Sunday, April 15, 2012

If Tomorrow Never Comes...




Placed third in the 81st Annual Writer's Digest Writing Competition

March 2011, New York

I heard singing from the dying patient's room. The male voice tried to hum a familiar melody, but the words were garbled, as if the singer could not get the words out.

Outside the door, one of the hospice nurses was talking in reverent tones to an elderly female. The patient’s mother sat at a chair; her face lined with unspoken grief. She clutched on her daughter’s wedding picture. I glimpsed at the image of a vibrant young woman in her wedding dress, her beautiful face caught by the camera as she basked in the adoring eyes of her equally vibrant husband.

The hospice unit occupied the left wing of the surgical floor in the community hospital. The atmosphere was somber, to reflect the inevitability of death in the unit. This is where terminal case patients spend their last moments on earth, in the company of their loved ones.

In this unit, death is a constant presence. Although an air of sadness permeated the unit, there is an undeniable sense that the staff in the unit feel that they belong.

The nurses, nurse practitioners, social workers, and the doctors in the hospice unit take pride in their work. The walls are dotted with plaques of appreciation from the patients’ families, a testament to the staff’s impact on the families left behind.

The big rooms accommodated a daybed, two comfortable chairs, a television set, a refrigerator and a microwave. The amenities would no longer benefit the patient, but have at least provided comfort for those who stayed vigil at the patient’s bed side.

Working as an adjunct faculty for the clinical rotation, I was assigned a group of 10 nursing students from the community nursing school. This was their last semester in nursing school, and so I wanted to give them a clinical experience that was fulfilling and inspirational.

Being assigned for one month at the hospice floor seemed like a daunting task, even for an emergency department nurse like me. I have seen a lot of deaths in my own inner-city ED, but somehow, I have protected myself from investing too much emotion. My armor was to shield myself from the constant reminders of man’s vulnerability and the helplessness and devastation that death and suffering bring front and center in the healthcare profession.

The hospice nurses provide an invaluable support for their patients and their families during these last days. They are like angels of mercy in a place where loss happens almost every day. I could not imagine being that strong.

Most of all, the hospice patients give us a lesson on fortitude and bravery every day. These men and women are courageous than I can ever hope to be. Because they face death in the face. And they live with it and die with it. They accept that the end is here and then they go, albeit unwillingly because of the family they leave behind, but at the end, they leave with dignity.

The nurse practitioner had given an inservice just an hour ago to my students. He reviewed Kubler-Ross' Five Stages of Grief. He admitted that their patients sometimes take a long time to reach the stage of acceptance. And when they do, the hospital staff would make their last days as comfortable as it possibly could be.

He was passionate in his work, and made my nurses tear up with his accounts of the memorable patients in his care. Somebody asked how he survived unscathed from the constant loss, he smiled sadly and said, “I take joy in knowing that my patients do not die alone.”

The nurse practitioner had informed us earlier that the cancer was detected during the patient’s pregnancy, but she held off chemotherapy until she delivered a baby girl just six months ago.

My student nurse looked distressed and her eyes were filling up with tears. She had requested that assignment, and knew from the primary nurse that the 35-year old patient with terminal ovarian CA would probably die that day.

I approached my student in order to pull her out from the assignment. I was afraid that it would be traumatic for her to witness her first patient death at this point. And besides, we always want to provide utmost privacy to the hospice patients and their family. In the throes of grief, they would not want strangers to hover around and intrude on their loss.

The singing stopped. And a male voice called for the nurse.

It was the patient's husband. He looked much older than his 40 years. His eyes were red-rimmed; he looked exhausted and defeated.

He asked, "Can anyone sing this song? It's her request, but I just couldn't." His lips trembled as he proffered a crumpled sheet of tear-stained paper towards the nurse.

It's the song lyrics for the song "If Tomorrow Never Comes" by Garth Brooks. It was also recently covered by Ronan Keating. It’s a song that I know very well.

The primary nurse shook her head; both her and my student nurse, who is a recent immigrant to America, didn't know the song.

The husband turned to me, and plaintively said, "Please, it's our song". It was obvious to everyone that the request was not made in jest.

The patient's thin face still bore the proof of her beauty despite her ashen color. The morphine eased the pain, and her glassy eyes turned intense for a moment as she kissed her husband's hand. My heart broke as she sweetly smiled and softly said, "Please."

I have an ordinary, sometimes pitchy, voice, and I could not even have imagined I would find myself in such an unusual situation. I was reluctant at first but then I realized that all that mattered for this couple is to hear the song again, for the last time.


If tomorrow never comes
Will she know how much I loved her
Did I try in every way to show her every day
That she’s my only one

And if my time on earth were through
And she must face the world without me
Is the love I gave her in the past
Gonna be enough to last
If tomorrow never comes






And so I ended up singing a song a capella to the dying woman, as her husband of five years held her hands. The patient’s lips twitched, as if she was trying to sing along.

It was an honor and a privilege to be a part of something so poignant and so powerful… to sing a wonderful song that meant so much to them. It was a herculean effort not to sob uncontrollably in the midst of all the misery. But what had helped was the thought that the couple was listening intently to the lyrics of the song.

While I was singing, I thought of the couple’s shattered dreams, of their lost hope, and the inevitable loss. But looking at them, I realized that this husband and wife had come to terms to the wife’s eventual passing.

However they had arrived at this acceptance, it was evident that they chose to savor every last moment that they were still together. There will be grief, there will be difficult moments ahead, but there was also a feeling of gratitude for having loved each other.

The patient’s elderly mother sat at the other side as she stroke her daughter’s hair in a gentle caress. She looked resigned to the fact that her daughter would be going before her. The husband continued humming the song long after I finished.

Just as I was leaving, the wife tried to raise her hand to me. She was weak and could only muster a light squeeze to thank me. I smiled through unshed tears and acknowledged her thanks, thinking that I should be the one thanking her.

It was a poignant but peaceful moment. I believe that the song comforted them, that it assured both the husband and wife in the knowledge that the love they shared had manifested its presence when it mattered the most. Its meaning transcended the obvious; it had somehow reassured the couple that although their tomorrows together will not come, they will be joined in eternity.

The patient held on until the rest of the family came. One last time. Another chance to hug each other. One long hug to keep in their hearts.

According to her primary nurse, the patient kissed the sleeping baby that she would be leaving behind. The baby was smiling in her sleep, oblivious to the sadness around her. But she will be loved and cared for; she is her mother's legacy.

The inevitable could not be delayed any longer. The patient died later that afternoon.

The student nurse thanked me for letting her share in that heart-wrenching but valuable experience. I was grateful that I have given the husband and wife a chance to listen to the song again.

In our post-conference meeting, I reminded my students to learn from the song. In the patient’s death, an important life lesson emerged. We should hold tightly on what we hold dear and live life to the fullest.

If tomorrow never comes… we should try every way, every day to show our loved ones how much we love them. We should seize the moment.



Watching a peaceful death of a human being reminds us of a falling star; one of a million lights in a vast sky that flares up for a brief moment only to disappear into the endless night forever.
~Elisabeth K├╝bler-Ross









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