Veteran Toronto nurse and author Tilda Shalof has long been a source of advice for younger entrants to her profession, such as Lisa Mochrie. Their new book “The Handover: A Nurse’s Last Shift” is a kind of valedictory message from Shalof as she retires, in her communications with Mochrie and other peers. In this excerpt she takes up their job’s biggest, most unavoidable topic.
An email I received a while back during the pandemic brought home to me the challenge young nurses are facing, grappling with the reality of death. Anya, a student from Toronto, asked for my input on a paper she had to write for school. “Since I’ve had such little clinical experience caring for dying patients, I was hoping you would be willing to share your thoughts on the meaning of the term a ‘good death’?”
There wasn’t much of that happening at the time, but OK, here goes:
Anya, dear, I have cared for thousands of people in their last moments. I wish I could remember each one, but in a sense, I remember them all. It’s a kaleidoscope of images, moments, and details that will always stay with me.
You ask about a “good death.” You are way ahead of me. At your stage of life, I couldn’t imagine there could even be such a thing. The term seemed absurd, an oxymoron. How could any death be “good?” Wasn’t death always a bad thing, something to be prevented at all costs? That’s how I thought at your age.
It was only when I was older, after years of participating in hundreds of violent and ugly resuscitation efforts (I can still hear the crunching of ribs under my hands as I did cardiac compressions), most of which ended in undignified deaths, that I began to think about death differently. I often wondered if the person would have wanted “everything done,” which was what we did. At some point, I began to accept that death happens — at least to “patients.” (I couldn’t bear to entertain the thought of it for myself or those I loved.) It took another few years before I realized something else — that there are different ways to die.
The first dead body you encounter will stop you in your tracks. Whoa. You feel for a pulse and look for chest movement. How still, how final. You fall silent, drop into deep thought. Or you may feel giddy and chatter away nervously to anyone nearby.
It begins to dawn on you that this thing — Death! — could happen to you or someone you love. In the distant future, of course. You think about losses you may have already had or ones yet to come. You tell yourself, Snap out of it. Get back to work. You put on your game face and provide comfort to the mourners. Then a few minutes later, the in-charge nurse tells you you’re getting a new admission from the ER. OK, on to the next patient. Put that one out of your mind.
Later, at home, you feel unsettled, even frightened. You try to process what you’ve seen and figure out how you feel. You worry about your loved ones. You move between sadness or disbelief. You may feel like one student told me: “I saw my first dead body today. I felt nothing. It was underwhelming — not sure what I was expecting. I wondered if they might be asleep. Had the monitor not shown a flatline, I wouldn’t have known that they were dead.”
You may feel more at peace when you participate in making a “good death” happen. My belief is that a “good death” is one that meets the wishes of the dying and the needs of the living. A doctor friend once told me about the “good death” of his sister.
“It was beautiful. The whole family was allowed to be with her around the clock. We were given privacy and a place to rest. Georgie was kept clean and comfortable until her last breath. They removed the machines and lines, so she looked like herself. It was exactly how Georgie would have wanted it.”
Anya, what I want you to know is that for a “good death” like that to take place, nurses must be involved every step of the way. Not that we do it alone, but we lead the way. We know how to make the space, time, and privacy for the patient and whoever wishes to be present. We are experts at minimizing suffering — and the appearance of it.
After a death occurs, we wait, and when the time is right, together with another nurse (no one is ever expected to prepare a body alone) we get to work. In an unhurried manner and respectful silence, we remove medical trappings — tubes, wires, catheters, IVs, bandages. We wash the body and wrap it in a plastic shroud. Then, we carry out a practice that was never taught and is not to be found in any policy or procedure manual. We sweep up the detritus – used syringes, ripped-open boxes of medications, bloodied gauze. We cover the body, only exposing the head and neck, sometimes the arms. We dim the lights and freshen the air. We guide the grieving family back, provide chairs, and allow them to stay as long as they need. (We resent when we have to hurry them out when the bed is needed, but it happens.) Later, the body is transported to the morgue.
If you, as a nurse, have a part in making a “good death” happen, it may surprise you that you aren’t sad. You go home proud, even elated. You feel the privilege you’ve earned to do this sacred work. You arrive home, whistling a merry tune. If you tell your family your patient died, they may wonder why you’re not upset. “What’s for dinner?” you ask and are astonished to realize you are hungry. Your appetite is strong. You are alive!
Other deaths may be troubling. You may see that a person is dying, but efforts are made to “keep them going,” to keep their body perfused and their heart beating. It may be for organ-donation purposes, or the family’s wishes or inability to let go. At times, you may feel, as we often did in the ICU, that we were only prolonging the inevitable, treating the family’s reluctance to let go, not the patient’s will to live. We will never know for sure.
You will find ways to comfort the grieving. As a grandmother lay dying, her family asked for a printout from the cardiac monitor of her “last heartbeats.” Should I give them a sample when she was in normal sinus rhythm, or would bradycardia be better, as her heart slowed down? Ventricular fibrillation was chaotic and too disturbing. If I gave them a strip of the erratic “agonal beats,” they could see the end was near. Asystole was merely a flatline. I don’t remember my choice, only the consideration I put into it and how precious that little strip of paper was to them.
There’s more, Anya, dear. You will realize that not every death is sad, and only a few are tragic. Nurses who grew up on a farm or close to nature seem to accept this, perhaps because they are more familiar and more comfortable with the natural cycles of life. Nurses who have religious beliefs or are spiritual also seem more at peace about it. Yes, you may feel upset when a patient dies, but you don’t become close with all patients and families, only some. Sometimes we feel afraid, but we can still help others who are afraid too.
To nurses, it’s almost an axiom that no one should die alone. When we learned an ICU nurse friend of ours died in a hotel in Texas, we were sad, but outraged he’d died alone. We talked it over in the staff lounge. Janet asked out loud, “I mean, how dead was he?” (Yes, there are degrees of dead.) “Why was he alone?” Jim had lived a rough life. His death was no surprise. That he was alone was more upsetting than that he’d died.
It never feels like a “good death” when patients don’t get their last wishes. For example, people often say they want to die at home. Families want this too. However, when you delve into what is required, you become dismayed to learn they might not get their wish. Either palliative care services are inadequate or there’s not enough support for family members to manage a death at home. Perhaps your generation will improve this situation for us Baby Boomers when our time comes.
Nurses think about death more than most people. Doctors may see a patient’s death as a failure, but for nurses it doesn’t call our practice into question. (Unless it does …) We don’t think in terms of win or lose. For us, it’s not a performance review. It’s not that nurses cope with death easier than anyone else, but we don’t take it personally. It doesn’t affect our careers or our research outcomes. When a decision is made to not engage in a battle or to not employ extreme measures, we accept that. We know that not every death is someone’s fault, a screwup, or that the “damn health care system” is to blame.
“Good death” or not? We’ll never know. They never let us know, do they?
Excerpted from “The Handover: A Nurse’s Last Shift” by Tilda Shalof with Lisa Mochrie. Copyright © 2026 Tilda Shalof and Lisa Mochrie. Published by University of Toronto Press, Aevo imprint. Reproduced by arrangement with the publisher. All rights reserved.
