It wasn’t the body that surprised me.

I’d heard there had been a death on our unit; someone from the local mortuary was on his way. No, what surprised me was that the door to room 110 was wide open. I could see right in there, see the body carelessly covered with a rumpled sheet.

I was a little offended. Show some respect! I couldn’t imagine any of our nurses treating a deceased patient this way. That door should be closed! And that sheet over his face – we never pull linens over anyone’s face! We courteously tuck the person in as if they were sleeping, plump the pillow, smooth the sheets, and close the door for privacy. Leaving him like that – a sheet thoughtlessly thrown over him, in full view of the nurses’ station – was disrespectful to the patient, to his family, and to visitors.

Some people might find it very unsettling, walking past the room and seeing someone like that.

Mind you, I didn’t really know who had died. No one had said to me, “Gosh, my patient in 110 passed today,” or “When the mortuary staff arrives, direct them to 110.” I just knew someone had died, somewhere on the unit.

But I didn’t trouble myself with the details. It was obvious, wasn’t it? I mean, you see a body lying motionless under a sheet, what else could it be, except a dead person?

Nobody would sleep like that, would they?

The answer, of course, is yes.

So the mortuary guy shows up.

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My patient had liver failure.

A lot of bad things happen with liver failure; one of them is a tight swollen belly. The liver isn’t producing proteins properly so fluid seeps out of the blood vessels, filling up the abdominal cavity, making the belly drum-like, firm and distended. We call the condition ascites. 

Ascites can be very uncomfortable, making it hard to breathe, even hard to move, so we do a procedure called a paracentesis. The doctors stick a needle into the belly and siphon the pale yellow fluid out, often great quantities of it. Like: two, four, six liters at a time. Yes, the fluid just builds up again. A patient with liver failure will likely need multiple paracenteses. There’s a lot of fluid in there.

My patient had undergone a bunch of these procedures in the past week. His belly, still stubbornly swollen, was covered with bandaids from all the needle pricks.

That particular morning, I was helping my aide change his linens. I had turned him towards me and was firmly bracing him with my body so he wouldn’t roll all the way out of bed. His swollen abdomen pressed against me as the aide washed his back and placed fresh sheets on the bed.

You know when you sense that something isn’t quite right?

Maybe there’s a faint tickle, a soft sound, a fleeting shadow – something that barely registers, something that makes you take a casual glance around – and you discover something awful, something you didn’t expect? And then, due to circumstances, you can’t shriek or recoil or faint, but you have to calmly carry on with a straight face, as if nothing were amiss?

Nurses and aides know what I’m talking about. Parents, too.

As I held my patient snugly against me, I became faintly aware that my thighs felt odd. Cold, maybe, or – I don’t know, something. Different somehow.

So I glanced down.

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My patient Harriet is a 91-year-old lady with dementia, in the hospital with a urinary tract infection. She lies in bed, sleeping soundly. I creep up to her at the start of my shift.

“Hello, Harriet,” I croon softly to her.

“Hello, dear,” she responds sleepily.

“Can I check your blood pressure, Harriet?”

“Yes, honey, of course, whatever you need,” she answers sweetly.

So I gently pull down her sheets, and she clutches them tighter to herself.

I gently push up her gown’s sleeve, and she pulls away with a deepening frown, eyes scrunched shut.

I gently place the blood pressure cuff on her arm – and my sweet little patient suddenly explodes.

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I was a nursing student, doing my summer internship on a Labor and Delivery floor. Patients were generally-healthy young women who were either in labor or had given birth to generally-healthy babies.

It was a happy place, and I found myself in tears nearly every day.

“This is such a beautiful moment!” I would sob each time a baby was being born. The new mother might be panting, bearing down, possibly screaming. The father was likely hovering anxiously nearby. And there I was, the supportive little student nurse, happily gripping the groaning mother’s knee. Tears spilled freely down my cheeks, as did the words from my trembling lips: “This is so wonderful! This is the best day ever! I’m so happy for you! I’m so honored to be here!”

I got a lot of odd looks from family members that summer. Continue reading →