Topic: Cleaning or My First Patient Death

02/05/92 7:35 A.M.  Res absent respirations, no palpable pulse, unable to auscultate BP, pupils fixed and dilated.  Call placed to Dr. Perrino. New Order: May release body to funeral home.  Resident’s daughter notified—-B Collins, LPN
02/05/92 7:50 A.M. Dgtr at bedside.  Paul Young funeral home arrived to transport res-B Collins, LPN
       It was my first patient death.  My first death of any kind really.  The first time I had been around a dead person except for attending a layout but that wasn’t the same as this.  I had graduated from nursing school in December of 1991 and was working the night shift at an Alzheimer’s unit of a local nursing home.  Our 24 bed unit was staffed at night with one nurse (me) and two nursing assistants, except when someone called off and our census was down below 20.  Then they figured we could make it work.  The night Alice died it was just me and Pat.
     Pat was what I called a career nursing assistant.  She was in her early fifties.  Despite her affection for drinking Hennessy on a fairly regular basis she was in terrific shape—must have been all that heavy lifting.  I went in to check on Alice.  She was 87, had advanced dementia, and had stopped responding verbally a few days ago.  I think she was septic which basically means she had a massive infection and the plan according to her daughter and Dr. Perrino was just to let her go comfortably.  She had a catheter and she had stopped eating or drinking in the past few days too.  So why I gasped with shock when I found her dead that morning made little sense.  I had trained for this.  I had expected this, but I still freaked out a little anyway.  I was 27 years old at the time.
     I called for Pat, “Oh my God, Pat, get in here.  I think she’s dead!”  I knew Alice was a do not resuscitate but I kind of froze about what I was supposed to do next.  Pat prompted me to call the nursing supervisor who told me she’d be over as soon as she could, that she had gotten pulled to the cart herself and was passing meds.  “Do whatever Pat tells you” was her advice.  I never saw the supervisor that morning.
     “Yeah she’s dead alright.  Did you call the doctor?  Did you call her daughter?” Pat knew what to do. No, I hadn’t done any of that.  But first I figured I’d check everything one more time.  I put the stethoscope on her chest, checked her non-existent pulse.  Pat gently closed her eyelids as she told me how it creeped her out to have a dead lady staring at her.  Then she gently patted Alice’s hand and told her to rest easy, that she had earned it.
      “We better get her cleaned up,” Pat said with some urgency.  Cleaned up?  I hadn’t thought about that.  I mean she was dead.  It wasn’t like she was going anywhere.  Then Mary Ellen, the lady next to Alice started wailing as she was prone to do and Pat left to tend to her.  I was alone with Alice.
     Calling the doctor was the easy part.  Calling the daughter was a little harder.  Just tell her I schooled myself. Be direct and kind but don’t use euphemisms they had told us in school.  Saying someone had “passed away” could be miscontrued.  So when I called Alice’s daughter I simply explained that her mom had died that morning.  Her daughter thanked me for the call and said she was on her way.
     The hard part of all of this was the cleaning.  I actually felt a bit frightened, of what I don’t know.  This is somebody’s mom, I told myself.   What are you afraid of?  Alice’s daughter would be here any minute to say goodbye.  If I didn’t get ready, no one would.   So I got a wash basin and filled it with soapy warm water and gave her bed bath.  I removed her urinary catheter and about jumped through the ceiling when her lifeless body expelled some gas when I pulled out the catheter.  Then I apologized to Alice for gasping.   I dressed her in her prettiest floral duster and put Jergen’s lotion on her feet.  I cleaned all the junk that was caked on her lips from days of mouth breathing.  I put some Vaseline on her cracked lips.  She looked better than she had in weeks.  “You’re looking good, Miss Alice,” I murmured as her daughter walked in behind me.