Two nights ago we had a patient pass away in our ER. There's nothing unusual about this. What made this case worth mentioning is the manner in which the events transpired and the lessons about human frailty that are embedded in it.

The patient was 56 year old female in the terminal stages of pancreatic cancer. She had been diagnosed 3 months prior and her family had made the decision in the last month to place her on hospice. She had home hospice nurses who would come to see her, and the family knew the end was near.

Earlier in the day, according to the family she began to exhibit a change in mental status. She would not eat, and was not responding to questions. The family panicked and called 911, which brought her to our ED. As soon as she got there, we begun the usual measures, trying to get an IV, checking her blood sugar, EKG, etc. Then one of the family members said to another "We should probably call Sandy". Since we could tell the prognosis was not good, and we weren't getting much of a history from the family, we grabbed onto this and immediately asked "Who's Sandy? Another daughter?" The response "Oh no, she doesn't have any children, Sandy's her hospice nurse." At the word 'hospice' we all came to a halt.

By definition, a hospice patient is placed on comfort care. They are in the terminal stages of a disease process and are usually DNR (Do Not Resuscitate), DNI (Do Not Intubate), and in some cases DNH (Do Not Hospitalize). We immediately set about calling 'Sandy' who then gave us the whole history, and wanted to know why the patient had even been brought to the ER. This question would not be answered until after the patient had passed. The family expressed a very obvious reluctance to take her back home. We could see they cared, and they were scared, and overwhelmed. The doc agreed to admit her for comfort care and the family left. They expressed that they did not wish to be called unless she passed.

She did. About 4 hours after they left, her heart stopped beating, and she ended her journey on earth, with five strangers, all nurses, at her bedside, two of us holding her hands. We had covered her with a special comfort blanket that our hospital provides and then we stood there and kept vigil, only moving away to tend to our other patients when they called, but otherwise staying close to her, sometimes talking to her, but mostly just silently holding her hand. We kept an eye on the cardiac monitor which we had silenced so it wouldn't alarm when her heart rate became erratic, and watcher as heart fluttered this way and that, until it finally stopped.

We all sighed when it was done, knowing we had been part of something very powerful and intimate. We had stood in, if only momentarily, for her family, and held her hand as she crossed from this side to whatever follows.

We then set about the business of calling the family, the sharing network, and anyone else that needed to know. It was somber and still in the ER, even the other patients were very quiet, like they all knew something was happening, even though no one but the staff knew of the events transpiring in that room.

When her family got there they stood around quietly, tears in their eyes. They thanked us and finally talked to us. "We were afraid, it happened too fast. We thought if we allowed her to die at home it would mean we had done something wrong. It just happened too fast."

Not everyone thought they did the right thing. There was the opinion that she should have been left to die at home at peace, instead of being carted to the ER. Maybe this is true.

But she did die at peace, with us. Her family reached out for a helping hand and we gave it. Had we insisted on sending her home who knows what would have happened. Instead we honored the wishes of those who had been caring for her, and we kept her comfortable until her heart gave out.

Such is life. Who are we to judge?