The start of anything begins with the end of something else.

One day, I was working dayshift, and I got this patient with a bowel obstruction. She was elderly and in really good shape. A real spit fire. She was fucking adorable. It was a busy day. She had an NG tube and we were trying to decompress her bowel with it and disrupt the obstruction.

The morning flew by. My patient didn’t want a shower, but she accepted a bed bath and foot soak from me. If I give you a bed bath, you’re going to feel like you just stepped out of the shower. Cleanliness is important to feel like a human being. It’s also an opportunity to talk to my patients and learn about them, and to do a really thorough skin assessment. Because the skin is the body’s first line of defense, this is incredibly important.

During her bath, my patient told me she would refuse surgery. She told me that at her age, she didn’t want a long surgical recovery. I told her I would support her decision. She thanked me. We talked about a lot of things, her children, her life. She was an amazing woman.

As the day went on, my adorable, spunky patient got worse. She started having increasing pain, clutching her left side. Her abdomen began to swell. Her vital signs deteriorated. I called the residents, and as shift change approached, I took her to ICU. After I gave report and headed to the elevator, I heard a code called in ICU. It was my patient. I was sure she would be gone.

I was off for a day, and then came back to work. It was a Saturday. I discharged a couple of patients and then the charge asked me to take a patient from ICU. The ICU desperately needed the bed, and in order to get that bed, they needed to send us a patient whose death was imminent. When I heard the her name, I said I would absolutely take the patient. The other nurses quickly offered to cover my patients and the charge promised me she would be there with me.

This was important, because I had never had a patient die. I’d saved some lives by making clever catches and having good rescue skills, but the truth is, I’m really good at getting my patients to ICU if they start to crump. I’m even better at keeping them out of ICU by catching slight changes in condition. I’m known for it. Because of this, and luck, I’d gone 5 years in nursing and nearly 10 years in healthcare and never had a patient die.  So I needed someone to stand by me and walk me through the process.

I got report from the ICU. My patient was in a coma, caused by kidney failure. Her bowel had died. They had attempted surgery, which she must have agreed to at the last minute, and found her bowel dead. When the bowel dies, the body begins to fill with toxins. The kidneys lose perfusion and become overloaded. The liver becomes overloaded. Eventually, the individual loses consciousness and dies.

When the patient transferred, I phoned her son to let him know where she was. He was in the middle of a flat out drive across the country to try to make it to his mom before she died. There was no way he would get there.

My patient arrived from ICU and she was barely breathing. Occasionally she would groan and I would give her a very small dose of morphine. Soon, her breathing became irregular, and her heart rate slowed. I knew it was time. I went and got the charge. My patient’s eyes were still opening, so we turned her so she could see the mountains. Then we held her hands, and waited. After a couple of minutes, she stopped breathing. The charge and I told her it was okay to go, I told her that her son loved her, and was thinking of her. I put my stethoscope on her chest and I heard her heart beat a strange rhythm and go quiet. She was gone.

The first thing I did was call her son. He wanted to know if she had died alone. I told him exactly what I wrote above, and he thanked me. His mother had made arrangements, and I let him know I was following those, so he didn’t have to worry.

Then a CNA and I went to work. We bathed the patient. I removed all her lines. We put in her dentures. We did the things people don’t think about needing to be done. I thought how just a couple of days before, I had washed the same woman, the same feet, the same face.I thought about how bright she had been, how full of life, and then I knew. I didn’t know it at the moment, because epiphanies don’t always come quickly, but a seed of change was growing in my heart.

I would love for there to be a God, but I cannot, having witnessed death, believe in a higher power, punishment and reward eternity. I cannot believe in an unforgiving, angry God, or a God that grants wishes. Good and bad things happen, but they happen because of things people do, or because of the existence of gravity, or fire, or electricity, They happen because of human error, and animals. Frayed rugs on wooden floors. Sometimes things happen for a reason, but the reason is that someone has made it happen for their own reasons.

That was the day I started to stop believing in God.