One of the wonderful people I’ve met on-line is Lucy, a nurse who used to work with chronically ill alcoholics and knows from experience the true horror of an alcoholic death. Now in recovery herself I asked her to write an account of her work with these patients.
The horror of an alcoholic death is probably not going to frighten anyone sober, yet it also something that we shouldn’t shy away from.
This is a story every should read….
Recently I wrote a piece looking at the physical effect of alcoholism from my experience as a nurse. It was a factual unemotional account of the physical complications of alcohol addiction. The account mirrored how I would be when on duty which is that when you are on shift you don’t really think about how you feel as you have to remain professional and almost detached. My colleagues and I worked hard to remain neutral in our emotions and were always sympathetic to people’s illness and the disease process. I don’t think I thought I had a problem with alcohol at the time so I didn’t view myself as similar and therefore didn’t really give my relationship to alcohol much thought. That said, in hindsight I feel that many of us drank to excess to forget the horrors of our day job. It is the most horrendously hideous way to die.
I can think of one particular patient, a women, who I nursed until death that really struck a chord as she and her partner wanted us to lie to her family about why she was dying and not to admit that it was alcoholism. Another reason she remains with me is because as a female, that made her unusual on our ward as they were mainly male alcoholics, plus she was only in her late 40’s so the closeness of age to many of the staff caused a sharp intake of breath and profound sadness from all of us when we were first told about her in hand-over. She had drunk a bottle of vodka a day for many years and was unable to stop but did not want her family to know this. This made the situation very stressful for the staff as the family did not understand why we were not doing more to treat and save her when in truth there was nothing more we could do.
She received medication via a subcutaneous pump. This contained medication to manage oral secretions as she was no longer able to swallow and so became quite ‘rattly’ which was not bothersome to her but was distressing for her partner. It also contained sedative medication as she, like many people close to death, developed terminal agitation which causes restlessness which is distressing for all involved. It may also contain pain medication if the patient is suffering with pain but she was pain free. One by one her organs began to shut down as her liver failed.
We gave her regular mouth care, washed and changed her if she soiled or wet herself. I seem to recall that she had a catheter in place that managed this for her. We regularly turned her from side to side to prevent pressure sore formation and checks were made that she was comfortable. Patients in liver failure become extremely swollen due to fluid leakage from the vessels into the surrounding tissue so skin marking from creases in the sheets and pressure sore risk is high. Always at this time, although she was now unconscious, we cared for her as if she were awake; talking to her never to each other and verbally soothing her if she appeared to be temporarily distressed from what we were doing. All terminal patients were checked hourly and if turning or aspects of the care became too distressing for them then we would reduce it to the minimum. It was about maintaining her dignity and quality of life in death with care and compassion.
Thinking about this now brings tears to my eyes and a lump to my throat. I think the reason I didn’t give it too much thought at the time is because it was just too painful and emotional and that if I started to cry I might not stop. Nursing someone to their death is an honour and a gift but can be deeply emotionally draining and I know that I drank to manage my grief and the other difficult emotions that were triggered by this.
You can read Lucy’s fantastic blog about getting sober here.