Witnessing death at close range: Tales from wards

Hannah Wanjiru Gitura, an Emergency and Critical Care clinical officer at AIC Kijabe Hospital.

Photo credit: Dennis Onsongo | Nation Media Group

What you need to know:

  • Mr Kinyua noted that caregivers also need reaffirmation that all is okay whenever they lose their patients.
  • For some time after witnessing the first death, whenever a patient who wasn’t stable was admitted at the facility, the thoughts of my first patient lingered.

The mystery of how life comes and goes is still unfathomable even to the most knowledgeable.

And while most people have to give it a thought once in a while, that mystery confronts the people who take care of critically ill patients almost on a daily basis.

From observing death right in front of their eyes to witnessing close shave with death (as is the case with some Covid-19 patients), the caregivers have deep-entrenched memories from the wards.

And from our interviews with six such caregivers last week, it emerged that sometimes they get attached to patients and feel an intense pain that they often mask when talking to patients’ families.

According to Cleopa Kinyua Njiru, a counselling psychologist at Chiromo Mental Health Hospital in Nairobi, every time someone dies, the caregivers feel responsible.

“First, it is by virtue of the ethical endowment on them to save life and second, because they are also humans,” he told Lifestyle.

It gets trickier when a patient who has been under their care for a while, for instance a terminally ill patient, dies. This is because of the bond that usually develops between a patient and a caragiver.

“The bond is inexplicable. It just happens,” said Mr Kinyua.

Dramatic moments

During those dramatic moments when life gives way to death, he observed, the issues that come into play include whether the caregiver took time to know the patient. 

Mr Kinyua noted that caregivers also need reaffirmation that all is okay whenever they lose their patients.

“They should be assured that it was God’s plan and not their personal fault, especially when they were determined to save the patient’s life,” said the psychologist.

Below are accounts of the six caregivers on witnessing death at close range and how it affects them.

Benjamin Thairu.

Photo credit: Dennis Onsongo | Nation Media Group

Benjamin Thairu 

Emergency and critical care clinical officer, AIC Kijabe Hospital

When I began my career, losing a patient could drain me so much. It got me wrestling with the thoughts of what I should have done better.  It is through the systems at my place of work, which provide avenues for decompressing, that I have been able to cope.

To date, I can’t recount the number of times I have visited the chaplaincy to discuss an issue that is troubling me, especially those related to the thoughts of losing a patient.

But nothing beats the gratification of seeing a patient walk back to the hospital to appreciate me for saving their lives.

Mr Victor* was brought to the hospital unconscious, with a pale skin, six months ago. When he was discharged, he could walk and talk.

Two months ago, he walked into the facility with a surprise card that read: “Thank you for saving my life, you’re forever my heroes”.

The card was placed in our parlour. Whenever I am walking into the ICU to attend to patients, I glance at the card and find motivation to keep doing my best to save lives and keep the thoughts of previous deaths away. 

Andrew Khisa Wasike

Senior nursing officer, Kenyatta National Hospital (KNH)

Andrew Khisa Wasike.

Photo credit: Jeff angote | Nation Media Group

I was on a Wednesday night shift when a senior retired physician got admitted. I was tasked with attending to him But upon admission, we — my colleagues, the patient and I — knew that he wasn’t going to make it out of the ward.

Based on his practice and experience, he was the first to notify us that he may never walk out of the ward alive; that he only had two hours or less to live. So, to some extent, we prepared for the death. He saw it coming. We knew it was inevitable.

It was as dramatic as it was horrifying. And I couldn’t console him because we both understood that he was definitely in his last hours on Earth.

What we could only do was to give him a befitting death. We made sure he was under oxygen, that there was no pain in his last two hours. We were monitoring him through screens as he was breathing his last, and we ticked all the boxes just to make sure we didn’t unduly prolong his life. We just did the very basic.

For his part, he wrote his last notes and left them with us because he understood that the inevitable was bound to happen. Two hours later, he breathed his last.

He left behind his watch and spectacles, which we kept in our office.

The whole process of preparing for a death we all knew was coming was mentally taxing. But we couldn’t rush things because a miracle could happen that might have seen him live much longer than we all thought.

The occurrence keeps reminding me that it is by grace and sheer luck that I haven’t contracted coronavirus because being in the frontline is a risky undertaking.

I don’t think I’ll ever overcome the memories of this warrior who died in my custody. They flash so vividly in my mind especially when I come across his belongings, which are still lying in our office. I occasionally think of him and talk about it with colleagues, especially when I stumble upon his spectacles. I imagine how my spectacles will be lying lonely after I have exited the Earth.

Jackson Agutu Obeto 

Emergency and critical care officer, Tenwek Hospital

Jackson Agutu Obeto.

Photo credit: Vitalis Kimutai | Nation Media Group

A man in his 40s was admitted to our facility when his sugar levels were so low. We resuscitated him. But sadly, he did not survive.,  and he left behind a young family.

My team and I watched helplessly as he breathed his last. We were calm, but there was disappointment written all over our faces following vigorous efforts to save him.

This is definitely not the first death I was witnessing, but listening to the widow speak, I felt the loss and the void the man had left.

Wherever I get home and remove my white coat, look at my baby, I think of the child the man left behind and how he is coping with his dad’s absence.

But it is not always gloom. Sometimes patients whom I have helped call me to talk about their progress and that brightens my day. It gives me the urge to fight hard to save more lives.

Hannah Gitura

Emergency and critical care officer, AIC Kijabe Hospital]

Hannah Wanjiru Gitura, an Emergency and Critical Care clinical officer at AIC Kijabe Hospital.

Photo credit: Dennis Onsongo | Nation Media Group

We lost a patient one Tuesday; a patient I had thought would be stable by weekend. She had developed breathing complications and her chances of survival, however slim, seemed high. I was in charge when she was admitted.

She was brought in an ambulance, but left in a hearse two weeks later. That was heartbreaking. From bouts of hope to a crushed spirit, my prayer was always that she survives to tell  a success story.

I sometimes watched her, by her sickbed, struggle to breathe and wondered what more I could do better to stabilise her breathing.  When she passed on, it is with the help of my colleagues who were present for me that I overcame the grief. 

As much as I was preparing for her death, it caught me by surprise, so much that I asked a colleague to accompany me as I broke the sad news to her family members.

I wished she could go home but she was going to another home. I had hoped for the best, but the worst happened instead. I do recall the extraordinary bond we had struck with the patient, and it has become a memory and a learning point.

Seeing her lifeless body being wheeled to the morgue left me feeling helpless. And the thoughts of her are always triggered when handling a patient showing similar complications as hers. But I have chosen to delight in successful attempts at saving humanity; in patients whom through my expertise, I have helped to successfully fight to save their lives.

The memories also propel the urge to fight harder to save the life at hand just so I can delight in seeing the patient walk home, feeling better. 

Rose Guchu

Nursing officer, Infectious Diseases Unit team leader, KNH

Rose Guchu.

Photo credit: Jeff Angote | Nation Media Group

One morning three weeks ago, a man in his 30s was admitted to KNH. He showed symptoms of Covid-19 and was taken straight to the dedicated isolation ward.

He seemed strong and healthy, with no underlying issues. I thought that in two weeks, he would test negative for Covid-19 and walk out of the ward.

On the first day, it was all good. He looked promising and enthusiastic. When I went to check on him, he was bubbly. We even spoke.

The young man — who suspected to have contracted the disease in the line of duty — in his prime age with a young family, talked about how going forward he would be more careful on how he handled everyone near him if he survived.

Until the morning of the day he passed on, he was fine.

Because we also talked enthusiastically about how cautiously he would live after survival, I felt like I owed him my best service to ensure he lives to tell his survival story.

Then one morning when I went to his bed,  he was so pale and was seemingly struggling to breathe. My team and I attempted all options to save his dear life. Our last option, upon exploring other available options, was to intubate him (insert ventilation tubes into his windpipe). Sadly, he succumbed to the virus that evening.

Every time I remember the young man, I can only speak about it to forget the incident. I hope that someday I will overcome this. But, I understand that his memories will take long to be erased in my mind.

Purity Karanja  

High dependency unit nurse, KNH

Purity Karanja, a nurse at Kenyatta National Hospital.   

Photo credit: Jeff Angote | Nation Media Group

Nothing quite prepares you for an encounter with death more than practically witnessing a patient die in your presence. This is a misfortune that the medical school didn’t prepare me quite well for, save for the paperwork which didn’t do much.

Watching a patient struggle to defeat death in vain is traumatising, I now know. A patient’s death isn’t one of the exciting things in my career that I would delight in waking up to.

I had just joined the workforce, fresh from campus, when I had my first encounter with a patient’s death.  I would have felt gratified if the patient survived.

I had just checked in for night shift when an ambulance raced towards the ward I was in.

That meant that it was an emergency. On that night, I was the runner nurse — basically ensuring that all that the doctor needed was provided on time in the vicious fight to defeat death or at least prolong life.

In retrospect, I think that was baptism by fire. I sometimes feel that had I been a little more exposed to handling critical patients, together with the team members, I would have put on a more worthwhile fight. But that couldn’t help much then.

When the patient succumbed, I really felt the loss to the core, what with the effort I had invested. All this is registered in mind and it feels fresh each time it flickers in my mind.  I really doubt the memory of that death will fade anytime soon, but it is also understandable because it was my debut into working at night when it occurred.

At the point of death, I even felt tears linger in my eyes. But my colleagues were strong and they consoled me; told me to expect more of that. That marked my initiation from school life to work life.

For some time after witnessing the first death, whenever a patient who wasn’t stable was admitted at the facility, the thoughts of my first patient lingered, and then the imaginations of a repeat of such an occurrence followed.