Last One Standing

Sarah Kilch Gaffney essays

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It’s the first week of nursing school and I’m trying to figure out why I’m not excited, why I cannot summon the passion and drive that previously kept me going. I’ve been on this path for a long time and I’m finally here. Then, in the middle of the afternoon, it strikes me: I gave up everything to pursue this, and for all the right reasons, and he still died.

I have been working towards nursing school for over two years. When I started taking classes part-time, my daughter was still a baby. Though he had been diagnosed with a brain tumor over two years prior, my husband Steve was still working, walking, and speaking. While on my school’s wait list, I raised my daughter, coordinated my husband’s care, and finished up my non-nursing classes.

When I finally entered the program, I gave it my best, struggling through seven weeks of juggling a heavy and stressful course-load, the needs of a 2-and-a-half-year-old, and the needs of my terminally ill husband. Then the corticosteroids Steve was taking to control his chronic brain swelling caused him to have two psychotic breaks in a 24-hour period. During the first episode, he suddenly stood up and walked out the door, stronger than he had been in months, and I spent an hour desperately trying to get him back inside.  Eventually EMS had to come retrieve him from the woods behind our house. Though we had marked seven years of marriage only a few days before, Steve was adamant that he had no idea who I was, so an EMT approached me and placed a hand gently on my shoulder before asking, “Ma’am, what’s your relation?” 

Later that night, the psychosis returned briefly, but at that point Steve was so exhausted that he could not get out of bed. He mumbled and yelled from the confines of the covers for a few minutes and then fell asleep. The doctors told us it would be a couple of weeks before the antipsychotic medication reached a consistent therapeutic level. In the meantime, Steve couldn’t be left alone and I left school.

When it was time for daycare pick-ups and drop-offs, I woke Steve and tucked him into the car along with our daughter. I left our bedroom door ajar and the shower curtain partially open so that I had a visual on his sleeping shape when I managed to take showers late at night. Eventually, I bought a video baby monitor so that I could do yard work or be in a different room without constantly worrying and wondering. I watched intensely for signs that he was still there, that he still knew who I was. He never had another episode of psychosis, but the possibility haunted me for the rest of his life.

It all went downhill from there. Which meant that the last good weeks and months of his life I was a stressed-out basket-case nursing student. Instead of spending quality time together as a family, I was running around like a madwoman trying to hold it all together.

I left school in mid-October. By November, Steve was having regular bouts of weakness and was frequently unable to walk or communicate. After Thanksgiving (which culminated in an ER visit when he did a face-plant in the hallway and broke his nose), he never returned to his weekly rehabilitation activities or the adult day facility where he had occasionally attended so I could still try and work a few hours a week. He was briefly hospitalized in early December and became homebound shortly after Christmas. By early January he had started hospice and by early March he was bedbound. He died March 22nd, 2014 at the age of 31.


Now here I am, it’s fall again, and I’m back in nursing school. Because it will be good for me. Because it will enable me to support my daughter. Because it is the right thing to do. But it will be a miracle if I make it.  

I know that I have the requisite academic ability and time management skills. My instructors are thrilled that I have returned to the program and enthusiastically support me. I believe I will love nursing, and everyone tells me what an amazing nurse I will be. They almost always add: especially because of what I have been through. 

After Steve’s death, when friends would say they shouldn’t speak about their lesser problems to me, that they could not hold a light to my suffering, I tried to tell them that their hurt was no less important than mine. I like to think that having to watch the love of my life slowly die has at least done some good, and has made me a kinder, gentler person. There is already too much hurt out there in the world. I care deeply about people, something that is at the heart of nursing and an enormous part of why I decided to pursue it. But my heart is just not in it right now.

To the very end, I held onto hope that Steve was going to make it, that he was going to defy the odds, that somehow everything everyone said would be wrong. I know I was the last one standing, but I couldn’t help it. 


Now everything about school reminds me of what I have lost. There are days when I wish I had never entertained the idea of returning to school, of becoming a nurse. How differently I could have spent those last few years of his life. How I gave it my all and he still died in my arms.

I am an adult. I can make my own decisions. Yet, I feel obligated to be here. As if, perhaps, I left the program and took my life in a different direction, that Steve would have died in vain of all that effort. He was the drive in my pursuit of a career in nursing: to take care of him, to provide for our family, to make a difference in the lives of others as his nurses had done for us. He was also my biggest supporter and greatest cheerleader, and that silence is crippling.

I recognize that everything nursing school has to offer, from the camaraderie and structure to the caring and career, will be good for me, but that knowledge makes it no less difficult. There are days when I think the only thing keeping me here is guilt. Guilt about spending all of this time and effort to get here while my life fell apart around me.  Guilt at having wasted those last few good months as a family. Guilt for the lack of motivation I feel to tackle school and provide a better life for my daughter, when I was willing to lay down everything when my husband was still alive.

Things are not at all the same as they were a year ago. There isn’t as much fight in me anymore. I am tired and lonely and grieving. My hope was that school would provide a welcome distraction, and it does, but not enough of one. I truly hope that I succeed. I hope that it gets easier with time and that I find my passion again. I hope that I manage to hold on for the next sixteen weeks and for the three semesters after that. I know that I alone will understand what a mountain it is to overcome.

I can’t change the past, difficult, as it is to relive day in and day out. When instructors mention hospice and death and pain control, and my heart feels like it’s going to push through my chest, I just try to breathe through it. When I experience a burst of grief, I try to let myself have that moment for what it is. When my 3-and-a-half-year-old daughter looks at me in wonder when I tell her that someday her mama might be a nurse, I try to hold on to the trust and belief in her eyes.  

When she screams and cries that she misses her daddy, I hold her in my arms and assure her that I miss him too, in great part because I don’t know what else to do. 



About the Author

Sarah Kilch Gaffney

Sarah Kilch Gaffney is a brain injury advocate, writer, and homemade-caramel aficionado. She lives in Maine and you can find her work on her .

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