Monday, January 30, 2006

When I Die and They Lay Me to Rest, I'm Gonna Go to the Place That's the Best

UPDATE: One of my readers has pointed out to me that it is a common misconception that juvenile onset diabetes is caused by an excessive intake of sugar, and is concerned that this misconception may have received a boost by this post. Those of us who read medical blogs who have a medical background understand this. Readers who do not may not understand that I am being sarcastic, that sugar intake has nothing to do with causing diabetes. I thought this was a legitimate issue and so I've added this update to the post. I appreciate the feedback.


Wow, I had no idea that eating Shredded Wheat was a nursing prerequisite! I would have put it on my applications!
How ironic that I used to eat it!

Under protest, of course.

It tasted like horse fodder.

Unless..... you smooshed it all up until it looked like a bowl of twigs, added enough sugar to ensure juvenile onset diabetes and then smothered it in milk, which you wouldn't drink afterward because little brown shredded wheat things were floating in it.

Ah, memories.

Now you can become a nurse by eating your Shredded Wheat composed of bite sized, frosted "mini-wheats" in a variety of flavors.


Another nursing tradition gone to the resting place of "Cap and Cape Heaven."


My initial experiences as a new RN (back when MTV was just a gleam in a cable company's eye) were in a Coronary Care Unit.

A CCU is a very different place than any other unit I've ever experienced.

Patients would talk to me. They often told me they were going to die. On that exact day.

And they did.

The one thing that the patients found hard to discuss were their "out of body" experiences during codes. This was not a topic that was widely discussed at the time. They were afraid the staff would think they were crazy.

Three patients opened up to me regarding their experiences during the years I worked in the CCU. Here are their stories:
  • Patient One was a young middle-aged female, in her early 40s. This was unusual in itself because young women were not a common sight in the CCUs of the late 1970s.
    • She had had an MI and had "coded" requiring defibrillation three days before. As I did her morning care, she happened to mention that she had felt she had left her body during that time, had followed a light at the end of which was her deceased uncle. Her uncle informed her that, " is not your time. Jeremy will meet you here." At which point she remembers being back in her room.
    • The odd thing? Jeremy was her husband. And he was still alive.
  • Patient Two was, again, younger man in his 40s who had had an inferior MI. As I began my evening care, he asked me how many people had died in the hospital last night.
    • Now that is not a question I get everyday and I asked him why he wanted to know. "Oh, just curious," he replied.
    • Later he opened up to me and said that last night two of the patient's "spirits" had come to get him, asking him to come with them. He said they were in the corner of the room. He told them he couldn't go, his son was a teenager and needed him. They asked three times and then they were gone.
    • Patient Two had been defibrillated three times the night before.
  • Patient Three haunts me to this day.
    • She was not very old, maybe mid 60s and she kept going into unresponsive ventricular tachycardia. She required defibrillation multiple times. I remember standing at the bedside, paddles in hand, while my colleagues worked on her medications and IVs.
    • Eventually things settled down and her rhythm stabilized. She called me over the bedside.
    • "Do you believe in an afterlife?" she asked. "Interesting question, " I answered. "Why do you ask?" For the record, I happen to be a Christian with a very strong belief in the afterlife, but I sensed this was not the time to discuss it, so I kept the focus on the patient and her situation.
    • What she said next was horrifying. She had been underground, cold, dark and surrounded by dirt, looking out of a coffin. All she could see was her sister's coffin next to hers. No warmth, no peace. Just coldness.
    • Her sister had already passed away.
    • I asked her if she felt the need to speak to the hospital chaplain. She said yes.
After I left CCU for the challenges of the ICU, I never heard any more stories of my patients' experiences with death. Unfortunately in the ER, I will never hear them, as most patients are intubated when coded.

I once described a code as having a tug-of-war with God. Every now and then he lets us win.

I like to think my patients are watching the struggle and appreciate the effort we make on their behalf.

Even if we lose.


At 1/30/2006 08:13:00 AM, Blogger Dr. Deborah Serani said...

{Sigh}I can *only* do the frosted ones.


At 1/30/2006 08:29:00 AM, Anonymous Susan said...

Wonderful post.

At 1/30/2006 08:36:00 AM, Anonymous Jenn said...

It's so eerie how people know when they will die. Every time a person says they are going to die, I'd do a thorough assement and keep a close eye on them. They usually coded (and usually died) within 24 hours.

My favorite was a nurse I was working with one night shift. His patient said she was going to die and he looked at her and said, "Honey, your bags may be packed, but you aren't checking out till at least after seven."

At 1/30/2006 08:38:00 AM, Blogger I am a Milliner's Dream, a woman of many "hats"... said...

Oh, no! I'm so screwed...I prefer Cream of Wheat...I'm going to be an AWFUL nurse then, right? :)

At 1/30/2006 09:49:00 AM, Blogger Fat Doctor said...

Love your post today. I've hard similar eerie things from folks before they "cross over." My own dad had two full codes (successful - what are the odds?) several years before he finally coded for good. He said on these occasions he saw no lights, heard no angel voices. In retrospect, he said, that was kind of creepy - was he going to a dark and quiet place? :)

At 1/30/2006 12:13:00 PM, Blogger PaedsRN said...

Yikes... spooky!

I've definitely had patients where I've said, "it's ok, you can let go now" and they've desaturated into the 50's thirty seconds later. I know some of them are listening, I just don't expect THAT immediate a response!

At 1/30/2006 06:42:00 PM, Blogger Third Degree Nurse said...

I've seen my husband and my father choose their times of death. Not that either wanted to go mind you; but if you know you're dying of cancer and can choose when to go, well, there's some solace in that.

I don't like that story of the patient visualizing herself underground, though. I wonder what her spiritual beliefs were.

At 1/30/2006 06:58:00 PM, Blogger Nephronurse said...

I had a patient once who described everything that had happened during a code at the opposite end of the unit from his room. At the time of the code he was a fresh post-op, sedated and on a ventilator. As soon as he was awake and extubated he was asking us what had happened to the woman we had used the "electric gloves" on, why we put that tube down her throat, and why we were sticking needles in her neck. He was very concerned about her and told us he had watched us. Spooky.

At 1/30/2006 07:31:00 PM, Blogger Jo said...

I want to believe that last lady's story was more a fear riddled dream then what really happened.
My personal belief is that the departed hang out with the loved ones who need them most for a time and then head off to their heaven.

At 1/30/2006 09:19:00 PM, Blogger kenju said...

I was with a friend when she was dying of colon cancer. She was obviously in pain, as the periodic deep groans were increasing over the hour I was with her. I told her it was okay to go, and within 5 minutes she passed over.

Kim, I considered it an honor to be with my friend when she died. If I worked in a ccu I would enjoy hearing people's stories of the oobe's they had.

At 1/30/2006 11:45:00 PM, Blogger Nancy said...

wonderful post.

This isn't the first time I've been here, but I'm delurking.

Thanks for coming over to my blog to see me.


My mom was a nurse and I've a sister who is a nurse.

At 1/31/2006 05:44:00 AM, Blogger Dr Dork said...

You've given me goosebumps.

At 1/31/2006 02:40:00 PM, Blogger MedicMel said...

Thanks for the stories. When working as a paramedic, my partner and I went to the CCU to visit a patient we had successfully coded. As we walked in and started to introduce ourselves, the patient interrupted us and said "I know you. You were pushing on my chest!" He was, of course, correct. I have also had patients tell me they were dying - and if they said it calmly, they were right!

At 1/31/2006 06:49:00 PM, Anonymous Anonymous said...

You brought me back to my days in ICU. I vividly remember a gentlemean telling me a a coleague, don't worry about dying girls it's fine, he had coded once and been resuscitated. I to left the unit for the ED where you never hear the stories of near death. I have always felt during codes that it was more Gods will than our efforts that made the difference in outcomes. The best run codes on witnessed arrests could result in death and the craziest on someone down in the field for 20 min before rescue arrived would survive.
A Massachusetts USA RN

At 2/01/2006 01:45:00 AM, Blogger angry doc said...

My own experience is that the patients will tell me they 'don't feel right', but can't tell you exactly how or why. You examine them, do the ECG, the bloods, and everything's normal.

The same afternoon they spring an MI and die.

At 2/01/2006 04:58:00 PM, Blogger mary said...

I worked in "CCU" in the early 80s, and like angry doc there said, it was the ones who said "something's just not right" who made me worry. After a while I just flat out KNEW that the ones who said, "I'm going to die"-were.

What about the vertical crease in an earlobe sign---is that still part of the CCU mystery signals? When we saw a cardiac patient with a single vertical earlobe crease, we always said a code was imminent. I've always wondered if that was just an old wives' tale...

At 2/02/2006 05:23:00 AM, Blogger Code Blue said...

You and I graduated from nursing school at about the same time (1976 for me). I attended the Medical College of Georgia where Ray Moody was. He was one of the first people to delve into the near-death experience and wrote a book called "Life After Life." I was fortunate enough to hear him speak as well and have been interested in the phenomenon ever since.

My contribution to the discussion here is the story of a young woman (31)who had an etherial experience without coding. She had a major stroke and saw angels and her deceased father with her in the emergency department. I was her nurse practitioner and followed her from ER to discharge. She told me about the experience some days later. I was a little surprised. She was clearly in great distress but I never felt like her life was in danger. This was the first person I had talked to who had an experience like this without coding. I've spoken to a number of patients who have had those out-of-body experiences during codes but this is the first time I was interacting with a patient while it was going on. Like you, I have strong Christian beliefs and feel that it was a privilege to be a part of that experience.

At 2/05/2006 05:53:00 PM, Blogger art-sweet said...

I KNOW I'm being petty. And I KNOW it's bad form to delurk with a complaint. But please...

You're a nurse. You know that there is absolutely no causal relationship whatsoever between juvenile (type I) diabetes and sugar consumption. So for the sake of those of us with diabetes, who have to deal with the idiots who don't understand that how much sugar your mom put on your wheaties has nothing to do with your immune system deciding to do a number on your pancreas - could you please take a minute to think before making medically inaccurate jokes?

stepping down from my soap box now...

At 2/06/2006 01:08:00 AM, Blogger Kim said...

Art-sweet - check your email!
I've added an update.....

At 2/06/2006 06:59:00 AM, Blogger art-sweet said...

Thanks Kim!

You'd be amazed at how many people actually think there is a relationship - and love to play
"blame the victim."

I've updated my blog to reflect your changes.


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