Abstract
To care for him who shall have borne the battle and for his widow, and his orphan…
Abraham Lincoln
We all stood at attention in the lobby of our VA Community Living Center as the American Flag draped coffin of our veteran rolled by. Having never seen this ceremony before, I was awestruck and numbed by the experience.
My first contact with “Jack” was about two months prior. As one of our residents, his Alzheimer's dementia had continued to progress until he now needed assistance with all activities of daily living (ADLs) and had urinary and fecal incontinence. A family meeting was arranged by his nurse practitioner and I was invited. The Veteran's wife and four daughters were present and a clinical update was provided. After discussing goals of care, a transition to our Hospice service was agreed upon and medication adjustments were made.
Weekly family meetings were scheduled with his wife, who was always tearful but supportive of our treatment plan. She asked many questions but was always respectful of the medical team's recommendations. As Jack became more obtunded, we educated the family on looking for nonverbal clues to help determine their loved one's comfort level and emotional state.
As death approached, the family began to spend nights in the visitors' room and remained at the Veteran's bedside 24/7. Jack's family was educated again as he became unresponsive and exhibited early signs of “death rattle.” Jack had a respectful and peaceful death two days later with his family at his side. Survived by his wife and children, our team explained the “Final Salute,” however, the family wanted time to think about this before ultimately agreeing.
Now as the progression began to walk by me, I realized the beauty and sadness that I was witnessing. All of our Veterans were wheeled or walked to the main lobby for this beautiful ceremony, as were the entire staff. Those who had served in the military saluted the coffin while those of us who had not placed our hands over our hearts. The song “The Caissons Go Rolling Along” played in the background for this Army Vietnam War Veteran. Just behind walked the entire family with Jack's wife in tears, looking side to side at the Veterans and staff silently honoring her late husband. As she passed me, she mouthed “Thank You.” After the processional ended, I returned to my office and wiped away my own tears, something I had rarely done in my 40 years of medical practice. Now I have a better understanding of what working for the Department of Veterans Affairs means and the respect we show those who have served as well as their families.