by Traci Mullins
I push another dose of morphine through Jerome’s IV. I’m giving it more frequently now, chasing it with Ativan, but nothing is working. Jerome has been restless all morning, and I know what I’m seeing.
Hospice nurses call it terminal agitation—a type of delirium that sometimes occurs in people who are dying. As a nurse practitioner, I’ve treated it successfully with drugs many times before. Why isn’t the usual protocol kicking in? I begin to wonder if some of my colleagues are right. Does agitation at the end of life have emotional and spiritual components, too?
Jerome’s family members have been dangling at the edges of the room, their anxiety hovering around them like a swarm of moths.
“Let’s try surrounding Jerome with some things that have brought him joy and comfort in the past,” I suggest.
Jerome’s brothers confer in whispers. The older one, Marlon, disappears and returns shortly with a pad filled with sketches. He shows me the people, animals, cars, trees, buildings…and dozens of motorcycles. “Jerome can draw anything,” he says.
“I found this, too,” he adds, holding up a toy monkey that has seen better days. Most of its stuffing is gone, and its faded fur attests to how many times it’s been through the washing machine. “Jerome loved this when he was little,” Marlon says. Sheepishly he adds, “I’ve teased him for keeping it.”
Marlon lays the monkey on Jerome’s chest and strokes his brother’s chocolaty skin. Other relatives bring their offerings: a soft blanket monogrammed with JAS, photographs of happier days, the family cat. I push more drugs.
We call hospice care “comfort care,” and Jerome does seem to be soothed by our various ministrations. Within ten minutes, his breathing slows and calm settles deep into his bones. I know what this means, too.
“Often,” I say quietly, “when people have the kind of agitation Jerome had, it’s as though they’ve been in a battle. They’re tired, they’re finally at peace, and that makes their transition to the next life easier. I don’t want you to be surprised if this happens.”
A sacred silence falls as the vigil begins. I know we could be here for hours, but I don’t think so.
Soon Jerome’s breathing changes again—fewer breaths, farther apart, as though what is left of his body needs only puffs of air to sustain it. As the minutes tick by, Jerome seems to levitate, he’s so light now. He takes one last breath, then crosses over.
With tears streaming down their faces, his brothers look on as Jerome’s parents lean down to kiss their baby goodbye. Thirteen is too young to die.