The NUSING SITUATION happened in December, near the holidays. I work in a medical-surgical unit with capacity for 40 patients.  My hospital is a community based institution that generally admits patients from multiple backgrounds and diagnoses. I was in charge of my unit that night. I assigned to one of my nurses a 74 years old male patient complaining of weakness with history of cirrhosis from alcohol abuse. He was confused but followed command, ambulatory and with vital signs within normal limits.
The nurse told me some hours after admission that he was starting to get more confused and trying to walk out, but he was really weak and not stable. The nurse asked me if it was possible to move the patient near the station to closely monitor him, because of his high risk for falls. I agreed and we moved him with his consent. He finally calmed down and went to sleep.

One of the nurse aids took his vitals around 0400, they were okay, but 30 minutes later, I saw that the cardiac monitor was showing a heart rate of 40, and after staying for 10 seconds I saw it dropping to 35. I rushed to the room to check the patient. He was pale and having shallow breathing. I called for the rescue team, but his condition was getting worse by the minute. Then we called a code blue after he stopped breathing, CPR was started and intubation was necessary. After working for over 20 minutes, we were unable to bring him back.

As a nurse, I think that losing a patient who was not expected to go is very disturbing, but I believe that informing the family or love ones is even harder. I try to help my nurses whenever I can during these stressful and sad situations. I started calling the phone numbers I found in the profile, but I had no answer. I was starting to worry, because usually there is someone out there for anybody, and we expect that to happen.

I finally got an answer. It was the voice of a sleepy middle age woman. I asked her if she was related to the patient. She was his neighbor and gave him her number in case of emergency. She explained to me that he had no known family members, and that she and another neighbor checked on him once in a while to make sure he is okay. She told me that he was a heavy drinker living out of welfare and never saw any other person with him except them. I realized the need to inform her of his expiration and that the county will take care of him because she had no direct relation. She appreciated the call, did not cry though, and did not stay on the phone long. 

I sat down thinking for a moment, organizing my thoughts; no one will come, no one will cry and no one will miss him for long. The only people around him were 2 women who felt bad for him and gave him a quick visit from time to time. My team and I were probably the last care givers for him. I understood that nurses are there like angels for the most lonely and vulnerable. Even after death, we were going to care for his body and dignify him as a person, caring for him as patient for the last time.  This black canvas was painted with oil paint to represent the transition of the human material form to the spiritual. The individual starts a new journey, the nurturer says goodbye for the last time, as he leaves this world alone.