The Last Beat

It was midmorning at the hospital where I was a clinical medical-surgical instructor. I was standing at the medications cart with Sally, one of my third-year nursing students. One of the floor nurses approached.

“You have Anna in Room 44, don’t you?” she asked Sally.

Sally nodded.

“You better go in there,” continued the nurse. “She doesn’t look too good.”

Sally put down the pill she was checking and looked at me. I sometimes work on this floor on my days off from teaching, so I know the nurses. This nurse never said “doesn’t look good” unless the situation was dire.

“Leave the meds,” I said to Sally. “I’ll go with you to check Anna.”

Anna Smith, eighty-plus years old, had suffered a stroke and was barely hanging on to life. Her family had signed the Do Not Resuscitate form the night before.

“She’s struggled long enough,” her son had said.

My first glance as we entered the room told me everything. Anna’s face was still, pale, unexpressive except for her slightly open mouth. The blankets were perfectly still. Anna had slipped into unconsciousness; her sufferings would soon be over.

I walked to the bedside and took Anna’s left hand. Sally moved to Anna’s right.

“Check her pulse,” I suggested. I could feel Anna’s pulse, very slow and weak—so feeble that it took Sally a moment to find it.

“It’s thirty-six,” she said.

In the two or three minutes we’d been there, Anna hadn’t taken a breath. “She’s DNR,” I reminded Sally.

“But…but….” Sally was close to tears. I felt I could practically read her thoughts: She’d gone into nursing to help people, not to stand by helplessly in the room of a patient who was DNR.

“We can’t do CPR,” I said.

“But…but we have to do something.”

“Yes. We can stand here and hold her hand until her heart stops.”

I was pretty sure Sally did not want to be there; I knew I didn’t. I’d had enough death already that year. I wanted to run from that room as fast and as far as I could. But the patient needed me. Even more importantly, my student needed me.

So I stood there.

I forced myself to be present—to be present to Anna, to be present to Sally. Not to let either one of them down. I needed to reach out to both of them. I tried to summon my own presence, to be fully in that moment, in that room.

I focused on my breath: In…2…3…4…5, out…2…3…4…5, slow and deep. I centered my attention on Anna. With my free hand I massaged her shoulder. I quietly said a few words to her.

“We’re here with you….We won’t leave you alone.”

As the second hand of the clock moved in its own rhythm, Sally seemed to pull herself together. She was stroking Anna’s dry hand slowly, almost in sync with the slowing heartbeat.

As we waited for each new beat, time slowed. Every time I thought that I had felt the last one, Anna’s heart contracted one more time.

Time stretched endlessly—and then it stopped, not like the sudden snap of a rubber band but like the slowly fade of a retreating siren, when you hear it in the distance and then realize you haven’t heard it for a while. It felt like an hour had passed since we’d last felt a heartbeat.

I looked up at Sally.

“It’s over, isn’t it?” she asked, swiping a tear from her cheek. I pulled my stethoscope from my pocket and listened to Anna’s chest for a full minute.

“Time of death, 10:37.” Had it really been only fifteen minutes since we left the pills on the medication cart?

I walked around the bed and hugged Sally. “You okay?”

She nodded and pulled a handful of tissues from the pack that lay on the windowsill.

“Tell her RN, and then go into the lounge and wash your face,” I said gently. “Take as long as you need.”

As she turned to leave, I added, “You did well.”

I remained in the room with Anna. Her spirit had left her body, but I didn’t want to leave her alone, not yet.

“Go in peace,” I whispered. This was a moment that would remain with me, I knew, just as other deaths remain. As the first death she had ever witnessed, it would remain with Sally as well.

A moment or two later, the RN came in and stood next to me.

“It’s hard even when you don’t know them,” she said.

She held out a tissue.

“Thanks,” I whispered, wiping the tears that only now filled my eyes.

“By the way, your student—Sally?—wants to do postmortem care with me.”

Surprised, I turned to look at her.

“It will be all right,” she said reassuringly. “The aide will help us, so Sally won’t have to do more than she’s comfortable with.”

I nodded. Sally will have to learn sometime, I thought.

As I left the room, I thought about Anna and how her life had ended. Somehow, it felt right. We had accompanied her as far as we could on her final solitary journey. She had not been alone.

I believed that she had felt our support, but I wondered if Sally had felt the significance of this as I had.

I needn’t have worried. In conference at the end of our clinical day, Sally told the other students about holding Anna’s hand in her final moments.  “Anna may have died among strangers, but we were people who cared about her in her last moments,” she said.

“And that has to be worth something.”