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What I have learned as a nurse who sees people die in a remote rural Scotland Society



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There are very few such unique, amazing and intimate experiences for a nurse to enter the house of an unknown person in the middle of the night and watch them die.

There is no hospice arrangement where I am located in the north of rural Scotland. For diagnoses of progressive and incurable diseases, such as cancer or heart failure, a health professional will offer them a preferred place of death. It is a rigorous option: a bed in the hospital of the local community (if available) or die at home.

For most of the agricultural families I visit, it is an easy decision. "They have to take me out of this place in a box" is a family saying. The farms have been transmitted from generation to generation and with it there is a way of life that covers everything that is, to the point where it ends.

I was once called to visit an elderly woman at the terminal stages of her illness. He was scarcely aware of the fact that he had not had the strength to get up, even though his agitation on his face and limbs indicated he had not stopped trying. "Can you believe I was in the garden explaining the cows this morning?", Asked his daughter in surprise. "And complaining because it took me in."

In the afternoon, the district nurse had introduced a tube to the bladder to allow the urine to drain. It had fallen and a new one was required. "Did you take it away?" I asked him, shaking the view of the balloon intact that he should have been sitting on the neck of the bladder and contemplating the possible journey he had made to freedom there. "Oh no, it just ended," said the daughter on the shoulder as she continued to wash. "She has had so many children, I would be surprised if something is there for a long time."

Farms are often expanding stone buildings surrounded by fields and pipes, which can not be found by satnav, without lights and barely noticeable in the middle of the night. They are well placed in steep hills that, when it is bad weather, loses the professional composition that it took when it landed in the car and slides down the slope, with the feet unable to adhere, like a drawing.

The people who live there are hard, fused by work and the weather, with strange sting.

I work at night turns. In the small hours, driving around the field can be spectacular. My is the only vehicle on the road, which revolves around a deer that stands out from the lighthouses or slows down to get stains and hurt in a panic. In the heat of summer, the light almost does not disappear and, once or twice, I was surprised in a rain of meteorites, the large open sky at night was full of light for a moment.

Pain is a great potential problem during the process of death – both for the patient and for his family. Sometimes I feel totally inadequate as I open the "case by case" box and look at the handful of vials I can administer for pain, agitation or nausea.

To my colleague she likes to tell a patient the unresolved abdominal pain was a huge problem when approaching death and the final solution that became the holy grail among the practitioners. She finally arrived when the nurse had a conversation with the elderly patient who trusted that, as a proud woman, she did not want anyone to see her without her prosthesis.

What most worried about death was that someone was withdrawn from the teeth after the event and was unable to stop them. At the moment the nurse reassured her, she made sure that her teeth were left intact, the woman's pain, which could not be treated with morphine and any other complementary treatment, would be dissolved simply. He experienced a peaceful death.

The deaths I see rarely are almost a person who dies. The family and loved ones are part of the experience, since I assume that we are nurses. The trip to death can be difficult to navigate. Sometimes it is not peaceful and we can not resolve pain or agitation. "They will have to get out of here in a box," it seems clay when you see a patient or a being unable to articulate their experience and throw and spin without rest for hours, turning to all the viewers that only They can guess what they might need. But it is also a truly human experience, the point where all our lives take us, and, to me, as a nurse, as humiliating as this meteor shower.

If you want to contribute to our series of blood, sweat and tears on experiences in health, read our guidelines and contact us by e-mail at sarah.johnson@theguardian.com

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