Veronica's Smile

 
I still remember the day Veronica died. It was over 17 years ago.
 
 Veronica was widower who came to live with us at the aged care facility, mainly due to her age and a decline in her mobility. She was in her late 80’s. She still enjoyed a social life and had large extended family who visited daily.
 
During her stay with us she was diagnosed CCF (Chronic cardiac failure) and PVD (Peripheral vascular disease).
As result of this illness, she started getting oedema in her peripheries, particularly her lower limbs. Her lower legs and feet became swollen, red and itchy. She developed several ulcers that would leak fluid.
 
 Veronica’s mobility suffered even more, it was painful for her to walk.
She had daily dressings to both legs as she had about 5 ulcers of various sizes on each leg.
This was  and be could painful for her. We would administer pain relief 30 minutes before attending wound care to alleviate or minimise her pain.
 
Despite her life limiting illness and the pain she was experiencing, Veronica had not been classified as palliative by her doctor, but the palliative approach was used. We were alleviating her symptoms, as we couldn’t cure them.
As nurses or carer’s this a common approach we deliver daily, particularly in aged care.
 
After a discussion with Veronica and her family, a end of care life directive was generated based on Veronica’s and her family's wishes, which included a Do Not Resuscitate order. So it was clear that her wishes would be honoured.
 
One morning ,a  fellow nurse and I went into Veronica’s room 30 minutes’ post pain relief, to dress her wounds.
 
 Veronica was on her bed as this was the most comfortable place for her to have legs done. Her breakfast was untouched, which the staff had reported to us. We encouraged her to eat and she declined. She did however tolerate   some small sips of water.
 
She was focused at  the end of  her bed. It drew her like a magnet. She had the most blissfully happy smile I had ever seen. I asked her if she had any pain and she said “no love”.
 
Normally, even with the pain relief, the dressing of her legs was “uncomfortable” for Veronica
She didn’t flinch once, she remained  focused at the end of bed, and her gaze never left it, still smiling. 
 
My team member and I had both noticed this, but said nothing to each other. At one point I asked Veronica who was at the end of the bed. She smiled at me and gave me a wink, said nothing and returned her gaze to the end of the bed.
 
As we finished and set her up for the day, I told her it was my shout for a cuppa and I would be back around morning tea time.  Veronica was still focused on the end of her bed and just nodded to me and beamed.
About a hour later the call bell went off for a staff assist in Veronica’s room, the carers found her not responding and in a semi-conscious state.
 
 Veronica was not for resuscitation (NFR).  Her family and doctor were called. In the short time that we made the call, Veronica went into a completely unconscious state. She wasn’t responding to verbal or physical stimuli. Her breathing changed and she was Cheyne–stoking, (more commonly known as the death rattles) She appeared to be in no pain. Her body was naturally shutting down.
 
Veronica was surrounded by staff when she died about 15 minutes later. Her family who were in the building just missed being present by about a minute.
 
After she had died she still had that same smile on her face. The one she had whilst looking at the end of her bed that morning.  I like to think whoever was at the end of the bed was waiting for her and she had comfort and peace in that knowledge.
 
 We washed & laid her body out according to her wishes, her family spent time with her and a priest came in to bless body and read her the last rites, as she wanted.
 
 
We could all feel the love around her, and the family commented how peaceful her room felt. Her death was quick, sudden and in the scheme of things fairly unexpected by her family and us staff. But not for Veronica, she knew.  
 
 
 I’ll always remember her, not for her death but for her smile.  Her absolute beatific smile, that I can still see to this very day when I reflect.  The whole universe radiated out of that smile, as Veronica met death with her smile.
 

• Based on a true story: Names have been changed