The code is over. Resuscitation was unsuccessful. Minutes ago there was a person-alive, terrified and alone. Now only a remnant remains-a body. In another room, the vigil is over. The family, resigned to impending death, has prayed, cried and watched as the respirator was turned off. The agonal EKG is now a flat line. The person who was alive and vibrant weeks ago is gone. Now only a remnant remains-a body.
Heroics have ceased. Arms flaccid, skin the dusky color of old plums, covered with electrodes and tubes, the tiny premature newborn, who will never know his family, is gone. Now only a remnant remains-a body.
Who cares for the remnant? Usually, a nurse or nursing assistant prepares the body. They call their actions postmortem care-care after life. That padded, insulated term for caring for the body-the physical remnant-of a person who has died, makes this care a procedural routine with goals, objectives, steps and rights and wrongs. First comes the paperwork-toe tags, forms in triplicate for the morgue. Then the tubes, electrodes and other medical paraphernalia must be removed. The body must be washed; wounds and orifices packed; and arms and legs tied gently so that they don't flop or bruise. Finally, the body is wrapped, ironically, in a way that is somewhat like swaddling a newborn.
I spent the first years of my nursing career on the front lines in the emergency room, intensive care unit and the recovery room. I participated in more than my share of codes for cardiac or respiratory arrest. During a code, orchestrated chaos occurs. People shout. Trash flies everywhere. A gridlock of IV tubing and plastic fluid bags suddenly appears.
The team focuses on one thing-save the patient. Recapture the cardiac rhythm. As the effort goes on, the sheer physical exertion of chest compressions exhausts one person, and another replaces him. The clock has heard the starting gun, and it races ahead. We race after it, checking vital signs, watching EKG rhythms. Finally, there comes a point when it becomes clear that this child, this young man, this old woman is not going to make it. Death is called-called at a precise moment. What a strange way to announce that the soul and body have parted, that the soul has been called home to God.
Quickly the room clears. A pale, naked body lies on a table or bed under a bright light, arms outspread, surrounded by the detritus of a medical death. No more battles will be fought here. The nurse is left alone to do postmortem care. It is an onerous task; so painful that gallows humor or anger often covers the grief or unwarranted guilt.
However, I never minded postmortem care. It was my time to quietly make things tidy and symbolically right. I could be tender and caring when all we had done before was rushed and painful. I used this time to ask for forgiveness for our failure and pray God's blessing for a soul I barely knew. It brought time to comfort family members, to hug and share tears. Occasionally, it was a time to rage at God for what I perceived as the unfairness of this specific death. This procedure was expiation for me-a time of prayer, a means of licking my wounds and a ritual of faith, caring and closure.
Psychotherapist and theologian Thomas Moore said, "We are wounded simply by participating in human life, by being the children of Adam and Eve. To think that the proper or natural state is to be without wounds is an illusion. Any medicine motivated by the fantasy of doing away with woundedness is trying to avoid the human condition."1 Most health care professionals grasp this on a cognitive level, but, oh, their gut tells them something very different!!
The body is the soul presented in its richest and most expressive form. In the body we see the soul articulated in gesture, dress, movement, shape, physiognomy, temperature, skin eruptions, tics, diseases-in countless expressive forms.2
We, the health care team, lost that soul. Graphically, we know this person has moved on, and we have been part of that journey. Those who think we are not wounded by this loss are wrong. We experience this loss and re-experience other losses. At the death of this individual, we may feel sad, relieved, guilty, at peace, enraged or a variety of emotions in combination. We may just feel numb.
We may build a wall around our emotions and tell ourselves this is just another task in an overburdened day. The height and breadth of that wall tells us this isn't true. With time and experience, we develop a protective shell, thick enough to protect but, we hope, transparent and flexible enough to maintain our humanity. The postmortem is a time when life cares for death, and God is intimately present in both.
Overwhelmed by the necessary tasks and emotional burdens of the moment, the nurse can benefit from a ritual that gives meaning and the start of closure to the moment. Rituals are meaningful, repetitive patterns of word and action that provide comfort and structure. A ritual can be as simple as a drink of water and a bedtime story or as complex as a grand cathedral's order of worship. Rituals can be personal and private or encompass the participation of a whole community.
A Christian nurse might welcome a ritual for postmortem care and the permission that ritual gives to express and address the nurse's spiritual needs. Theologians Herbert Anderson and Edward Foley state that rituals are essential and powerful. They provide a vehicle for creating and expressing meaning.3 The guides on the cards offer a ritual for nurses during postmortem care.
Meditation Guide for Postmortem Care
Purpose: The purpose of this meditation is to praise God for the life of the person who has died, to ease your personal pain as you perform your task and to honor the deceased as you provide this final nursing care.
Directions: There is no right or wrong way to use this meditation. Use it as a basic guide or as a starting point to direct your meditation or prayers. Add thoughts, prayers or hymns from your own tradition to praise God, to comfort you and to honor your patient.
A Litany for One
Taking Away: Almighty God, as I remove this____________ (name the medical appliance), I recall the suffering and pain of your Son, Jesus Christ, who died that our souls may be saved. I recall our efforts to save________________'s (name of the patient) life. I pray for his/her soul and for those who mourn for him/her. (Repeat this silently or out loud as each item is removed. Uncritically recall the events of this person's death, giving yourself permission to feel whatever emotions or memories of this or other events that may come.)
The Bath and Wrapping
Dear Lord, as I bathe and wrap _________ (insert the patient's name), I recall times in our lives when water has brought healing and comfort. (Silently or out loud recall incidents that have personal meaning to you and possibly to your patient-for example, splashing in mud puddles, soaking a sore foot, bathing your child, swimming, or your baptism.)
I remember that Mary Magdalene, Mary, the mother of James, and Salome came to the tomb to prepare the body of Jesus for burial. I remember their amazement, Lord, when they found he was risen. I praise you and thank you for your gift of eternal life for those who truly believe. I pray for________'s (insert the patient's name) soul.
Dear Lord, as your Son was wrapped in swaddling clothes as an infant, I wrap your child, __________ (insert the patient's name), a final time. I ask your blessing on him/her and on those of us who cared for him/her. Comfort us and help us to cope with the feelings that arise in us at his/her death. Sustain us, Lord, for we must reach out to other patients facing death. Help us to be your comforting and consoling presence at their bedsides.
Benediction
(As you take leave of the body, say a final prayer for this person and for yourself.) Heavenly Father, may all touched by _________ (insert the patient's name) find peace and comfort in your abiding love. Amen.