Saturday, May 12, 2018

Skin to Skin Post Mortem Care

Skin to skin contact meant something entirely different to me than the currently popular post partum mother / infant tactile bonding technique. When I first heard the term, I asked myself  How in the world did someone discover one of my personal secrets?  I  felt compelled to lift the patient from the death bed or OR table with my bare arms contacting their skin. It was part of my way of saying goodbye.  There was a trick to this that involved spreading the morgue shroud open on a nearby Gurney with the distance dependent on the patient's weight. A 50 kg. patient could have the waiting litter across the room while a 100 kg "heavy hitter"  better be close to the bed. I tunneled my right arm under the patient's shoulders for a mid axillary target and my left arm went under the knees. A helper carefully supported the head while I carried the patient to the cart. There was something special about being there in actual contact with the patient skin to skin as they say. I always said a silent prayer for a peaceful journey to a peaceful place as I gently lowered them to the awaiting shroud.

Every old nurse had something unique and special to impart during post mortem care. Jane who was a dental hygienist before becoming a nurse always offered meticulous mouth care to the departed patient. When she was done the waste container was always filled with lemon glycerine swabs and an empty peroxide bottle. Bonnie hated to leave any tell tale sign of invasive medical procedures. The first thing she went for from the supply closet was adhesive tape remover and cartons of 4X4s. Every little bit of residual adhesive tape was lovingly removed. We did not have those fancy task specific devices to stabilize endotracheal tubes and all that tape about the lips and around the neck made an unsightly mess that Bonnie always made disappear. Lois hated those flimsy shoelace-like ankle and wrist ties and always substituted soft strips of wide Kerlix. After her gentle ties were in place she often kissed the patients hand. I hope I have a nurse like Lois when it's time for me to enter that shroud. I'm certain the journey to the other side will be pleasant with a send off like that.


  1. I always tried to be as gentle as I could with the recently departed. ETT tape residue was made to be gone, and no blood splotches were to be seen from IAPB, chest tube, IV or other insertion sites.
    Unless, of course, the patient met the criteria for a county coroner's autopsy. Then a completely different set of proto- cols applied; all lines had to be left in place, etc.
    But ~ as our county hospital contained the official county morgue, I do have to admit to the humming of Queen's "Another Bites The Dust" on the way downstairs on more than one occasion.

  2. Every nurse seems to have a special tune they sing or hum while caring for the recently departed. Mine was Home on The Range. Don't ask me why.

  3. If the patient died on the ward, we always used to open the nearest window "to let the soul fly out". I guess with the air-conditioned high rise hermetically-sealed windows hospitals now have, that would be impossible these days.

    My training hospital had another tradition that we always kept - when a body was transported to the mortuary only a Sister, in full uniform (including scarlet cape) could escort the deceased. It was always done in a very dignified manner. A student nurse or anyone else was never permitted to do this, it had to be an RN. It was considered the last thing the nursing staff could do for the patient. When we explained this to the relatives they found it very comforting that this last service was always performed.

    You sound like a wonderfully compassionate nurse OFRN and you obviously had some jewels of nurses that worked with you as well. Sue.

  4. I hope my dear departed parents received half as much respect when their times came. Thank you.

  5. I'm sorry for the loss of your parents Officer Cynical. Old school nurses had many faults, but caring deeply for departed patients was not one of them. Diploma nursing schools emphasized post mortem care almost to a fault. Before that long sought diploma was in hand each student had to perform post mortem care to the satisfaction of the demanding instructor. If the student managed to attain senior status without the required care, they were on call for any death in the hospital.

    One of my fellow students received a severe reprimand for being overzealous when the death call finally came in. A somber state of mind was mandatory when dealing with the departed.

  6. I've always made sure the deceased's hands are clean - not many family members want to hold their loved ones' hands, but when they do it's even more upsetting to see blood, dirt, etc on them. So, spotless hands it is. If the IV must be left in place, it's covered with a 4x4.

    1. Should edit to add - not many people in my ER want to hold their hands, because it's usually a traumatic or sudden ending, and often messy.

    2. Still trying to grow up and be a real RN. Most of my gigs I have been blessed with a Robin, Barbara, or, most recently a Kim. There is a rational explanation for why I was drawn to OB, Unfortunately, intrauterine fetal demises and neonatal demises are a special kind of hell.
      Every workday screams for me to grow up.and deal with the unavoidable reality of death. So far, I have been able to rely on nurses made of stronger stuff to step up. It may be that now that my wrinkles override my pimples, and OFRN’s like you are few and far between, I may be forced to dig deep and be a real nurse.

    3. With your keen insight, I'm sure you were a very special "real" nurse from day one. I sometimes felt like my efforts were fruitless in lending help to sick people. The traumas kept on coming until the whole world seemed like it was injured or sick and there was nothing I could do to stop it.

      My friend Janess always said that as long as you are at the patient's bedside doing your best to work hard and being present to the patient, you are helping as much as anyone could.

      I think that's why I never left the bedside. The guilt from sitting in an office would have destroyed my spirit as long as there were folk's in need of care.