"I saw his breath beat quicker and quicker, pause, and then his little soul leapt like a star that travels in the night and left a world of darkness in its train," said W. E. B. DuBois in On the Passing of the Firstborn. As a nurse caring for cancer patients, I have often felt that the world should stop for a moment when someone dies.
The first spirit I felt leave a patient's body was that of a 34-year-old with lung cancer, whose hand I held as he died. Johnathan Stewart was admitted to the hospital the Monday before Thanksgiving and died the following Monday. In that time, he deteriorated from a strong, healthy man with a bothersome cough to a gaunt-faced creature struggling for each breath.
On Monday, before diagnosis, Mr. Stewart was hopeful, optimistic, and ready to fight for his health. He had just bought a new motorcycle and was planning to ride it to Sturgis, South Dakota, for a big motorcycle gathering. On Wednesday, when he heard the diagnosis of lung cancer with metastasis to the bones and brain, I could see the shadow of death enter his eyes. But he was still prepared for battle. "I'm not ready to die," he said. "I have too many plans."
Not wanting to spoil his family's Thanksgiving celebration, he asked us not to notify them. But on Friday, the physician told him that there would be no battle; it was too late, the cancer was too extensive to treat. The shadow in his eyes darkened. Within 12 hours, he went from breathing normally to needing a 100% nonrebreather mask. His breathing, which had been calm and unlabored before the news, became so loud and labored it could be heard from the nurses' station. We moved him to a private room.
Mr. Stewart finally allowed us to call his family; his mother and brother came the next day. He told them, "I have cancer, but I'm not ready to die." They sat beside his bed, not knowing what to say. They turned to us, the ones who were supposed to know the right words. But what can you say to comfort a 34-year-old who is dying of cancer? I could only assure him and his family that he would be as comfortable as possible, that we would make sure he would not be in pain, and that he would not have to struggle for breath.
Sunday, before he stopped talking altogether, Mr. Stewart told me, "I'm going to ride that motorcycle, in this world or in the next one." He was drowsy from the morphine. His face was relaxed. His eyes looked peaceful; the shadow of death had left them and suffused the entire room.
Monday morning he lost consciousness, but I told his family he could still hear us speaking. I left them alone with him, but something drew me back into the room. His mother was at his left side, holding his hand, and his brother was at the foot of the bed. I took his right hand, and we watched him breathe. As his breaths became shallower and farther apart, I told his family they were his last. His brother went into the bathroom, tears running down his face. I held Mr. Stewart's hand tighter and told him it was all right to go. He took one last, deep breath.
Still holding his hand, I felt his spirit rise out of his body and float gently away. The shadow of death left the room along with his spirit, leaving an emptiness in its wake. His mother cried and bent down to give him a kiss. I left her and the brother alone to say good-bye.
I thought time should have stopped, that there should have been some acknowledgment of his passing. But it didn't. It never does and it never will. I struggle with this each time a patient dies. I feel such an immense loss; I feel that the whole world should be aware of it as it occurs. As W. E. B. DuBois said, "The day changed not; the same tall trees peeped in at the windows, the same green grass glinted in the setting sun." The heartless, implacable hands of time keep driving me past that moment of death.