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.
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?
family members have been dangling at the edges of the room, their anxiety
hovering around them like a swarm of moths.
try surrounding Jerome with some things that have
brought him joy and comfort in the past,” I suggest.
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.
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
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.
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.
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.”
sacred silence falls as the vigil begins. I know we could be here for hours,
but I don’t think so.
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.
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.