A time to give birth and a time to die...

Let me start out by saying that this was not just any patient. This particular patient had frequently been in our hospital several times.

This patient and family had spent the better part of the month with us. Needless to say, all of our nurses on the unit had cared for this patient.

On an afternoon, I walked out for report that morning, I immediately recognized the name written on the room, but couldn’t put a face to it. A short while later the patient’s family came from the waiting room to ask if we knew
anything at this point. As soon as I saw the family, all the details flooded back to me. With the help of the a few clinicians, I began to call all of the patient's previous doctors. We are blessed at Texas Health Fort Worth to have very talented physicians to work with. Within 30 minutes one of the patient's doctors was in the room and had talked to the family. He came back from the private waiting room they had been put in, and said they wanted to withdraw life support once all their family was there.

The orders were written to make the patient a DNR (do not resuscitate) and all of the withdrawal orders were in place. While we waited for the rest of the family, one of our patient care technicians said that the family asked her if we could wait to withdrawal until the patient was outside. I will admit the ICU nurse in me said ”WHAT?! We can’t take a ventilator outside!”

Once I returned to the unit, the family was in the room along with their priest. One of our palliative care nurse practitioners came by and we began to talk about the situation. I think just having her around makes you calmer and more compassionate. We talked for a while about how we could make this possible.

We then had to think of ways to get to the meditation garden without having to go straight through the lobby. She made a call to the palliative care unit and the nurses there as well as our PCT began to make calls to figure out how to get the back gate of the garden open. After endless phone calls, we had it figured out. We had the code to the gate and within a short amount of time the stretcher
was there as well as the two palliative care RNs.

We all decided we needed to do a test run to make sure the stretcher would fit through the gate as well as be able to get it where we needed it. We completed our test run successfully. The palliative care nurses went to set up their privacy screens for the small areas we would have to go by before we got into the garden. Once back upstairs, we set up the stretcher and I told the family the plan. They were going to go down to the garden and we would meet them there momentarily. The five of us moved the patient to the stretcher, got him comfortable and started on our way to the garden.

There were a few small bumps,but we made it and it was a beautiful
80-degree Texas day. There was a light breeze making it the perfect afternoon.
All of the patient's family was gathered in the shade next to the waterfall. The patient's next-of-kin said they were ready, and I extubated the patient. Through their tears, the family told the patient that he/she was loved and that the family kept their promise not to let him die in the hospital. We all stepped away to give the family alone time with the patient in these final moments. As we stood at the main entrance to the garden, I looked at the wall and saw the plaque that read “There is an appointed time for everything. And there is a time for every event under heaven. A time to give birth and a time to die…” It was perfect. Within a few minutes, the patient took one last breath and passed away in the arms of a loving family.

We have to deal with many deaths as nurses in the ICU, most of which are
unexpected and terribly traumatic. While no death happens without sadness, this was the perfect way for this patient to finish life. It was not in the hospital, as the family had promised the patient, and in the arms of a wonderful and caring family.

- An ICU Nurse
Texas Health Fort Worth