Death and dying in hospital: the ultimate emotional labour

Abstract

The impact of dying in hospital and the feelings surrounding its unsuitability as a place to die struck me the first night I did a night shift early on in the study. Hannah and Lily were the regular nurses for the shift. I was there as an extra to help out where I could. Although the ward only had 16 beds, at least half the patients were acutely ill. One patient had been admitted following a drug overdose and was being regularly monitored. Another two were receiving treatment for diabetes. Their blood sugar levels, hovering around danger point, were being constantly checked, and their intravenous infusions regulated.

I was aware of and had read a number of studies about dying before I wrote this chapter. These studies included Glaser and Strauss’s (1965, 1970) work: Awareness of dying and Anguish: a case history of a dying trajectory, and David Field’s Nursing the dying (1989). I also talked to Nicky James and read her work on hospice care. All are fine works and undoubtedly heightened my sensitivity and drew my attention to particular aspects of death and dying in hospital. For example, Glaser and Strauss (1965, 1970) address three key issues which are apparent in the structure of my chapter: (1) how death and dying are defined in hospital and the uncertainty surrounding if, when and how it will occur; (2) how the patient’s dying trajectory is systematised and managed by hospital personnel given the unpredictability of death (patients can alternate between ‘certain to die on time’ and ‘lingering reprieve’); and (3) accountable and nonaccountable aspects of terminal care. Nurses were held accountable for physical care, observation of vital signs and pain relief, which often increased as death approached. No member of staff was held accountable for psychosocial aspects of care, with the result that the ‘demanding’ patient of their case study became more isolated as death approached.