December 18, 2006, 5:58 am

Run And Tell All of the Angels, This Could Take All Night

basalBedside metabolism?

This was measurable?

For what purpose?

Seems we are supposed to know.

The ad says we “realize the value of this information.”

The Doctor can carry the test to the bedside.

That looks like a Nurse carrying it to me!


You weren’t supposed to be alive.

You didn’t want to be. You told your family.

You filled out all the papers.

The nursing home couldn’t find them.

The paramedics had no choice, they were obligated to resuscitate you.

Knowing it wasn’t what you wanted.

Not having the papers to prove it.


If you had fudged your age a bit, you could have served in World War I.

I wonder if you served in World War II.

I know you married and had three sons.

I know this because the doctor talked to all three of them.

They weren’t happy you had been resuscitated.

I bet you weren’t either.


You could not express any frustration. You were intubated.

Your ribs were fractured from the CPR and you were showing signs of decerebrate posturing.

Your eyes opened and closed.

You did not follow commands.

Oh, and the papers stating your wishes? The ones the nursing home could not find?

They were found in the stack of papers the nursing home sent with you to the ER.


God bless the emergency room doctor that night.

He spoke to all three of your sons.

They all agreed the endotracheal tube should be pulled and that you should be made as comfortable as possible.

That was very good of them to give us permission to do that.

It would have been even nicer if any of them had shown up to be with you.

If I remember correctly, none of them lived all that far away.


We did it.

You were extubated.

You looked immediately more comfortable.

It was expected that you would not last long once the tube was pulled.

I didn’t want you to die alone.

In an emergency department.


I am a registered nurse.

A health care professional.

I’m not supposed to be judgmental.

I’m not supposed to become emotionally involved.

But dear God, if my dad had lived as long as you did, I would have had him another forty years!

There would be no way in hell that he would be dying alone in any emergency department.

Perhaps when you have your father as long as your sons had you, you tend to take them for granted.

I wouldn’t know about that.


I pushed my thoughts, my anger back into my subconscious.

Where they belonged.

They would do you no good.

They certainly were doing me no good.


You were tough.

You held on. You kept breathing. Your oxygen saturation stayed up with just a bit of oxygen.

I stayed with you as much as possible. So did the doctor.

We talked to you.

Your unseeing eyes would move; your arms would rotate in the classic decerebrate posturing.

Your breathing became labored.

I gave you morphine. You relaxed and so did your pulse.

I wonder if that allieviated some of the pain of your fractured ribs.

I wonder if you could feel them.


Nobody lives as long as you did without being tough.

And nobody your age should have been in the position you found yourself during the wee hours of that morning.

I gave report to the angels by praying you would not continue to suffer.


By the end of the shift, it was obvious your celestial room was not yet ready.

I gave report to different “angels”. The ones residing on the medical/surgical floor.

Time for me to go home.

Seems it wasn’t yet time for you to do the same.


I checked back that night.

And the next.

And the next.

My goodness. I wonder what you were waiting for.

Permission to go?

A chance for your sons and grandchildren to say goodbye?

Did they ever show up?


You should have gone peacefully that night. Your heart had stopped. Your breathing had ceased.

Instead you were physically and chemically wrenched from the arms of God for the lack of a piece of paper. Another celestial tug-of-war.

But….He gave you back.

For three days.

Perhaps you had unfinished business. Perhaps your children had unfinished business.

All I know is that on the fourth day you made the “transfer” to a Higher Level of Care.


I hope your kids appreciate and say a prayer of thanks for the extra three days they had with you.

I would give everything I own for just one more chance to say goodbye to my dad.

Ooops! Better get those thoughts back in their proper place.

I’m a professional, after all.

A rock!

An island in the sea of health care.

And after all,

“….a rock feels no pain.

And an island never cries.”

With all due respect to Simon and Garfunkel…

That’s bull.


  • Karen

    December 18, 2006 at 8:35 am

    Wow. What a touching story. Your commitment to your patients is very apparent. God bless you!

  • Dawn

    December 18, 2006 at 10:20 am

    This post brought tears to my eyes. Very touching. I too wish I’d had just one more chance to speak to my mom before her passing.
    Thanks for sharing.

  • Susan Palwick

    December 18, 2006 at 12:51 pm

    This is gorgeous, Kim. I’ve seen cases like this, where kids or even spouses leave dying patients in the ER alone. I know how hard it is not to get judgmental, because I do that, too. I tell myself that I need to pray for the apparently hard-hearted family, because they’re probably staying away out of fear, or maybe because of family history we can’t know about.

    They have their own stories and their own reasons. I know that, but it’s hard to remember.

    I don’t have kids, and I’m the youngest in my family, so my chances of dying alone in an ER are higher than average. If that happens, I hope I have someone like you as my nurse.

  • Georgia

    December 18, 2006 at 2:00 pm

    That was really beautiful.
    New to the ED myself (for now, as a Nurse’s Aide), I am still just getting used to being around death; old, young, people who remind me of my family members and send me into tears – having to leave the room and hoping they didn’t see. Moments where it feels almost impossible to collect myself. Or other moments where I can feel myself briefly feeling the tragedy of a situation and I just have to switch “Off” and keep going – not wanting to be unfeeling, but also needing to do my job without breaking down.
    I hope that I work with nurses like you when I graduate in May and start work in the ED.

  • universalhealth

    December 18, 2006 at 2:03 pm

    Your words describe what words should not be able to….

    Been there – so sorry to have had to have done that, and may you find comfort in having done what you did.

  • #1 Dinosaur

    December 18, 2006 at 4:54 pm

    That is a poem, Kim! A gorgeous, lyrical, moving POEM!!

    (Oh, and once upon a time, there was this test called the “Basal Metabolic Rate” that had to do with temperature and pulse and stuff. Things we now recognize have more to do with thyroid function and other stuff we can’t quantitate. Measuring the BMR required special equipment, so the creation of a portable aparatus was kind of the 50’s version of an Accucheck, or pulse ox, or portable x-ray machine. What if we eventually found out that blood sugar didn’t mean anything? Someday, someone would be laughing at all those Accucheck ads in today’s journals.)

    (And apologies if you knew all that and were just funning around with us. My bad.)

  • cat

    December 18, 2006 at 6:08 pm

    thanks so much for posting this. I work on a cardiac floor and see so much of this. Its so hard to see patients suffer whether or not they have the paperwork. sometimes family won’t follow what the patient wants and that is even harder. I am so glad I got to spend the time with my mom before her journey. I wish I had been old enough,(2 y.o.) to be there for my dad.

  • jen

    December 18, 2006 at 6:24 pm

    i HATE extubating in these situations in the ER……
    i don’t even know what I’d say or do if i could have another day with my dad, before he was intubated he told all of these ICU RNs that I was a nurse and that i’d be there soon…….he was so proud of me, and i was totally a new grad in a little tiny ER. some days i just want to cry my head off.

  • Alyson

    December 18, 2006 at 6:29 pm

    The thing I cherish most about my mother’s passing is that I was the one to care for her during the last month, and that our last words to each other were “I love you”.

    I can’t imagine not wanting to have been with my mother during those last moments, or with my father when that time comes.

  • kingmagic

    December 19, 2006 at 2:56 am

    Strikes an all too familiar chord.
    I have done a full resus on a patient at home and called it after consulting with my crewmate and the relatives. And then the relatives start an argument over who gets what and who is going to arrange the funeral?
    Even though in most cases the relatives are genuine in their sadness and loss, its the ones who dont turn up or are too busy that stand out.

  • Candy

    December 19, 2006 at 7:36 am

    As always, perfect. And your timing is perfect, too, with my dad coming to live with us tomorrow for his final days. I AM grateful for the extra time I’ve had and I’ll pay special extra attention to him now for me and for you. If you could give report to the angels on him from time to time, I’d appreciate that, too.

  • Mother Jones RN

    December 19, 2006 at 3:41 pm

    That was powerful, Kim. Your patient was lucky to have you as his nurse. Thank you for sharing your thoughts with us.


  • AlisonH

    December 19, 2006 at 6:06 pm

    Thank you thank you thank you. For what you did by who you are.

  • Dawn

    December 20, 2006 at 8:19 am


    You rock. Thank you.

  • Liana

    December 20, 2006 at 4:22 pm


    What a beautiful post. I needed to hear that. I’m doing ICU/internal medicine right now. It is horrible. I’m nost made of strong enough stuff to be cool and impassive when my patients are dying and their families are grieving.

    I needed to hear that there are other medical professionals out there who despite years of practice, don’t become hard and jaded and unemotional.

    Thank you.


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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