6.06.2009

The Long Goodbye

A person I've become very close to is about to pass. I was surprised he didn't pass in front of me...I secretly wished he had passed on my time instead of with someone who didn't appreciate him the way I thought I did.

Everyone says their goodbyes in different ways. Sometimes they'll say their goodbyes before they go on vacation, or they'll say them with a song sung at their bedside. They might say goodbye literally, or they might not. They might say goodbye with a deep, passionate kiss of lips or morphine. Sometimes with a touch or swab-on-a-stick full of ginger ale.

I never feel obligated to perform a goodbye ritual. As I see my friend dying in front of me, the care I give is the care I gave him every day. No goodbye is necessary. Every act was the goodbye. Every encouraging word conceals a cognitive assessment. Every touch relays volumes of information about the body.

Touch is so important but so overlooked and suppressed in our culture (and, curiously, in middle-eastern cultures...both are comortable a foot-and-a-half away from eachother, while most of the earth's population is comfortable six inches away from the person they're talking to), so I take every opportunity to make those simple connections that the "professional" world overlooks..something a cherished colleague referred to as "comprehensive care", which I prefer to refer to as "holistic care"(.


I got the compliment regarding delivering comprehensive or holistic or whatever care because I dropped some music he liked in his room with one of my devices. While I was a nursing student I always imagined some nonprofit service that would provide any music electronically for free to the dying. Now I've done it.

A concept related to this in some arcane way in my mind is the concept I ran across in a journal article I read while working on a resolution for the NSNA (a beautiful and talented colleague of mine did the actual research). I don't remember the name of the article or where you can find it, but it was about a synergistic model of nursing education (maybe that was the title).

From this article I extracted an axiom of sorts. Don't treat anybody else around you worse than you'd treat a patient. Even more than that, use the same approach to teach a patient as you would to teach junior faculty. The nursing process is basically the scientific method personalized a bit, and you can apply it to anything, just as you can apply the scientific method to anything. "Assessment, Diagnosis, Planning, Implementation, Evaluation" might as well be "Characterize, Hypothesize, Deduce and Experiment". The major difference is that in the provision of routine care, you don't experiment. You implement the evidence-based practice that has been proven to optimize outcomes (if you have the resources). Nursing Research, of course, is a rich field of exciting developments in evidenced-based practice, but the in-the-trenches reality of the workplace often necessitates a certain amount of compromise.

Some measures are easy to implement, however, those "holistic" or "comprehensive" nursing measures. The most obvious way to enact these holistic or comprehensive provisions of care is to make the process pervasive in all interpersonal communication. Why would you treat a patient worse than a dear friend?

The largest obstacle or biggest challenge I see reflected in my compatriots is not being fully present. Everyone in every role requires us to be HERE AND NOW and not somewhere or sometime else. Routines make this difficult. A sense of reverence makes this easy.

At first it's difficult to meditate because it hurts. Later it's hard to meditate because you fall asleep. See?

I don't say goodbye because it's all a goodbye. To you, to them...is this me saying goodbye? I hope not. I'll always hold out hope for some amazing advancement in science that allows my consciousness to exist anywhere, indefinitely. Secretly I'm afraid it'll happen while I'm on my deathbed, and I'll be left behind, forgotten.

It's ok, you did it right. Don't worry. Here, have some of this. We'll miss you. Maybe we'll see you soon.

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