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Ken was terminal, but this wasn't his day to die by Susan Hamner, R.N. Ambulatory Care Should we, as nurses, play a role in the timing of another’s death? This question came into focus for me early in my nursing career, several months after I called a code for one of our patients on a pediatric floor in a teaching hospital. The charge nurse in pediatric oncology clinic (where I was working on a research project for my master’s thesis) remarked, “That code should have never been called.” She didn’t know that I had been involved. How could I explain that it was important that the code was called? Ken was a nice-looking, intelligent, personable African-American adolescent who had the misfortune of having osteogenic sarcoma in his left arm.  The nurses and staff on 7 East had gotten to know Ken over time, as he was admitted regularly to our floor for his treatments. He lived with his grandmother and had no other relatives that we saw. Ken elected to have a limb-sparing procedure for his osteosarcoma, which was relatively novel treatment in the early 1980s (the standard treatment was amputation of the affected limb). Afterwards, he had chemotherapy, and in due course, radiation. Everyone on the unit liked Ken. He had a pleasant way about him, quiet, but engaging. Despite what he was experiencing, he always took an interest in the other patients on the floor, as well as in the lives of his caregivers.  He was always ready with a smile and a word of encouragement, no matter what the situation.  Another way that several nurses got to know Ken on a deeper level was through his journal. Since he was left-handed, he had difficulty writing after his surgery. He would sometimes ask me to record his thoughts for him in his journal.  At the time, I was rotating between day and evening shifts, and it would be in the evenings, when the floor lost its hectic pace, the numbers of people, or the heightened noise level, that he would ask me to write for him. I have always felt honored that he would share his innermost thoughts with me, be they the more mundane events of what transpired that day or the soul searching questions of the meaning of his illness and his life.  Hanging chemo or taking vitals did not often afford a nurse such insight into another’s life. Ken’s disease progressed. Was it because of the limb-sparing procedure, or would his cancer have spread regardless?  He was undergoing palliative radiation therapy to decrease his pain and to decrease the size of the tumors now in his lungs. I was working day shift and saw someone bringing Ken back from radiation in a wheelchair. I went into his room to assist another nurse in transferring him to his bed.  It was obvious that Ken was not feeling well, and he seemed very, very tired. He was on oxygen at the time, and we needed to switch him from the portable oxygen tank back to the wall unit.  When I looked up, time seemed to stand still. Ken’s coloring had suddenly become that of a gray winter morning. His eyes were slowly closing and his breathing was imperceptible. The three of us (the radiation tech, the other nurse and myself) must have all looked at Ken at the same time and then our eyes met. The thought that this life was extinguishing before our eyes got me moving out the door to call a code and get help.  The room was filled with people and equipment by the time I returned. A residents’ meeting happened to be in progress across the hall, and everyone made it to Ken’s room in a split second. I have to admit that I was relieved not to be needed in the mechanics of saving Ken’s life. It wasn’t too long before he was transferred to the pediatric ICU.  It was a couple of days later when I went to see Ken. He was still on the ventilator, but the nurses had given him a small chalkboard to use for communication.  I don’t remember all of the questions he scrawled to me on that chalkboard, using his right hand, but one of them was “Who was there?” So I described to him the frantic scene of all the people coming to help him.  Another question was “Was anyone crying?”  I told him that my face was not the only one wet with tears. He had other questions for me, but the statement that is still etched in my mind, these many years later, are the last words he scrawled across that small chalkboard…“Thank you.” Ken survived that episode. He graduated from high school that spring with his class, traversing that very important stage in his wheelchair, his friends and classmates cheering for him.  I was not there when Ken died later that year. I had gone back to graduate school and was working on the floor only occasionally.  Was his death more painful than it would have been had he never opened his eyes again on that other day?  Perhaps. But Ken was not ready to die that day. He still had goals to accomplish, questions to find answers to, and people to inspire and make smile. There was a memorial service held for Ken in the hospital chapel, filled with his caregivers, who had become his friends. During the time I worked there, this was the only time a service was held for a patient who died. Should the code have been called? Those two words on the chalkboard give me my answer. *Note: Even though Ken’s case was terminal, he did not have a “Do Not Resuscitate Order.” As health care providers, it was our professional and ethical duty to respond. Editor’s note: The story was reprinted with permission from the   booklet, “The Many Faces of Nursing” for the MUSC Medical Center.       Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.