I recently entered a patient’s room just as he was drawing his last breath. This lovely man had been my patient for only two weeks. But it was clear that he was an extraordinary person, and I adored his sweet family as well.
The nurse quickly came to the bedside to “pronounce” the death. She and I spent a few moments comforting the grieving family, and then the nurse offered to have one of the aides provide postmortem care for the patient’s body. The family accepted the offer, stepping into the waiting area to make phone calls. I asked the nurse if I could observe the postmortem care, and she readily consented.
One of our CNA’s, Marta, entered the room. She filled a basin with warm water, adding a small amount of soap. Marta mentioned that she also added toothpaste to the water, to give the body a fresh smell.
I watched as Marta donned gloves and dipped a washcloth into the basin, wringing it out so that it was barely damp. She gently washed the patient’s face, ears and neck. She washed the patient’s arms and legs, uncovering and recovering each limb with utmost care. Marta hummed an African hymn as she worked. The patient looked peaceful, almost as if he were sleeping.
Marta explained that sometimes patients lose bowel or bladder control at the moment of death, so she had me help her roll the patient onto his side so that she could check his underside. The patient was clean and dry in this case, so there was no need to change the disposable brief or the chux pad underneath him. We replaced the top sheet with a fresh one. We left the patient’s arms on top of the sheet in case family wanted to hold his hand. We removed the pillows for the family to take home if they wished. I said one final silent blessing as I combed the patient’s hair. With that, our care of the body was complete.
Before we exited the room, we bundled up all of the dirty linen and trash in the room. We moved flowers and boxes of tissue to surfaces where they could be seen and accessed. We straightened the chairs and opened the balcony door, as it happened to be a sunny day. I thanked Marta for allowing me to participate. We hugged briefly, and I walked toward the family to let them know the room was ready for them.
Postmortem care varies from place to place. In some settings, a “chin strap” (a scarf, a tie, or rolled piece of bed linen) is used to hold the mouth closed. Marta did not do this, as it’s not standard practice on our unit. She turned off the patient’s O2 and removed the oxygen cannula, but did not remove his PICC line. She explained that the latter is done only when the family requests it. The purpose of postmortem care is to prepare the patient for viewing by the family, and also to prepare the patient for transport to the morgue or funeral home. The intentions are respect for the patient’s body, and compassion for the patient’s loved ones.
What I learned from this experience is that the care we provide to the dying does not end when they are dead. I have a newfound appreciation for the work of undertakers and others who support the various rituals of preparing our earthly bodies to reach their final destinations, a job that is still carried out by family members in many parts of the world. It is yet another sacred opportunity on the continuum of care that we are honored to be part of, and for me, it was a perfect way to bid farewell.
