I saw the nurse sitting calmly at bedside. I knew she was the night nurse; it was shift change. Usually, the end of a nursing shift is busy with finishing tasks and telling the next nurse about the patients they’re taking over. I got up to check on the nurse and the patient. We’d just transitioned the patient from full code to comfort care. “Comfort care” means no life-prolonging measures – just medications and other interventions to help people be comfortable as they die. Minutes earlier I had put in the comfort care orders.

“Hey, do you need anything else?” I asked the nurse. “I only put in a few orders and just wanted to make sure I wasn’t missing anything you need.” The nurse was holding the patient’s hand.

“No. They’re dying now,” the nurse said. She was looking at the vitals monitor; I shifted my gaze from her to the monitor too. The blood pressure was 15/0 (recall that normal is 120/80). The heart electrical line (usually a dramatic up and down) was flat. The patient was taking agonal breaths (the last gasps a person takes as they die; they aren’t true breaths). The patient’s eyes were blank. I had known that the patient would die that day but it was happening faster than I expected.

“We let the patient’s pastor know, but she won’t make it for another half hour or so,” I said. The patient didn’t have any family. They had listed their pastor as their emergency contact and the person who would make decisions for them when they couldn’t make decisions for themself.

“I know,” the nurse said. “That’s why I’m here. I’ll be here. I don’t let anyone die alone.”

The nurse sat quietly on a chair next to the patient holding their hand. I stood with her and the patient for a little while watching the monitor. Eventually I left the room and got my stethoscope. When everything on the vitals monitor was zero, the nurse closed the patient’s eyes gently. I did my exam and determined the time of death. Next time I looked at the room there was a picture of a butterfly on the closed door (alerting people that the patient inside had passed).

When I looked at the room later in the day the bed was empty and made with new linens. It was as though the patient from the morning had never been there. Yet, I remembered the nurse and patient holding hands as the patient’s heart stopped forever. I did not know what the patient did when they were alive but, at least, I knew they hadn’t died alone. I was reminded that small acts change lives. I was reminded that heroes only wear capes in movies. I wondered how many people die alone – I was grateful that this patient wasn’t one of them.