The Sound Of Silence Essay, Research Paper

The Sound of Silence

I have attended to many deaths in my short career as a nurse. I guess that is the

hardest part of geriatric nursing. I remember one man in particular, Joe*.

He was a veteran of World War II, and a retired mechanic. He was nearly 90 when I

met him. His beloved wife of 45 years, Sara, had died only months earlier. He was

diagnosed with Chronic Obstructive Pulmonary Disease (COPD). In this disease, the

lungs lose their elasticity and begin to fill up with fluid. Eventually, a person will

literally drown in his or her own secretions. It is slow and sometimes very painful for a

person to endure.

Taking report from the off-going nurse, I was not surprised to hear that Joe was

taking a turn for the worse. The physician had been called earlier and ordered some

Morphine to ease his pain. The unspoken thoughts exchanged between us had been the

same, “This is it”. As I prepared for the long night ahead, I looked over Joe’s chart. He

was listed as a “DNR-Do Not Resuscitate”. His wishes were to die without any

*All names have all been changed to protect privacy

life extenting means, only comfort measures to ease his pain. He had listed only one son

as a relative. I proceeded to call his son, Jack, to inform him of his father’s change in

condition. As a nurse, this is especially hard to handle. Most often, you expect families

to react in grief and sorrow. Sometimes, you encounter a cold, uncaring individual who

does not want to be bothered. Fortunately, Joe’s son was very concerned. He had

planned his usual weekend visit, but, considering this news, would be up as soon as

possible. Hanging up the phone, I felt glad that Joe would be with his family. So many

elderly die forgotten and alone.

As I made rounds, I could hear the familiar sounds of the night in a nursing home:

soft snoring, an occasional soft voice, televisions and radios, the familiar hum of the

oxygen machines and feeding tubes throughout the corridors. Even though Joe’s room is

just off the nurses’ station, I saved it for last knowing I would need more than a couple

of minutes to tend to him. As I walked into his dimly lit room, the familiar smell of

shaving cream and soap filled my nose. Kim, a nursing assistant, had taken care of Joe

for two years and was emptying a pan of water and straightening his room. Joe was

particular about his appearance and even in his diminished capacity, the nursing

assistants knew he wanted to look well-groomed. I touched his hand as I came to his

2

bedside. His eyes opened, piercing blue and full of pain. I told him that the pharmacy

would be bringing his stronger medicine within the hour and that his son would be

coming soon to be with him. He smiled a weak smile, nodded and squeezed my hand.

I proceeded to take his vital signs, being careful not to inflict undue pain. His blood

pressure was extremely low and his breathing was very labored and slow. He wore a

nasal cannula that provided warm, moist oxygen. His body temperature was well below

normal. Kim kept a couple of warm blankets on him and the room heater on low. He

was emaciated, resembling a skin covered skeleton. The bell of my stethoscope was as

wide as his forearm. At 6′ 3,” he topped the scale at only 92 pounds. His skin was tissue

paper thin, with many small, dark purple bruises everywhere. He was propped on

pillows to ease the pressure of his spine pressing into the mattress. As I left him, I knew

in my heart that he would not make it through the night.

As I began to chart, the pharmacy soon arrived with Joe’s morphine serum. I decided

to page the physician once again. With Joe’s vital signs being as diminished as they

were, the morphine may have depressed his respiration’s to a point that they might

cease. The physician, a long time friend of mine, returned my paging. As I made him

3

aware of the situation arising with Joe, he instructed me to try to wait until his son

arrived before I gave the morphine. I hung up the phone, and laid my head in my hands

on the desk. I hated being placed in this situation, my patient needing the relief and his

son needing to spend a few moments with his dying father. I know that my injecting Joe

with the morphine would hasten death to within fifteen minutes. In nursing school, we

are taught that we are not causing a death, it is a side effect of the medication. However,

when I am standing at a patient’s — a friend’s bedside, it doesn’t feel like a side effect. It

feels like euthanasia.

Jack appeared, his clothes were disheveled and his salt and pepper hair was covered

with a baseball cap. The tall, barrel-chested man in his early fifties was a carbon copy of

his father at that age. The pictures in Joe’s room confirm the resemblance. Jack’s wife,

Karen, clad in an overcoat and the same wrinkled attire was standing at Jack’s side. Their

worried expressions and mine spoke volumes. I prepared them for what would happen

with administring the medication. Immediately Karen began to cry, “I have to call the

kids”. I directed her to the phone. Jack was standing silent, I touched his shoulder. “Go

see him.”, I prompted.

Soon after the phone calls were made, three grandsons, one girlfriend, and a couple

4

of friends of the family all gathered. Within minutes, Jack emerged from the room. Joe

had asked for me. My heart was in my throat. At Joe’s bedside, I touched his hand, his

eyes met mine. I asked if he was in pain. His voice was barely audible, “I’m ready.”, he

whispered. I left the room and prepared the medication. Upon returning, everyone left

the room except Jack. As I injected the morphine, Joe closed his eyes and squeezed his

son’s hand. I stoked Joe’s hair briefly, kissed his forehead and left. Minutes later, Jack

appeared in the doorway, his eyes filled with tears as huged his son. I went back into

Joe’s room. Placing my stethoscope on his chest, I heared a sound that will ring in my

ears forever, the sound of silence.

5