Death is inevitable and every one of us will go through it, only that we do not know how it will happen and when. Nurses go through a lot of mental, emotional and physical stress in their everyday rewarding careers; sometimes the magnitude of the stress nurses go through is so much beyond imagination. If you know any ER or ICU nurse out there, talk to them how it is like to be on the front seat that determines life or death of a patient.

I happened to take care of a patient few nights ago who has been fighting cervical cancer with lungs and brain metastasis for the last two days. For privacy reasons, I will use the name “Eta” as in the greek alphabet. Eta was admitted to intensive care unit due to respiratory distress and high heart rate, something we call tachycardia.

With heart rate as high as 150, it is impossible for the heart to continue getting enough oxygen and the time it needs to rest before the next contraction. In other words, the time between every contraction is too short for the heart to get fresh oxygenated blood and take enough rest to get ready for the next contraction. So whenever the heart rate is this high, it is just a matter of time before it gives up due to exhaustion.

Eta oxygen saturation on arrival was about 70% on 100% oxygen via not rebreather mask. Her breathing rate was anywhere between 35 and 50. The average breathing rate for a healthy person is about 16 breaths a minute with 20 breaths as the higher limit. When breathing is faster than 20 breaths a minute, just like we talked about the heart rate in the paragraphs above, the lungs do not get enough time to get in fresh blood, and time to expand and recoil fully. This causes the lungs to move in more oxygen in the body than needed, something that is potentially dangerous. As a result, the patient goes into a state called respiratory alkalosis. Severe alkalosis can be life threatening. I will not go into details about these body chemical states for now but in my future articles. To stay informed, just become my fan here on hubpages. I also publish on "tell it out as greggy"

After reading the last two paragraphs, you are now at a better position to understand what Eta was going through as problems stemming from the major condition she had, cancer. When death happens, it is always because of cardio-pulmonary failure caused by other things (diseases). In isolated cases is death caused by neurological failure and even then, the heart and the lungs have to fail followed by the brain.

Her family came into the ICU running when they heard that she was not doing well. Eta had a son about 15 years old and the only kid born of her. Her son is a strong young man who has always been there for her sick mom day and night. He needed this moment as much as he could to tell her mother how much he loved her; and he did.

Time was running out for Eta to continue struggling with breathing, poor oxygenation, poor heart perfusion, pain and exhaustion. We needed to bring in the son as soon as possible to say as much as he could to his loving mother as we gathered together equipments to intubate Eta. Intubations simply means that she would be put on life support machine to breathe for her, that way controlling her oxygenation, hoping to improve the overall condition.

“I love you Mom”; these were the last words Eta’s son could say to her loved Mom before we immediately sedated her and intubated her in an attempt to save her life. The 15 years old teenager is in such a tender age to bear with such stress magnitude. We were well aware of that but having that short last moment with her mother could be the best thing he will never forget on her mother’s last moment.

In about 3 minutes, Eta was intubated and cruising on life support machine. The procedure went well without any complication, although it is a life threatening procedure that is always performed with all cardiac arrest equipments by bedside in an event of cardio-pulmonary arrest.

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The mother had a living will she had written when she got diagnosed with terminal cancer and she gave it to her son and only her son knew about it. After the intubation was completed and the family allowed to come back in again, the son eyes popped when he saw his mom intubated. Everything was explained to him and he said… Nooooo!! We all thought that he was in denial about the whole situation. The son did not initially understand what was to be done to his mom to help her breathe. His grandmother was with him and he said to her that her mother had told him to never let her be put in any life support machines incase she ever get to that point.

Eta’s son said she wrote and signed some papers that he kept with him and only him knew about it. Eta had a notarized legal living will and advance directives, only that she never made it known to the hospital during admission. Only her son knew about it. The son was taken home, this time by hospital police and he brought the documents.

Chaplains and all the responsible doctors reviewed the documents as authenticate. Sedation was turned off and it was time to extubate Eta according to her legal will and directions in her advance directives. Eta did not want to be intubated or resuscitated in an event of cardio-pulmonary failure. All these were in authenticate documents the son brought.

Eta’s son and his grandmother were by bedside when she was extubated, about 5 hours after initial intubation. The son had a moment to hug her mother tight before she took her last breath.

Eta’s last words to her son were; “I must go now son, live like I always taught you”. Eta closed her eyes. His son cried loudly as the chaplains did their role in a crisis situation. Nurses and doctors too could not avoid breaking down as we watched the monitors tell us the worst was about to happen.

“I love you Mom”. Eta’s son said in his cry for desperation. Eta responded by opening her eyes briefly, smiled and then slowly closed the eyes down halfway. That was the last strength Eta had before she took her last breath.

Eta died with her eyes halfway open wearing a beautiful smile on her face. Her son was taken away from the scene by her grandmother and the chaplains. Even hours after Eta demise, she was still wearing a beautiful smile.

It was no doubt that Eta lived her life up to the last moment, as she would have wanted. She wanted to be with her son in her last moment, and she did. Eta died a happy woman.

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