turned on the kettle, dished up his breakfast and watched him hoover it up.

“I got another one!”  I whispered to him.

I went through to my bedroom and closed the curtains.  I sang to myself as I changed out of my scrubs and showered.  

Ten minutes later I climbed into bed with my tea, took out my cell phone and clicked on “photos”.  I had been looking forward to this moment all night. I opened my most recent photo, and saw the dead face of Edna Powell.  Her mouth was open, her lifeless eyes stared, unseeing, from my screen.  I swiped to the previous photo.  Edna Powell stared back at me, a look of fear across her face.  This was taken right after I had injected a massive dose of beta blockers into her port, along with enough insulin to fell a horse.  I had needed her to die quickly before Avril returned from her tea break, but not before I told her that she was about to die and photographed her horrified response.  I had even turned the lights up and removed her oxygen mask to get a better photo of my subject’s expression.

“N-no!” she had gasped weakly, the fatal chemical cocktail already taking effect.

I switched back to the dead Edna photo and enlarged it with my forefinger and thumb.  I made it so large that the entire screen was filled with her dead eyes.  

“Gotcha!” I whispered.

I chuckled to myself as I toggled back and forth between dead Edna and live Edna.  After a few minutes, I moved both photos into the folder where I had stored the pictures of the others who had come before Edna Powell.  I had built up quite a collection.  All of them had been expected to die and none of them had required a post-mortem.  I, a revered nursing sister with twenty years’ experience and an employee of the year award, had written “natural causes” on their death certificates.  I had laid out their bodies and had sent the evidence for incineration.

I put my phone on charge, turned out the light and rolled over.  

I killed Edna Powell last night.