As a nurse in the ICU, we see death frequently. I think probably that ER nurses see it more, certainly more graphically, but we see it a lot. I have seen thousands of people die in my 26 years of nursing. It gets easier, but still is a very sad and somber event for me. I will not allow someone to die alone. Something inside of me will not allow the last breath of someone to be exhaled into the loneliness of a sterile hospital room. I have been that way throughout my career, maybe it's just me. I cannot remember the first death I was present for, I only remember the last twenty or so. I hold the hand of the person and talk to them, I don't know if it makes any difference at all in the big picture, but for one moment in time...all that matters is that individual and their journey home.

  The ICU is a place where sudden traumatic events are precursors for their stay with us. Families are worried, some shattered, some have come to terms with events, some not prepared at all for events to come. Since so many end up with us through unforeseen events....car accidents, debilitating heart attacks, severe intercranial bleeds and hemmhorages, traumatic falls...there are few times that families are ready for their loved one to die.Their pain is evident and so raw. They search for any sign that could be a positive one, perhaps indicating improvement. I think I would do the same. Sometimes we as nurses are helpless to make the situation any better. We can make sure that the patient is as comfortable as possible, try and provide emotional support for the family members, and just be there for whatever may come up.

  We become calloused about  things. Continued exposure to something does desensitize you, but I have found that when I am about to lose someone all of that falls away and I feel small in a big world. But at that time, I always feel as if the ONLY job I have at that moment, is to escort that individual to their appointed destination. I feel a bit like a military honor guard walking beside a casket. Actually, to be with someone as they die IS a honor, at least to me.

  The grief of family members is so painful to watch sometimes. The wife or husband of 45,50, sometimes 60 years, the children, grown or not, the grandchildren...watching their grief is difficult. Tears are sometimes present for nurses, either you have made a connection with the patient or family, or something strikes you in a way that touches you deep inside. I cried a lot in the months after my father died with families as their loved ones died. It was grieving for him all over again. But I have not cried of late.

  I think it is more difficult for new nurses to handle. I remember how it felt when I was new. Now I know that i have done everything that I could have done, that we as a team have done everything, the rest is out of hands. I have witness various cultural rituals at the bedside in preparation of passing. Perhaps the most memorable was the Native American Shaker ritual of bells and chanting, because even with the door closed the haunting sounds of chanting voices and muted bells drifted through the dimly lit hallways. As I write this I can see and hear it in my mind.

  I write this as an obituary for Pavarotti is on TV, and his voice plays through my living room. I will remember now for the rest of my life, sitting at this computer, writing on this subject, and Luciano's voice as it drifts to the land of perpetual silence.