I was starting an IV[1] on an elderly patient. He was obviously very ill- probably Sepsis. As I prepared to insert the needle I said, “Little poke and then it will be over.” He smiled and shook his head to affirm understanding.

I held his right hand with my left hand as my right hand guided the needle into his vein. I heard him sigh just after the needle broke the skin, but the sigh turned into an extended exhalation that lasted an inordinate length of time. Every nurse recognizes this death breath expiration. I looked up at the daughter and asked, “Does he have advance directives?”

“He is a DNR[2] ,” she said.

“It's time,” I said and placed his hand in hers.

This type of death is routine in an Emergency Department. Not a daily or even weekly occurrence but fairly common. In most cases, the nurse is not the last person to speak to the patient. Often times people are unconscious just before dying.

In this case, I wish I had chosen my words better. It is bothersome that the last words this man heard were so utilitarian and insipid.

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