The end of life. The right to die with dignity. How often do we hear these phrases and even experience death with loved ones, yet there is no magical way to assure that each person’s wishes are respected and carried out.

My first painful memorable experience came as a young nurse at a veterans hospital in Madison, Wis. I treated a patient who had no lung capacity left due to tuberculosis and was kept comfortable with nasal catheter oxygen. I cared for "Sir Cedric," as I fondly called him, with precise directions from him on how to tape and administer the oxygen. As I cared for him, fed him and bathed him for more than three months, I came to know him and his wishes. Finally, the end was near, and as the p.m. charge nurse, I called the officer of the day to the ward. He ordered me to bring the cardiac arrest tray. In those days, a long needle was placed directly in the patient’s heart and adrenalin was administered.

As I held his wrist, taking his pulse, I followed the physician’s orders and watched as Cedric responded and gave me the most awful look: "Brownie, how could you do this to me?" He did not speak, but his eyes told me how he felt and I will never forget that look as he died. I returned to the glass-enclosed nurses station and yelled at the physician for disrupting his right to die with dignity. The physician said he followed the Hippocratic Oath and had I told him of my patient’s pathophysiological condition, he would not have performed the procedure. I have never "followed" a physician’s orders since and strongly advocate interpreting orders based on nursing knowledge of the patient’s data and diagnosis.

Years later, as a patient care administrator, I was making patient rounds and saw a young nurse step out of a patient’s room crying. I asked her what was wrong. It was her first death, so we did the final care together and we talked about dying and that it is all right to care.

Death is part of the continuum of life. Sometimes death occurs when least expected, as in an accident or trauma. Preparation is seldom considered and the family needs are great for physical and emotional support. Nurses are the closest to the caring and are rarely allowed enough time to care for the family. Then the nurse involved suffers the loss, too.

A living will should ensure the right to die with dignity and determine the end-of-life wishes not to use extraordinary extension-of-life procedures, but this is not always observed by the physicians who admit patients, especially in emergency situations.

I took my father’s last apical heartbeats at home as he died of lung cancer, but stupidly called for an ambulance to transport his body to be pronounced dead. What a mistake. I rode in the ambulance to the hospital, and he was admitted to the emergency room of a big, city hospital where I was a resident in hospital administration. In the waiting room, I suddenly realized that they would not know that he had died of lung cancer. I ran to the room as they were hooking him up to everything and I pulled the plugs. He did die with dignity at home, with loving family at his side, but to this day my brother feels he did not die at home.

What a family perceives to be the wishes of the patient is of utmost importance. While we are busy being professional and efficient, we neglect to consider the impact on those around us.

Whether a neophyte nurse, a family member or even a young physician, we all share in the experience of death and dying. Nurses and physicians have the unique opportunity to enable all people to experience the end of life with compassion and dignity.

Many at the end of life, especially the elderly and homeless, have no family to care for them, so we must be there. It is my life and it is my right to choose. Each nurse accepts the responsibility to uphold that right as the practice of nursing demands.