It's amazing how sometimes patients hold on just long enough for that one person...

I used to be skeptical about the idea that comatose or actively dying patients could actually will their body to keep fighting until something they're waiting for happens. I mean, how often do we see people die unexpectedly in this world, never getting a chance to say goodbye or live a full life? But after this past weekend, I'm convinced even comatose, actively and imminently dying unresponsive patients can sometimes find the strength to stick around until they decide they're ready.

We get very, very sick patients on my unit. In fact, we relatively often have patients end up on hospice or comfort measures if they aren't upgraded to ICU first. Usually, these are patients too unstable to transfer to home or outpatient hospice because they are expected to die literally any minute. So we take off their monitors, stop treating them medically, and focus on making them as comfortable as possible, both physically and emotionally. This usually involves some pretty heavy medications for agitation, difficulty breathing, and pain. This weekend, I had one such patient. It was sad to show up to work on Friday and see him on hospice, because I had him the week before and he was talking and moving. Confused, but still talking and much more alert. In fact, he was so strong last weekend he ended up in restraints because he kept trying to get out of bed and pull off lines and monitors. He loved to talk to himself, and honestly even though you couldn't really understand what he was saying, he was really cute. I did not expect to see him in a nearly unresponsive state when I returned to work a few days later. I will call him George.

George's family spent the week coming to terms with the fact his body was shutting down and there was nothing more to do. Based on the notes by providers, it took a few days for the family to accept the inevitable outcome and allow switching George to inpatient hospice. The family said it was hard to see him like he was, and I have to agree. I was assigned him this weekend, and he really looked like he was at death's door. He was pale and stiff, unable to speak or move more than small fidgeting movements occasionally. His breathing rate slowed significantly, and I was fully convinced he would pass over the weekend. According to the hospice notes, the family had even stopped coming in and would instead call to check on his status each day. They all agreed they said their goodbyes and couldn't handle seeing George in his state. I can't say I blame them.

As the weekend went by, he continued to deteriorate. By day two, he was essentially comatose. No response to pain, breathing 6 breaths per minute, no movement, eyes stuck open. We had to start adding eye drops because his eyelids wouldn't stay closed and his eyes would start to dry out. His blood pressure hit lows that I don't think I've ever seen in a living person over my 6 years as a nurse. On day three, his record blood pressure was 40/19 with a MAP of 26. He had been hanging out in the 40s and 50s for days. With all the morphine, valium, haldol, and versed he was getting, I was absolutely dumbfounded that by the end of my third shift, he was still breathing. I went in to hold his hand and talk to him a few times throughout my time with him.

"Your family has said their goodbyes. You can go whenever you're ready, George. I'm here, you're not alone." I checked on him very often, watching for agonal breathing or end-of-life agitation so I could be with him in his final moments. But those signs never came. Before leaving him this morning, I sat next to him again. "I have to go home... I won't be back for several days. I'm sorry I couldn't be here for the end of your journey, George. I don't know who or what you are waiting for, but I hope you find peace so you can move onto your next life." It genuinely perplexed me that George was still holding out. He hadn't eaten or had any fluids in a week, was bleeding internally, was getting no blood perfusion to his brain with that blood pressure, his kidneys had shut down. It made no sense that he was still alive knowing all that.

Day shift arrived, and I told our nurse educator how his vitals were and that he's somehow still alive.

"He's waiting for someone," she replied knowingly.

"But his family has already come and said goodbye. Who could he be waiting for?"

"I don't know, but he's clearly not ready. He's holding on for someone."

I thought about George all the way home, wondering what he was holding out for, and how long he could possibly keep waiting. When I woke up tonight, I texted the day nurse assigned to him asking if he was still alive. His reply shocked me, and left me genuinely in awe.

The son decided to visit one more time today. Keep in mind, no one had visited George in 4 days. During those 4 days, he remained practically comatose and alone, hanging on by a thread. It was almost unnatural. It wasn't until his son visited that he finally decided he was ready. George passed away with his son at his side. I'm still in awe and my eyes are still full of tears as I write this. He was completely unresponsive for days, with unreal vitals that defied all reasoning, all because he wanted to die with his son by his side. There's no other way to see it in my opinion. He wanted to feel his son's presence before he left. Sure, we can be skeptical and think it was just luck... But I've actually seen this before and it never ceases to amaze me. I choose to believe George just wasn't satisfied dying alone, so he waited until his son was there. I know now George is looking down from above, no longer stuck in bed, no longer in pain, no longer confused. And I'm so happy for him that he was with his son when it happened.

RIP George. I'll never forget you and how you fought to feel your son's presence one last time.

• Bella, RN