Speaking of Dying....

What I didn't know about dying

Margaret Ann Ackerman

What I Didn’t Know About Dying

Lorinna broke my heart quietly. Todd, on the other hand, undid me with his strength—and his tears.

Before I became a death nurse, I was a surgical nurse, helping people to get better. On the unit where I launched my career, I was known for the energy I imposed onto the patients under my care, yanking them out of bed just hours after surgery.

“Get up, get moving,” I’d say, willing them back to their previous lives.

I loved the fast pace, the excitement and yes, even the chaos. Tangling recovery out of the web of medicine and surgical procedures was gratifying… solving problems, fixing things. I dreamed of working in the Emergency Room (ER), and envisioned myself plowing through the chaos, making order out of disorder. Plus, the docs and nurses who worked in the ER were energetic and threw great parties.

But a requirement to be an ER nurse was critical care experience, and I could not bring myself to work in an ICU caring for tubes and machines. I have a little dyslexia and didn’t trust myself to keep all that equipment straight. So, I shifted gears to administration where I was sure to find plenty of chaos.

And I did. Nursing administration was a lot like firefighting, I ran to the latest emergency, patched things up and tried to find long term solutions.

Solutions that rarely materialized before the next crisis: budget cuts, staff resignations, staff injuries, new babies…the list goes on and on. I discovered the only sure thing in administration was chaos.

But to be an effective manager, I had to know the hands-on issues. So, I rolled up my sleeves and worked alongside the nurses. And the trajectory of my career began to change.

The unit was a busy neurological surgery hub center in the heart of Manhattan. Patients with brain tumors were admitted for the miracle of a newly developed surgical technique. But there were no miracles, and the illness ran a brutal course.

They arrived full of hope. “I’m going to beat this thing,” they’d say. But brain cancer usually won and ate away at the spirit.

Lorianna had long, red, thick, curly hair—Sicilian red, she told me—that had to be cut so the surgeon could drill into her head and remove the tumor. She shrugged it off and wore colorful turbans. I watched this vivacious woman submerge into a zombie-like state, withdrawn and mute. Her turban was askew, covering half her head, then disappeared, showing purple markings for radiation treatments, her face swollen like the moon from steroids. She stopped talking and would answer me with silent tears when I spoke to her.

I remember Todd. A 50-year-old sporting a U.S. Marine cap, tall and proud of his service.

“I’m going to beat this thing,” he said on his first admission. Surgery, radiation, and he went home, still optimistic. A few months later, he was back. I barely recognized the skinny, bald man in the Marine hat, unable to stand on his own two legs. He wept as we nurses moved him from the bed to the stretcher. I wept when I left his room, alone in my office.

Did he want to continue with treatment? I never asked, never talked about dying. That was the doctor’s job.

Looking back, I never said the word “dying.” I offered presence, not permission. I knew how to touch, how to comfort, but not how to name what was happening.

I thought this silence was compassion. But over time, I came to understand it was training. We were taught to manage death quietly, to treat it as failure, not inevitability.

We memorized pharmacology, perfected our skills, and charted meticulously. But no one taught us how to talk about death. Not with patients. Not with families. Not with ourselves.

There is no billing code for sitting at the bedside. No chart field for dignity. We speak in euphemisms, “end-of-life transitions,” “goals of care”, rarely saying the words patients need to hear.

And we grieve alone. If at all.

Detachment is presented as professionalism. But often, it’s fear. Fear of saying the wrong thing. Fear of stripping away hope. Fear of our own helplessness.

But silence has a cost.

It leaves patients alone at the edge of life. Families unprepared. Caregivers disconnected from the very humanity that drew us to this work. I wanted to make dying easier, more peaceful, and spent my 25-year career as a Nurse Practitioner working with dying patients, becoming an expert, known as “Palliative Peg”.

I write stories about the patients and family members who taught me how to break my silence and talk about dying. How to make decisions about what they want, who they want to speak for them, and in those painful moments, how they want it to end.

I hope, through these stories, to offer something meaningful--to patients facing the end of life, and to the caregivers, families, nurses, and doctors who walk beside them.

If you’ve ever sat at the bedside and wondered what to say, how to help, or simply how to be—this space is for you. Subscribe to join the conversation about dying, caregiving, and what it means to be present.